Inspection·May 21, 2024

F 0690 had BM in his bed and all over his body. Level of Harm - Minimal harm or potential for actual harm Review of the Employee Corrective Action Form dated 05/13/24 revealed STNA #606 was given a final written warning due to performance/ policy violation regarding providing patient care and insubordination as she did not complete a directive by the charge nurse. Residents Affected - Few Review of the witness statement dated 05/14/24 and completed by STNA #606 revealed on 05/10/24 she arrived at work at 7:00 A.M., and the nurse asked her to clean up Resident #131, who had a BM. She asked one of the other aides to assist her since the resident required two staff assist, and the other aide stated she would help after she was done with one of her residents. She started her rounds and was getting residents up out of bed. She asked for help again around 12:00 P.M., but the meal trays were getting dropped off. STNA #606 notified the nurse that she would get to Resident #131 after she passed lunch trays. She passed trays and started doing something for another resident and lost track of time. Interview on 05/20/24 from 8:09 A.M. to 8:34 A.M. with Resident #75 revealed on 05/10/24 an aide came in her room (she was unable to identify the aide by name) and stated an aide (also unable to identify the aide by name) assigned to Resident #131 did not change him all day, and he had bowel movement all over his body and hands. The aide provided his lunch tray even though he was incontinent of BM and made him eat in that condition until late afternoon when he was finally cleaned up. Interview on 05/20/24 at 2:56 P.M. with Resident #131 revealed he was cognitively impaired and unable to recall the incident that had occurred on 05/10/24 and/or any other incident where he was not timely assisted with incontinence care. Review of the [NAME] as of 05/21/24 for Resident #131 revealed staff were to anticipate and meet the resident's needs, and provide assistance as needed with ADL. He was dependent on staff for rolling left and right and for toileting and hygiene. Observation on 05/21/24 at 5:44 A.M. revealed STNA #610 provided Resident #131 with incontinence care without any issues. Interview on 05/21/24 at 8:02 A.M. with STNA #612 revealed she came on duty on 05/21/24 at 7:00 A.M. and was assigned Resident #131's care. When she arrived to the unit, she smelled something resembling a resident was incontinent of BM but at that time was unable to determine which resident was. Between 8:30 A.M. to 9:00 A.M. the nurse (unable to identify by name) came to her and stated Resident #131 was incontinent of BM and needed cleaned up. asked STNA #613 to assist her, but she was busy with another resident, so she started getting other residents up. At approximately 12:00 P.M. she thought about trying to complete his care, but the lunch trays came, so she and STNA #613 decided to clean him up after lunch trays were delivered. She did provide Resident #131 with his tray and knew he was still incontinent of BM as she could smell it. At the time she passed his tray, he did not have any BM on his hands. After lunch she got busy completing care for other residents. Between 2:00 P.M. to 2:20 P.M. Resident #131 had BM all over his body, hands, and bed. At that time, he was cleaned up. She verified she had not provided incontinence care and/or any other care from the time she came in on 05/10/24 at 7:00 A.M. until at approximately 2:00 P.M., and he laid in BM for a prolonged period of time (seven hours). She also verified she never asked for any other assistance from any other nurses and STNAs except STNA #613, who was busy and unable to assist her both times she asked. Interview on 05/21/24 at 8:40 A.M. with the Director of Nursing (DON) verified Resident #131 did (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366008 If continuation sheet Page 2 of 3 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 366008 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/21/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grande Pointe Healthcare Commu Three Merit Dr Richmond Heights, OH 44143 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)

F 0690 not receive timely incontinence care on 05/10/24. Level of Harm - Minimal harm or potential for actual harm Review of the undated facility policy labeled, Perineal Care- Male and Female revealed the purpose of the procedure was to provide cleanliness and comfort to the resident, to prevent infections and skin irritation and to observe the resident's skin condition. The policy revealed providing personal care services promotes a sense of well-being and meets hygiene standards of care. Perineal care would be care planned for each individual resident to meet his or her specific needs, choices, and frequency. Residents Affected - Few This deficiency represents non-compliance investigated under Complaint Number OH00153965. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366008 If continuation sheet Page 3 of 3