Inspection·December 28, 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 observations, medical record review, staff interview, and resident interviews, the facility failed to ensure timely response to call lights and providing care per personal preference. This affected two (#30 and #61) of three residents reviewed for call light responses. Facility census was 69. Residents Affected - Few Findings include 1. Review of the medical record for Resident #30 revealed an admission date of 06/21/23. Diagnoses included chronic obstructive pulmonary disease, atrial fibrillation, muscle weakness, dysphasia, chronic pain, anxiety, and chronic pain. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #30 was cognitively intact and required substantial/maximum assist for toileting transfers and mobility. Review of the plan of care dated 10/18/23 revealed resident had an activity of daily living (ADL) self-care deficit related to memory loss, mobility, and cognitive loss with interventions resident requires one to two person assist for repositioning and turning in bed, encourage use of call light and was an extensive/dependant assist for transferring, toileting, and personal hygiene. The care plan also revealed resident had bowel and bladder incontinence with interventions to assist with being clean, dry and comfortable as needed, assist with toileting as needed, check resident as needed and as required for incontinence care and change clothing as needed after incontinence episodes. Observation on 12/27/23 from 10:00 to 10:20 A.M., revealed Resident #30 had her call light activated and two separate staff walked into resident room and turned off the call light. Interview and observation on 12/27/23 at 10:20 A.M., with Resident #30 revealed she had turned her call light on at 10:00 A.M. and staff had walked in and asked what she needed. When she told them she was wet and needed incontinence care, they turned off the light and said they will get the State Tested Nurse Aide (STNA). After about 15 minutes of waiting, the resident revealed she put her call light back on and a second staff member walked in and turned off her call light. She reported she informed the second staff member of her need for incontinence care and they informed her they would get the STNA. Resident #30's revealed she was wet at the time of the interview and confirmed her call light was off as staff had turned it off. Resident #30 activated her call light for the third time at 10:25 A.M. Licensed Practical Nurse (LPN) #191 responded with the surveyor present at 10:29 A.M. Resident #30's outfit was also visible soiled with food stains and crumbs present. Resident #30 revealed she would like to get cleaned up as her family was visiting later in the day. Resident #30 stated that she prefers to receive incontinence care at 10:00 P.M. and then again around 9:30 A.M.-10:00 A. M., as she does not want to be woken up or disrupt staff when they are busing passing breakfast (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 7 Event ID: 366039 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 366039 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Majestic Care of Point Place 6101 N Summit St Toledo, OH 43611 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)