Health inspection·March 4, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the medical record, review of the facility fall investigation, review of facility policy and interview with the resident and staff, the facility failed to provide adequate assistance with care to prevent a fall for Resident #34. This affected one resident (Resident #34) of three residents reviewed for falls. The facility census was 44. Findings include: Review of the medical record revealed Resident #34 was admitted to the facility on [DATE] with diagnoses including need for assistance with personal care, muscle wasting and atrophy, Alzheimer's disease, diabetes, and cerebral infarction. Review of the plan of care dated 01/30/20 revealed Resident #34 had alterations in self bed mobility. Interventions included a bed mobility program and two-person assistance with all bed mobility. The care plan had subsequent revisions on 10/06/21, 04/10/23 and 07/24/23 to add Resident #34 was at risk for impaired functional range of motion related to left side weakness, had a behavior problem of refusing care and was at risk for falls and potential injury related to impaired gait and mobility, and level of assistance needed for transfers. Interventions included bed stabilizers, locked bed, keep commonly used items in reach, Hoyer lift with two-person assistance with transfers and low bed. The revisions did not indicate what level of assistance Resident #34 required with bed mobility. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #34 had moderately impaired cognition, was incontinent of bladder and bowel and required extensive assistance of two staff members for bed mobility. Review of the annual MDS 3.0 assessment dated [DATE] revealed Resident #34 had severely impaired cognition, was incontinent of bowel and bladder, and was dependent on staff for rolling in bed. Review of the fall assessment dated [DATE] revealed Resident #34 was at risk for falls. Review of the Point Click Care nursing assistant Task charting from 01/01/24 to 01/12/24 revealed Resident #34 was dependent on staff or required two staff assist for rolling side to side. Review of the progress notes dated 01/12/24 at 9:10 P.M. revealed the nurse was called to the room of Resident #34 by the nursing assistant. The nursing assistant stated that during incontinence care while the resident was turned onto her right side her left leg went too far, and she lost her balance and slid off the bed. When the nurse entered the room, the resident was kneeling on the right (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: 366087 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 366087 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center, The 100 Vista Drive Lisbon, OH 44432 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)