Health inspection·January 16, 2024

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on record review, interview, and policy review the facility failed to obtain weights as ordered by the physician and according to the policy for Resident #164. This affected one resident (#164) of three residents review for weight loss. The facility census was 163. Residents Affected - Few Findings include: Review of the closed medical record for Resident #164 revealed an admission date of 05/27/21. Diagnoses included arthritis, anemia, anorexia, stage four chronic kidney disease, and dysphagia. Resident #164 expired on 12/26/23 at the facility. Review of the Minimum Data Set (MDS) assessment for Resident #164 dated 11/09/23 revealed the resident was moderately cognitively impaired. She had an impairment to both sides of her body on the upper and lower halves, required substantial or maximum assistance for eating, oral hygiene, personal hygiene, toileting, showering or bathing, and upper body dressing. She was totally dependent on staff for lower body dressing. The resident had no swallowing disorders or dental issues. She had weight loss of 5% or more in the last month or 10% or more in the last six months and was on a mechanically altered diet. She received hospice services. Review of the plan of care dated 10/01/23 for Resident #164 revealed the resident had the potential for inadequate food intake due to anorexia and hospice with a goal to consume more than 25% of meals. Interventions included documenting meal intake amounts, providing snacks and preferences, assisting as needed, and monitoring weights and labs as ordered. Review of the physician orders for Resident #164 revealed an order for a Boost supplement twice per day (BID) beginning on 09/20/23 and weekly weights beginning 10/23/23. Review of the resident's vital signs revealed Resident #164's weight was obtained on 08/02/23 and she weighed 171.4 pounds, 10/11/23 she weighed 137 pounds and 11/03/23 when she weighed 127 pounds. There was no documented evidence a reweight was obtained after the 10/11/23 weight of 137 pounds which was a 19.7% (significant) weight loss in two months. There was no documented evidence that the resident refused to be weighed. There was no documented evidence that the dietitian or physician were notified of the severe weight loss. Interview on 01/16/23 at 8:56 A.M. with Diet Tech #209 revealed weights were to be obtained monthly unless otherwise ordered by the physician, and refusals to be weighed would be documented in the resident's medical record. She added it was the facility's policy to discontinue weekly weights when a resident was placed on hospice. She could provide no documented evidence a weight had been obtained for Resident #164 in September 2023. (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 4 Event ID: 366045 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 366045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Jennings Hall 10204 Granger Road Garfield Heights, OH 44125 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)