Health inspection·January 30, 2020

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of the facility's policy, observation and staff and resident interviews, the facility failed to ensure the resident's choices were honored. This affected two residents (#23 and #29) of three residents reviewed for choices. The facility census was 32. Findings include: 1. Review of the medical record for Resident #23 revealed the resident was admitted to the facility on [DATE]. Diagnoses included abnormal gait, amnesia, Parkinson's disease, neuropathy, sleep disorder, dementia and metabolic encephalopathy. Review of the annual Minimum Data Set (MDS) 3.0 assessment, dated 12/13/19, revealed the resident had moderate cognitive deficits. The assessment further revealed the resident required extensive assistance with bed mobility, transfer, dressing, toileting and personal hygiene. It further revealed it was very important to the resident to choose their own bedtime. Review of an All About Me assessment, dated 01/18/20, revealed the resident's preferred wake up time was between 5:00 A.M. and 7:00 A.M. Observation of Resident #23 on 01/28/20 at 5:05 A.M. revealed the resident was in bed with her top on. Interview with Resident #23 on 01/27/20 at 4:10 P.M. revealed she did not like the staff getting her up so early in the mornings and did not understand why they were doing it. She stated some days the State Tested Nursing Assistants (STNA) got her up by 4:30 A.M. She further stated they would get her washed up and dressed from the waist up. Resident #23 further stated some days the staff would put her back into bed and other days she was left up in her wheelchair and then sit there until breakfast which was after 8:00 A.M. She stated she would like to get up around 7:00 A.M. or 7:30 A.M. and has talked to the staff about this but it does not change. She further stated the staff told her they had to start their routine early to get it all done. She further stated some days they even changed the beds that early. Interview with STNA #120 on 01/28/20 at 5:45 A.M. verified they get Resident #23 up early. The STNA stated the resident was on the get up list for night shift so they were to get her washed up and get her top half dressed. She stated the resident did not want her pants back on when she laid back down. She further stated sometimes they had to lay her back down because she did not want to stay up. She verified today the resident was woke up at 5:30 A.M. and washed up completely, had her teeth (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 5 Event ID: 366181 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 366181 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/30/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grand Rapids Care Center 24201 W 3rd St Grand Rapids, OH 43522 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)