Health inspection·March 28, 2024

F 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure all required notices were provided to residents when skilled services were discontinued. This affected two (#2 and #11) of three residents review for beneficiary notices. The facility census was 41. Residents Affected - Few Findings include: 1. Review of Resident #2's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses included anemia, chronic kidney disease, and dislocation of the right knee. Further review of the medical record revealed Resident #2 was discharged from skilled services while using her Medicare Part A benefit on 10/02/23 and chose to remain in the facility. Review of the notices given to Resident #2 revealed the resident received a Notice of Medicare Non-Coverage (NOMNC) as required; however, the additional required Skilled Nursing Facility Advanced Beneficiary Notice of Non-Coverage (SNF ABN) was not given to Resident #2. 2. Review of Resident #11's medical record revealed the resident was admitted to the facility 10/23/23. Diagnoses included chronic obstructive pulmonary disorder, anxiety disorder, and epilepsy. Further review of the medical revealed Resident #11 was discharged from skilled services on 12/19/23 and chose to remain in the facility. Review of the notices given to Resident #11 revealed the resident received a NOMNC as required; however, the additional required SNF ABN was not given to Resident #11. Interview with Social Service Director #450 on 03/27/24 at 8:15 A.M. verified no SNF ABN was given to Resident #2 and Resident #11 as required. Page 1 of 2 366118 366118 03/28/2024 Elms Retirement Village Inc 136 S Main St Wellington, OH 44090

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, and resident and staff interview, the facility failed to ensure dependent residents received appropriate nail care. This affected one (#22) of two residents reviewed for activities of daily living. The facility census was 41. Residents Affected - Few Findings include: Review of Resident #22's medical record revealed admission to the facility occurred on 10/19/23. Diagnoses included major depression, Parkinson's disease, chronic kidney disease, pressure ulcers, and anxiety. Review of Resident #22's Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #22 was assessed with intact cognition and required substantial assistance with showers and activities of daily living (ADLs). Observation and interview with Resident #22 on 03/25/24 at 9:27 A.M. revealed Resident #22 was observed with have long finger nails on both hands. Interview with Resident #22 stated she did not like long finger nails, and stated no staff offered to cut them and she really wanted them cut. Observation on 03/26/24 at 2:07 P.M. revealed Resident #22 received a shower on and her finger nails remained long. Observation and interview with State Tested Nurse Aide (STNA) #426 on 03/27/24 at 8:07 A.M., in the presence of Resident #22, confirmed Resident #22's finger nails were long and untrimmed. STNA #426 confirmed she would trim Resident #22's finger nails at that time. Interview with the Administrator on 03/27/24 at 12:13 P.M. confirmed the facility had documentation activities staff provided nail care for Resident #22 on 02/10/24. 366118 Page 2 of 2