Inspection·April 13, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, guardian interview, and policy review, the facility failed to notify a resident's representative when new orders were received. This affected one (Resident #23) reviewed for change in condition. The facility census was 35. Findings include: Medical record review for Resident #23 revealed an admission date of 05/22/17 with diagnoses including dementia without behaviors, chronic obstructive pulmonary disease, malnutrition. emphysema, acute cystitis without hematuria, metabolic encephalopathy, weight loss, bladder dysfunction, hypothyroidism, hyperlipidemia, schizoaffective disorder, major depressive disorder, anorexia, obsessive compulsive disorder, delusional disorders, essential tremor, and osteoarthritis. Review of the Minimum Data Set (MDS) assessment dated [DATE] with for Resident #23 revealed intact cognition. Resident #23 required limited assistance for bed mobility, extensive assistance for transfers, limited assistance for eating and extensive assist for toileting. Resident #23 was assessed with no coughing or difficulty swallowing during the look back period. Resident #23 was on a mechanically altered therapeutic diet. Review of the plan of care for Resident #23 dated 04/11/23 revealed the resident was at malnutrition/dehydration risk due to cognitive deficits, mood problems, history of weight loss, dysphagia (difficulty swallowing), and medical problems. Interventions included medications as ordered, diet per physician's order: pureed with thin consistency liquids, speech therapy as ordered, and monitor and record oral intake. Review of the progress notes dated 04/07/23 at 6:16 P.M. revealed Resident #23 coughing with food/liquid and having difficulty swallowing. A nursing measure, downgraded to pureed diet with referral to speech therapy (ST). Review of the speech therapy notes for Resident #23 dated 04/11/23 revealed new onset of increased signs and symptoms of dysphagia and coughing/choking during oral intake, indicating the need for speech therapy to access and evaluate oral function. Resident #23 choked on peaches per verbal report from state tested nursing assistant. The resident was downgraded to puree diet until an evaluation completed. Resident #23 presented with mild dysphagia with decreased oral motor strength and function resulting in increased mastication (chewing) time and decreased bolus (round mass of food) formation. Resident #23 with inconsistent swallow onset increased risk for aspiration. (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 6 Event ID: 365970 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 365970 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Union City Care Center 907 East Central Street Union City, OH 45390 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)