Health inspection·July 10, 2023

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 record review, interview, and facility policy review, the facility failed to reasonably accommodate the desire of Resident #11's family to install an electronic video device in Resident #11's room. This affected one resident (#11) of three residents reviewed for resident rights. This had the potential to affect all residents. The facility census was 79. Residents Affected - Few Findings include: Review of medical record revealed Resident #11 was admitted to the facility on [DATE] with diagnoses including hemiplegia (one sided paralysis) affecting right side, unspecified dislocation of left hip, unspecified fracture of left acetabulum (concave service of the pelvis), and cerebral infarction (stroke) due to thrombosis (blood clot) of unspecified carotid artery. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #11 was severely cognitively impaired and required total dependence from two staff for all of his activities of daily living, except eating. Interview with the Responsible Party (RP) of Resident #11 on 07/10/23 at 11:18 A.M. revealed approximately two weeks after admission, the RP wanted to install a camera in Resident #11's room since Resident #11 had developed a broken and dislocated hip from a previous facility. The facility told the RP it would cost $700.00 to install a camera, since the camera had to run off the facility's Wi-Fi and required installation of wires behind the walls. The RP offered to get their own hot spot, but the facility declined that option. The RP stated she could not afford the $700.00 to install the camera. Interview on 07/10/23 at 11:45 A.M. with the Administrator revealed residents were allowed to have a camera in their room, but they must follow the facility's policy and procedures on how it is placed. The camera must be in a fixed location, come from an approved list, and be installed by someone the facility hired. The family could not use their own hotspot since it interfered with the electronic medical record. The cost of the installing the camera was at the expense of the RP/resident. Random intermittent observations throughout the facility on 07/10/23 noted numerous residents using facility Wi-Fi on various electronics, including but not limited to cell phones and other electronic devices. Review of the policy entitled Electronic Monitoring in Resident's Rooms Policy, dated November 2022, revealed the facility will permit residents and legally authorized people to install and use fixed electronic monitoring devices in accordance with applicable laws .The facility has an approved (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 2 Event ID: 366011 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 366011 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Concord Ridge Health and Rehabilitation 9901 Johnnycake Ridge Rd Mentor, OH 44060 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)