Health inspection·September 25, 2024

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, interview and policy review, the facility failed to ensure notification of a resident's change in condition and subsequent hospitalization. This affected one resident (#31) of one resident investigated for notification. The census was 108. Findings include: Review of Resident #31's record revealed an admission date of 10/02/23. Diagnoses included multiple sclerosis, diabetes mellitus II and depression. Review of the Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #31 required staff assistance with all activities of daily living. Further review of the medical record including progress notes revealed no documentation Resident #31's family was notified of a change in status with subsequent hospitalization. Review of the Telehealth notification dated 08/24/24 at 7:19 P.M. revealed Resident #31 on video, repeating, I feel good, I feel good, and I feel oriented, I feel oriented, and I feel good, I feel good, I'm getting ready to watch a movie, I'm getting ready to watch a movie. Then back to, I feel good. She appeared lethargic. Further review revealed nursing stating she was usually alert and oriented times four. Sending her to emergency room (ER) for further treatments and evaluation. Feel she may need a urinalysis and/or CT of head. Review of a nurse note dated 08/24/24 timed at 7:57 P.M. revealed Resident #31 was repeating words over and over. She was alert to self and place only. She did not seem like her usual self. Telehealth was notified and ordered her to be sent out. Interview with the Licensed Practical Nurse/Unit Manager #316 on 09/25/24 at 10:57 P.M. confirmed the lack of notification to the family concerning Resident #31's change in status and subsequent hospitalization. Review of the facility's undated policy Notification of Change in Condition revealed the attending practitioner would be promptly notified of significant changes in condition and the medical record must reflect the notification, response and interventions implemented to address the resident's condition. The policy also revealed when a change in condition was noted, the nursing staff would contact the resident representative. Notifications that for emergency situations required prompt notification as soon as time permitted. Examples included but were not limited to: transfer to hospital, severe change in physical or mental health and unexpected death. This deficiency represents non-compliance investigated under Complaint Number OH00157587. 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 6 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 09/25/2024 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)