Inspection·April 10, 2025

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 medical record review, observation, staff interview, and review of facility policy, the facility failed to ensure call lights were within reach. This affected two (#11 and #33) of two residents reviewed for call lights. The facility census was 57. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #11 revealed diagnoses including encephalopathy, myocardial infarction, stage four chronic kidney disease, venous insufficiency, anxiety, bipolar disorder, depression, schizoaffective disorder, left knee effusion, history of falling, chronic pain, weakness, lymphedema, cardiac pacemaker, atrial fibrillation, communication deficit, and mild cognitive impairment. Review of the quarterly Minimum Data Set 3.0 (MDS) assessment dated [DATE] for Resident #11 revealed she was a fall risk, had mild cognitive impairment, used a wheelchair, required supervision with transfers, and required assistance with toileting. Observation on 04/07/25 at 9:46 A.M. of Resident #11's room revealed she was unable to see or reach her call light. Resident #11 was sitting in her recliner next to her bed and the call light was tangled around the back of the bed handle. Subsequent interview with Graduate Resident Care Associate (GRCA) #406 confirmed Resident #11 could not see or reach her call light. 2. Review of the medical record for Resident #33 revealed diagnoses including congestive heart failure, heart disease, hypertension, disorientation, fall on the same level, and unsteady gait. Review of the quarterly MDS assessment dated [DATE] revealed Resident #33 was cognitively intact, used a manual wheelchair and required moderate assistance with transfers, bathing, and toileting. Observation on 04/07/25 at 9:42 A.M. of Resident #33's room revealed Resident #33 was sitting in her wheelchair in the center of her room. The bed was against the wall and the call light was tied to the bed handle on the wall side of the bed, out of her reach of the resident. Subsequent interview with Floor Technician #405 confirmed Resident #33 was not able to reach her call light. Observation on 04/09/25 at 10:07 A.M. of Resident #33's room revealed Resident #33 was sitting in her wheelchair at the side of her bed. The bed was against the wall and the call light was tied to the bed handle on the wall side of the bed, opposite the resident and out of the resident's reach. Subsequent interview with GRCA #409 confirmed Resident #33 was not able to reach her call light. (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: 366365 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 366365 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Willows at Bellevue 101 Auxiliary Drive Bellevue, OH 44811 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)