Health inspection·June 1, 2023

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, resident interview, staff interview, review of facility concern logs, review of staff in-services, and review of Resident Council meeting minutes, the facility failed to ensure resident call lights were answered in a timely manner. This affected two (Resident #1 and #2) of seven residents reviewed for call lights. The facility census was 36. Residents Affected - Few Findings include: 1. Review of Resident #1's medical record, revealed the resident was admitted to the facility on [DATE]. Diagnoses included osteoarthritis, rheumatoid arthritis, weakness, pain in left shoulder, tremor, Charcot's joint, right ankle and foot, muscle weakness, muscle wasting and atrophy, and anxiety. Review of Resident #1's quarterly Minimum Data Set (MDS) 3.0 assessment, dated 05/15/23, revealed the resident was cognitively intact and required extensive assistance of two staff for bed mobility. No behaviors were noted within the assessment. Observation on 06/01/23 from 9:54 A.M. to 10:56 A.M. revealed Resident #1's call light had been activated for at least 62 minutes. Interview on 06/01/23 at 10:35 A.M. with Resident #1 revealed the resident was waiting on an aide to come and adjust the sheets and blankets underneath of her straightened out. The resident reported the aide was likely showering other residents and would come when she was able. Interview on 06/01/23 at 11:01 A.M. with Licensed Practical Nurse (LPN) #101 revealed LPN #101 had not realized Resident #1's call light was going off for so long. LPN #101 stated the aide who was assigned to the hall where Resident #101 resided had been on lunch break at that time, which is why LPN #101 went to check on the call lights that were activated. 2. Review of Resident #2's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses included weakness, respiratory failure, difficulty in walking, mild intellectual disabilities, cognitive communication deficit, unspecified psychosis, anxiety, need for assistance with personal care, and history of falling. Review of Resident #2's annual MDS 3.0 assessment, dated 05/10/23, revealed the resident was cognitively intact. The resident required extensive assistance of one staff for transfers and toileting. No behaviors were noted within the assessment. Observation on 06/01/23 from 10:28 A.M. to 10:50 A.M. revealed Resident #2's call light had been (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: 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 06/01/2023 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)