Health inspection·January 9, 2020

F 0550 Level of Harm - Minimal harm or potential for actual harm should be served table by table in the dining room. If a resident normally dined in their room-but chose to dine in the dining room-they should receive their meal with the other residents at the table. If a resident was seated at the dining table-the meal to be served was on a delivery cart for the room meals-then the resident should politely be moved from the table until the meal was taken from the room cart to the dining room. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366111 If continuation sheet Page 2 of 5 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 366111 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/09/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Falling Water Healthcare Center 18840 Falling Water Strongsville, OH 44136 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)

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to accurately code the Minimum Data Set (MDS) 3.0 assessments for two (Residents #29 and Resident #52) of twenty-eight residents reviewed for assessments. Residents Affected - Few Findings include: 1. Resident #29 was admitted to the facility on [DATE] with diagnoses that included type two diabetes, diabetic neuropathy, chronic lung disease, depression, and anxiety disorder. Review of the facility's Shower Observation Sheets revealed Resident #29 received a shower on 10/03/19 and 10/06/19. Review of section G of the MDS 3.0 assessment dated [DATE] revealed the facility answered, activity did not occur in the past seven days, to the question, How resident takes full-body bath/shower, sponge bath, and transfers in/out of tub/shower. On 01/09/20 at 4:16 P.M., Registered Nurse (RN) #219 verified the MDS was inaccurate. 2. Resident #52 was admitted to the facility on [DATE] with diagnoses that included depression, anxiety, chronic lung disease, arthritis, weakness, and anemia. Review of the progress noted dated 06/17/19 at 1:43 A.M. revealed Resident #52 had a fall in her room on 06/16/19 at 10:40 P.M. Review of the Post Fall assessment dated [DATE] revealed Resident #52 had a fall near her bed at 10:40 P.M. Review of section J of the MDS 3.0 assessment dated [DATE] revealed the facility answered no to the question, Has the resident had any falls since admission/entry or reentry or the prior assessment (OBRA or Scheduled PPS), whichever is more recent. On 01/08/20 at 11:05 A.M., RN #219 verified the MDS was inaccurate. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366111 If continuation sheet Page 3 of 5 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 366111 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/09/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Falling Water Healthcare Center 18840 Falling Water Strongsville, OH 44136 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)

F 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record and document review, the facility failed to ensure all portions of the call light system were functional and repairs/replacements were completed timely. This affected four residents (#28, #109,#124, and #89) in three of 32 room environments observed. Facility census was 112. Residents Affected - Some Findings include: During an interview with Resident #109 on 01/06/20 at 2:45 P.M. the resident requested the surveyor get him some water. Resident #109 reported he had pressed his call light a couple of hours ago but no one responded. The resident's call light was observed at this time and noted to be broken. The top portion of the call light was broken off exposing a small tube inside. The resident attempted to demonstrate activating the call light by pressing the call light as if there was an actual button on top. The wall jack and the light outside his room were not activated. On 01/06/20 at 5:48 P.M. the director of nursing was informed the call light was not functioning. On 01/06/20 at 5:51 P.M. the director of nursing reported Maintenance director #229 repaired the call light and would complete a whole house sweep to make sure all the call lights were functional. Interview with Maintenance director #229 on 01/08/20 at 12:40 P.M. revealed call lights were changed upon a resident's admission and checked on a monthly basis. He said no residents complained and no other call lights were noted to be broken during the whole house sweep. Maintenance director #229 said staff documented in an electronic system what needed repaired or replaced. Review of the electronic system reports since June 2019 revealed most requests/repairs were completed within a day; however, there were a couple of maintenance request that took days to be completed. On 07/18/19 a request for a flat call light was not completed until 07/24/19. On 09/06/19 a request to repair a broken call light in room [ROOM NUMBER] W was not completed until 09/09/19. On 10/17/19 a request for a flat call light for room [ROOM NUMBER] D and regular call light for room [ROOM NUMBER] W was not completed until 10/21/19. On 10/20/19 a request to repair the outside call light for room [ROOM NUMBER] was not closed until 10/25/19. On 10/28/19 a request to change out the call light in room [ROOM NUMBER] D and 228 W did not want the pad type of call light was not completed until 10/30/19. On 01/06/20 at 2:46 P.M. a broken call light was entered into the system for room [ROOM NUMBER] (Resident #109). It was marked as competed on 01/07/20 at 6:23 A.M. An environmental tour was conducted by Maintenance director #229 on 01/09/20 beginning at 1:37 P.M. Rooms 103, 106, 110, 120, 125, 221, 219, 215, 208, 242, 236, 232, and 226 all had call bells in place and were functional when tested. Interview with Therapist #45 on 01/09/20 at 4:45 P.M. revealed she saw Resident #109 in bed in his room on 01/06/20 at 12:00 P.M. and a call bell was in place. Interview with the administrator on 01/09/20 at 2:29 P.M. revealed on 10/20/19 room [ROOM NUMBER] was occupied by Residents #124 and #28. Review of Resident #124's medical record revealed she had a fall on 10/14/19 and the intervention was for the call light to be in reach. Resident #28's record revealed she had dementia and psychosis and had a fall in the last six months. There was no indication in their medical records regarding issues surrounding call lights. The administrator reported room [ROOM NUMBER] was empty on 10/17/19 and Resident #89 lived in room [ROOM NUMBER] on 09/06/19. Review of the fall observation tool dated 07/12/19 indicated a fall intervention for Resident #89 was to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366111 If continuation sheet Page 4 of 5 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 366111 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/09/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Falling Water Healthcare Center 18840 Falling Water Strongsville, OH 44136 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)

F 0919 have the call bell in place. Level of Harm - Minimal harm or potential for actual harm Further interview with Maintenance director #229 on 01/09/20 at 3:25 P.M. revealed on the dates noted on the electronic systems report he did not have a maintenance tech and was not able to complete the repairs or replacements timely. He reported keeping extra call lights and bells available for staff to implement until he completed his repairs/replacements. There was no documented evidence these items were provided to the residents during the dates indicated. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366111 If continuation sheet Page 5 of 5