Inspection·June 22, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 provide routine scheduled showers for three residents reviewed, Resident #38, #44, and #6, of four residents reviewed for showers. The facility census was 45. Residents Affected - Few Findings include: 1.Record review for Resident #38 revealed an admission date of 05/17/18. Diagnosis included paranoid schizophrenia, unsteady on feet, bipolar disorder, dementia, anxiety disorder, muscle weakness, and paranoid personality disorder. Record review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #38 was severely cognitively impaired. Resident #38 required extensive assistants with personal hygiene. Record review of the care plan dated 05/10/19 revealed Resident #38 required extensive assistants with showering. Record review of the shower schedule revealed Resident #38 was to receive showers on Tuesdays and Fridays. Record review of Point of Care (POC) documentation for April, May, and June 2023 revealed Resident #38 received a shower/bath on 04/06/23, 04/13/23, 04/20, 04/24/23, 04/27/23, 05/04/23, 05/08/23, 05/11/23, 05/15/23, 06/01/23 and 06/12/23. Record review of POC revealed no further documentation of Resident #38 receiving a shower or bath. Observation on 06/15/23 at 12:37 P.M. revealed Resident #38 ambulating up the hall independently. Resident #38 's hair was dishuffled and oily. State Tested Nursing Assistant (STNA) #108 verified SR's hair was dischuffled and oily. Interview on 06/15/23 at 4:51 P.M. with DON revealed the facility did not do any paper documentation to confirm when showers for residents were completed. All showers were documented in POC by the STNA ' s on the days the showers were due. Shower documentation would include confirmation the shower was given or if the resident refused the shower. DON confirmed each resident was to receive a minimum of two showers a week. DON confirmed the documentation of showers provided to Resident #38 revealed Resident #38 did not receive two showers a week. DON revealed she was unsure if residents received their showers. 2. Record review for Resident #44 revealed an admission date of 04/12/22. Diagnosis included (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 4 Event ID: 366274 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 366274 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Laurels of Chagrin Falls 150 Cleveland Street Chagrin Falls, OH 44022 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)