Health inspection·January 12, 2022

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to timely develop comprehensive resident centered nursing care plans to meet the needs of two (Resident's #39 and #52) of 22 residents reviewed for care planning. The facility census was 75. Findings include: 1. Review of the medical record revealed Resident #39 was admitted to the facility on [DATE] with diagnoses including end stage renal disease, type two diabetes, sleep apnea, and dysphasia. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #39 was cognitively intact, required extensive assistance of two staff for activities of daily living, received dialysis services, had an indwelling Foley catheter and was occasionally incontinent of bowels. Review of the care plan for Resident #39 revealed care plans for falls, assistance of for activities of daily living, bowel incontinence, skin integrity, anti-coagulant therapy, decreased cardiac output, diabetes, and end stage renal disease were not developed or put in place until 01/10/22. Interview on 01/10/22 at 3:00 P.M. with MDS Nurse #217 verified Resident #39's nursing care plans were not developed until 01/12/22, two months after admission. 2. Review of the medical record revealed Resident #52 was admitted to the facility on [DATE] with diagnoses including end stage renal disease, anemia, heart failure, and chronic obstructive pulmonary disease. Review of the most recent MDS 3.0 assessment dated [DATE] revealed Resident #52 was cognitively intact, required extensive assistance of one staff for activities of daily living, received dialysis care, intravenous medications, and had mild depressive symptoms. Review of the care plan for Resident #52 revealed no nursing care plans were developed. Interview on 01/12/22 at 11:03 A.M. with MDS Nurse #217 verified that no nursing care plans were developed for Resident #52. 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 3 Event ID: 366428 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 366428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE O'Neill Healthcare Fairview Park 20770 Lorain Road Fairview Park, OH 44126 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)