Health inspection·July 2, 2024

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 record review, observation, and interview the facility failed to ensure call lights were within reach of Residents #37 and #176. This affected two residents (#37 and #176) of 73 residents residing at the facility. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #37 revealed an admission date of 02/20/21 with diagnoses including multiple sclerosis, heart failure, dementia, depressive disorder, acute kidney failure, Parkinson's, and difficulty walking. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #37 had intact cognition and required moderate assistance of staff for eating, bed mobility, transfers, and hygiene. Review of the care plan dated 04/26/24 revealed Resident #37 had a history of falls related to Parkinson's, weakness, and dementia. Intervention included keeping the call light within reach. Observation on 06/30/24 at 9:45 A.M. of Resident #37 revealed she was lying in bed, and her call light was lying on the floor next to her bed. Interview at this time with Certified Nursing Assistant (CNA) #508 verified the call light was out of reach and stated the resident was able to use her call light. CNA #508 stated Resident #37 was not on her assignment. 2. Review of the medical record for Resident #176 revealed an admission date of 04/18/17 with diagnoses including Parkinson's, schizoaffective, epilepsy, dementia, obesity, and anxiety. Review of the quarterly MDS 3.0 assessment dated [DATE] revealed Resident #176 had intact cognition and impairment to one side. The resident required set up with eating and was dependent for transfers and bed mobility. The resident was dependent on staff for toileting and showers. Review of the care plan dated 06/20/24 revealed Resident #176 was at risk for falls related to weakness and seizures. Intervention included using call light for assistance. Observation on 06/25/24 at 11:49 A.M. of Resident #176 revealed she was lying in bed, and her call light was lying on the nightstand next to her bed on top of several stuffed animals. The call light was out of her reach. Interview with Resident #176 stated CNA #508 and State Tested Nurse Aide (STNA) #586 changed her earlier today. The call light was placed on the nightstand by staff during care. Staff forgot to put it back within reach prior to leaving. (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 6 Event ID: 366346 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 366346 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manor of Grande Village 2610 East Aurora Road Twinsburg, OH 44087 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)