Inspection·December 10, 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 record review, fall investigation review, interview and policy review, the facility failed to have documented evidence fall prevention interventions were implemented and failed to ensure care plans were updated timely to prevent repeat falls for Resident #56. This affected one resident (#56) of three residents reviewed for falls. The facility census was 55. Findings include: Review of the medical record for Resident #56 revealed and admission date of 08/31/23 and a discharge date of 11/28/24. Diagnoses included dementia, diabetes, adult failure to thrive, anxiety, cognitive communication deficit, insomnia, and lack of coordination. Review of the quarterly MDS assessment dated [DATE] revealed Resident #56 was severely cognitively impaired. He required supervision or touch assistance for eating, and partial to moderate assistance from oral hygiene, toileting, showering, dressing, and hygiene. Review of the care plan dated 10/23/23 revealed Resident #56 was at risk for falls due to dementia, medications, and impaired safety awareness. Interventions included elbow protectors to be worn as tolerated, encouraging the resident to use the bathroom upon rising, before and after meals and at bedtime, and providing periods of rest. Review of the physician's orders for November 2024 revealed an order to remind and demonstrate the use of the call light two times a day for Resident #56, which began on 11/20/24. Review of the fall risk assessment dated [DATE] revealed Resident #56 was at a high risk for falls. Review of the fall investigation dated 11/23/24 at 3:00 P.M. revealed Resident #56 was found on the floor and lying on his back in between the beds in his room. Resident #56 did have a bowel movement, and it appeared Resident #56 was rushing to get to the bathroom and fell on his way. No injuries were noted. An intervention was added to assist Resident #56 to the toilet after lunch in between lunch and dinner. The investigation did not include documented evidence of Resident #56's witness statements regarding the event, when Resident #56 was last toileted, and if Resident #56 was wearing elbow protectors and non-skid socks. There was also no documented evidence that the resident's care plan was updated to include assisting the resident to the toilet after lunch and between lunch and dinner. Review of the fall investigation dated 11/25/24 at 1:58 A.M. revealed Resident #56 was observed (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: 366123 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 366123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accord Care Community Orrville LLC 1980 Lynn Drive Orrville, OH 44667 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)