Health inspection·December 27, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews the facility failed to notify Resident #94's responsible party after a fall. This affected one resident (Resident #94) of three residents reviewed for notifications. The census was 121. Findings include: Record review of Resident #94 revealed an admission date of 04/05/22 with diagnoses including myelodyspastic syndrome, Alzheimer's Disease and major depressive disorder. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #94 was cognitively intact. Review of the progress note dated 11/28/23 and timed at 3:34 A.M. revealed Resident #94 had a fall with no injury. A note at 10:05 A.M. revealed her hand was swollen and bruised. An x-ray was ordered. A note at 12:36 P.M. revealed there was no fracture. There was no indication the responsible party was notified. Review of the Change in Condition report titled SBAR, dated 11/28/23 revealed it was not completely filled out including notification of responsible party. Review of the post-fall evaluation dated 11/28/23 revealed it does not indicate if a responsible party or physician was notified. Interview on 12/27/23 at 12:11 P.M. with Licensed Practical Nurse (LPN) #303 revealed she did Resident #94's post-fall assessment and progress note. She stated she was not sure if the family was notified but stated she asked the Certified Nurse Practitioner (CNP) for an x-ray though it was not documented. Phone Interview on 12/27/23 at 12:29 P.M. with Registered Nurse (RN) #300 revealed she was the nurse on duty when Resident #94 had fallen. She stated she was told because the resident fell on the mat it was not considered a fall. She did start a fall investigation however it was not completed. She stated she did not notify the physician, CNP or the responsible party. Interview on 12/27/23 at 3:45 P.M. with Director of Nursing revealed any change of plane was considered a fall. DON verified there was no evidence Resident #94's family was notified of the fall. Review of the policy titled Fall Management, dated 09/22/23 revealed the licensed nurse will notify Page 1 of 2 366078 366078 12/27/2023 Laurels of Massillon, The 2000 Sherman Circle NE Massillon, OH 44646

F 0580 the physician and responsible party of a fall and document in the medical record. Level of Harm - Minimal harm or potential for actual harm This deficiency represents non-compliance investigated under Complaint Number OH00149121. Residents Affected - Few 366078 Page 2 of 2