Health inspection·June 13, 2019

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on record review, observation, staff interview, and review of facility policy, the facility failed to ensure residents had a dignified dining experience when residents were not served their meals at the same time as other residents at their table. This affected one resident (#25) of 22 residents who were eating lunch in the main dining room. The facility identified 18 residents who required assistance with eating. The facility census was 59. Findings include: Review of Resident #25's medical record revealed an admission date of 01/30/15. Diagnoses included contracture of left hand, aphasia, hemiplegia and hemiparesis, Alzheimer's disease, dysphagia, cerebral infarction, heart disease, hypertension, dementia with behavioral disturbances, and major depressive disorder. Review of the physician orders, dated 01/09/19, revealed an order for pureed texture with honey thick consistency. Review of the Minimum Data Set (MDS) assessment, dated 04/21/19, revealed Resident #25 was rarely or never understood and was totally dependent on staff for eating. Review of the resident's care plan, revised on 04/18/19, revealed the resident was at risk for aspiration due to dysphagia, required a mechanically altered diet and was dependent for feeding. Observation on 06/10/19 from 11:56 A.M. through 12:33 P.M. of the main dining room revealed Resident #25, #26, #33 and #46 seated at a table. Resident #33 was provided her meal of mashed potatoes with gravy, grilled cheese, cottage cheese and fruit. At 11:57 A.M., Resident #26 was provided her meal. At 12:01 P.M., Resident #46 was provided her meal. All three residents, Resident #26, #33 and #46 were observed feeding themselves while Resident #25 waited. At 12:17 P.M., Resident #25 still seated at the table with no meal. Resident #25 was observed chewing on her right thumb and hand while Resident #33, #26 and #46 ate. At 12:21 P.M., State Tested Nursing Assistant (STNA) #110 assisted Resident #46 with reaching her french fries. STNA #110 looked at Resident #25 and adjusted her clothing protector. Resident #25 still did not have a meal. At 12:23 P.M., the kitchen staff started delivering dessert of mint pie to residents who had completed their meals. Resident #33, #46 and #26 were offered pie. Resident #25 still did not have a meal. At 12:28 P.M., Resident #25 was still seated at the table with Resident #26, #33, and #46. Resident #26, #33, and #46 had completed their meals including dessert and Resident #25 still had not been provided her food. Interview on 06/10/19 at 12:30 P.M. with STNA #110 verified Resident #25 had not received her food (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: 366184 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 366184 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/13/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elizabeth Scott Community 2720 Albon Rd Maumee, OH 43537 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)