Health inspection·November 8, 2022

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 observation, record review, and interview the facility failed to ensure call lights were within reach and accessible for Residents #6 and #19. This affected two (Residents #6 and #19) of 54 residents reviewed for call light placement. The facility census was 54. Residents Affected - Few Findings include: 1. Record review revealed Resident #6 was admitted to the facility on [DATE] with diagnoses including peripheral vascular disease, difficulty walking, muscle weakness, dysphagia, and severe morbid obesity. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #6 was cognitively intact and required extensive assistance of activities of daily living. Review of the care plan dated 10/05/22 for Resident #6 revealed Resident #6 was a risk for falls. Interventions included to have commonly used articles within easy reach such as water, call light, remote control, and telephone. Maintain a clear pathway. Observation of Resident #6 on 11/06/22 at 9:03 A.M. revealed Resident #6 was lying in bed and call light was not within reach, it was on the floor. Interview with Licensed Practical Nurse (LPN) #442 on 11/06/22 at 9:03 A.M. verified the call light was out of reach. 2. Record review revealed Resident #19 was readmitted to the facility on [DATE] with diagnoses including hemorrhage of the cerebrum, dysphagia, cognitive communication deficit, hemiplegia affecting the left non-dominant side, acute kidney failure, encephalopathy, and dysphagia Review of the Annual MDS 3.0 assessment dated [DATE] revealed Resident #19 had moderately impaired cognition and required total assistance of activities of daily living. Review of the care plan dated 11/06/22 for Resident #19 revealed Resident #19 was a risk for falls. Interventions included be sure the resident's call light was within reach. Observation of Resident #19 on 11/06/22 at 9:24 A.M. revealed Resident #19 was lying in bed. Her call light/touch pad was located on floor behind the bed and not within reach. (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: 366058 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 366058 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aristos Nursing and Rehabilitation 4650 Rocky River Dr Cleveland, OH 44135 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)