Health inspection·October 5, 2023

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure personal protective equipment (PPE) was worn while providing care to a resident on contact precautions. This affected 10 of 10 residents who received care provided by State Tested Nurse Aide (STNA) #209, Residents #5, #24, #37, #48, #54, #57, #63, #69, #76 and #77. Residents Affected - Some Findings include: Review of Resident #5's medical records revealed an admission date of 08/30/23. Diagnoses included muscle weakness, falls and cellulitis (bacterial infection involving the inner layers of the skin). Review of Resident #5's Minimum Data Set assessment dated [DATE] revealed Resident #5 had intact cognition, required extensive assistance with bed mobility, toileting and personal hygiene. Resident #5 was incontinent of bowel and bladder. Review of the care plan dated 09/20/23 revealed Resident #5 had a Clostridium Difficile (C-diff) infection (bacterial infection that causes diarrhea and inflammation of the colon) and was on isolation precautions. Interventions included implement isolation precautions. Review of current physician orders dated 09/26/23 revealed an order to place Resident #5 in isolation precautions. Review of progress note dated 09/27/23 revealed Resident #5's stool sample tested positive for C-diff. Observation on 10/03/23 at 11:40 A.M. revealed a sign posted outside of Resident #5's room indicating contact precautions and an isolation bin that included gowns, gloves and masks. Further observation revealed STNA #209 exiting Resident #5's room without PPE and immediately entered another resident's room. Continued observation revealed STNA #245 exiting Resident #5's room at 11:42 A.M. and doffing a gown and gloves. Interview with STNA #245, at time of observation, revealed Resident #5 was on contact precautions for C-diff. STNA #245 stated she was required to don PPE including a gown and gloves prior to entering Resident #5's room. STNA #245 stated she had assisted STNA #209 with providing Resident #5 with a bed bath and incontinence care. Interview on 10/03/23 at 12:07 P.M. with STNA #209 revealed he was aware Resident #5 was on contact precautions for C-diff. STNA #209 confirmed he had not worn PPE while in Resident #5's room providing care and was unable to provide an explanation as to why he had not worn PPE while providing Resident #5's care. (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 2 Event ID: 366111 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 10/05/2023 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)