Health inspection·July 2, 2019

F 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to notify residents or their responsible party of the facility's bed hold policy. This affected one resident (Resident #42) of two reviewed for hospitalization. The facility census was 43. Findings include: Record review revealed Resident #42 was admitted on [DATE]. Diagnoses included chronic respiratory failure and chronic obstructive pulmonary disease. Review of Resident #42's progress notes revealed on 05/25/19 the resident was sent to the hospital via emergency medical services (911) per physician order for difficulty breathing, low oxygen saturation and diminished lung sounds. There was no documentation found in the medical record the resident and/or family member was notified of the facility's bed hold policy. Interview on 07/01/19 at 12:05 P.M. with Social Service Director (SSD) #559 verified there was no evidence of bed hold policy notification for Resident #42 when he was admitted to the hospital 05/25/19. SSD #559 revealed the facility had not been notifying family representatives of the bed hold policy. Review of facility's undated bed hold policy revealed the responsible party of the resident would be notified by certified mail on the day of the transfer or the day after the transfer. Notification would inform responsible parties of the transfer, the bed hold restriction and number of available bed hold days. 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: 366277 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 366277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bel Air Care Center 2350 South Cherry Street Alliance, OH 44601 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)