Health inspection·November 6, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, resident record review, resident and family interviews, staff interviews, facility policy review, call light audit review, resident council meeting minutes review, and concern log review, the facility failed to ensure call lights were in reach for two residents (#31, #62) and also failed to ensure call lights were answered in a timely manner for eighteen residents (#6, #17, #20, #24, #27, #60, #61, #65, #68, #72, #89, #92, #94, #101, #110, #127, #133, #136). This had the potential to affect all residents residing in the facility. The facility census was 136. Residents Affected - Some Findings include: 1. Review of the medical record for Resident #65 revealed she was admitted to the facility on [DATE] with diagnoses including sepsis, hyperlipidemia, and atherosclerotic heart disease. Review of the physician orders revealed an order to encourage Resident #65 to reposition dated 10/04/24 and an order dated 10/08/24 for hoyer lift transfers at all times. Review of the Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #65 had a memory problem, was moderately impaired regarding task of daily life with inattention that was present but fluctuated and was dependent on staff for care. Review of the care plan dated 10/04/24 revealed Resident #65 was at risk for falls and had a self-care performance deficit related to limited mobility and pain. Interventions included ensure the call light was within reach, assist with transfers, require hands-on assistance including holding, lifting, and supporting trunk and limbs, and transfers of two staff with mechanical hoyer lift. Interview on 11/04/24 at 8:34 A.M. with Resident #109 revealed her call light response time were always too long. Resident #109 revealed staff would enter her room after she activated the call light, turn it off, and not return until later. Resident #109 revealed she always waited over 15 minutes. Resident #109 revealed there were never enough staff to cover staff breaks. Resident #109 revealed after activating her call light, staff didn't return until at least 45 minutes later. Observation and interview on 11/04/24 at 2:31 P.M. revealed Resident #65 was sitting in her tilt-in-space wheelchair, slouched down, leaning on her right side. Resident #65 revealed she was uncomfortable, sliding down in her wheelchair, and was feeling sick. Resident #65's daughter, who was in the room, pacing back and forth looking out the door for staff, revealed Resident #65's call light was activated 30 minutes ago. Resident #65's daughter revealed Certified Nursing Assistant (CNA) #889 came in the room, turned off the call light, and stated she would return to assist Resident #65 into bed. Resident #65's daughter revealed the resident was not feeling well, was uncomfortable in the (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 10 Event ID: 365926 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365926 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Normandy Manor of Rocky River 22709 Lake Rd Rocky River, OH 44116 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)