Inspection·June 28, 2021

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure call lights were within residents' reach. This affected two (Residents #35 and #36) of two residents reviewed for call lights. The facility census was 27 residents. Residents Affected - Few Findings include: 1. Record review of Resident #36 revealed an admission date of 03/04/21. Diagnoses included muscle weakness, abnormalities of gait and mobility, and lack of coordination. Review of the admission Minimum Data Set (MDS) dated [DATE] revealed the resident had intact cognition and required extensive assistance of one staff for bed mobility, transfers, and toilet use. Interview on 06/21/21 at 1:42 P.M. with Resident #36 revealed she wanted to ask staff about her shower. During the interview, Resident #36 attempted to reach for her call light; however, the call light was on the other side of her bed near the headboard tucked under the bed linen, and Resident #36 was sitting in her wheelchair near the foot of the bed. Interview on 06/21/21 at 1:48 P.M. with the Regional Registered Nurse (RRN) #269 verified Resident #36's call light was not in reach, who then moved the call light with reach for Resident #36. 2. Record review of Resident #35 revealed an admission date of 09/10/19. Diagnoses included dementia without behavioral disturbance, muscle weakness, and stroke. Review of the quarterly MDS dated [DATE] revealed the resident required extensive assistance of two staff for bed mobility, transfers, and toilet use. On 06/21/21 at 2:50 P.M., Resident #35 was observed laying in bed and the call light was observed attached to the wall at the end of her bed and not in reach. Interview on 06/21/21 at 2:51 P.M. with Registered Nurse (RN) #259 confirmed Resident #35's call light was not in reach. RN #259 then placed the call light near the resident, and said Resident #35 knew how to use her call light. On 06/23/21 at 8:08 A.M., Resident #35 was observed sitting up in bed eating breakfast. Her call light was observed on the nightstand located at the foot of bed against the wall. Interview at this time with Stated Tested Nurse Aide (STNA) #220, who was assisting Resident #35's roommate, confirmed the observation. STNA #220 said Resident #35 knew how to use her call light and when she did, she never wanted anything but for staff to come and hold her hand. (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 7 Event ID: 366267 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 366267 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/28/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Mayfield Village, Inc 290 North Commons Blvd Mayfield Village, OH 44143 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)