Inspection·June 21, 2025

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 medical record review, resident interview, and staff interview, the facility failed to ensure sufficient bathing was provided to all dependent residents. This affected two (Residents #1 and #20) of three residents reviewed for activities of daily living (ADL). The census was 45. Residents Affected - Few Findings Include: 1. Resident #1 was admitted to the facility on [DATE]. His diagnoses were infection and inflammatory reaction due to indwelling urethral catheter, sepsis due to MRSA, COPD, muscle wasting and atrophy, dysphagia, type II diabetes, urinary tract infection, obstructive and reflux uropathy, unspecified severe protein calorie malnutrition, congestive heart failure, pleural effusion, hypertensive heart and chronic kidney disease, acute kidney failure, atrial fibrillation, anemia, aortic stenosis, and hyperlipidemia. Review of his Minimum Data Set (MDS) assessment, dated 04/17/25, revealed he had mild cognitive impairment and was dependent on staff for bathing/showering. Review of Resident #1 current shower schedule revealed he was scheduled to have a bath/shower on Mondays and Thursdays in the evening. Review of Resident #1 shower logs/documentation, dated 04/10/25 to 06/20/25, revealed the following dates did not have documentation as shower/baths being offered to Resident #1: 04/28/25, 05/01/25, 05/05/25, 05/08/25, and 05/15/25. Interview with Director of Nursing (DON) and Administrator on 06/20/25 at 3:30 P.M. confirmed there is no documentation for Resident #1 being offered a bath/shower on the above listed days. They confirmed the resident needs at least some physical assistance and/or reminders to take a bath/shower from staff. 2. Resident #20 was admitted to the facility on [DATE]. His diagnoses were cognitive social or emotional deficit following other cerebrovascular disease, alcoholic cirrhosis of liver, dementia, patient's non-compliance with other medical treatment, adult failure to thrive, unspecified severe protein calorie malnutrition, edema, cellulitis of left axilla and right upper limb, anxiety disorder, asthma, hoarding disorder, delusional disorder, dietary folate deficiency anemia, restlessness and agitation, and alcohol abuse. Review of his MDS assessment, dated 04/10/25, revealed he was cognitively intact. Review of Resident #20 MDS assessment, section GG, dated 04/10/25, revealed he refused to take a bath/shower during (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: 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 06/21/2025 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)