Inspection·February 5, 2024

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview with facility staff and staff from the local Summit County Health Department, the facility failed to maintain an effective infection control program to ensure recommendations by the local health department were implemented/completed to identify and prevent the spread of infection. This affected two residents (#9 and #75) and had the potential to affect 18 additional residents (#8, #12, #19, #21, #22, #25, #27, #28, #37, #39, #51, #54, #55, #56, #58, #59, #65, and #67) who resided on the facility [NAME] Wing. Residents Affected - Some Findings Include: Review of Resident #9's medical record revealed an admission date of 08/19/22 with admitting diagnoses including paraplegia, chronic respiratory failure, resistance to antibiotics, lupus and chronic kidney disease. Record review revealed the resident was discharged on 11/01/23 and re-admitted to the facility on [DATE]. Review of Resident #9's medical record revealed a progress note dated 09/29/23 at 10:26 A.M. which reflected the resident had tested positive for a carbapenem producing organism (CPO) Acinetobacter Baumannii A. The resident's physician was advised and had no new orders. On 01/31/24 at 12:03 P.M. an interview with the Summit County Health Department Infectious Disease Nurse (IDN) revealed the facility had notified them of a positive case of a carbapenem producing organism (CPO) Acinetobacter Baumannii A. The resident who was affected, had not been in contact precautions at the time of or prior to the diagnosis. The IDN revealed according to the guidelines and recommendations, if a patient had a confirmed case of CPO, a facility should do a contact screening on the unit in which the index case was on. The facility completed an initial round of screening on 9/25/23 to test for CPOs and had two residents (Resident #9 and Resident #75) come back positive during the colonization screening. According to the IDN and guidelines, if there were positive cases on the initial screening, the facility would then need to have two consecutive negative colonization screenings to assure there was no further transmission on the unit. According to the IDN, the facility did not complete these steps in the screening process and was sporadic in communication, despite multiple attempts over the past few months by the Communicable Disease Unit to follow-up with the facility. The IDN revealed the following communication between the facility and local health department: a. On 10/02/23 after receiving the positive screening notification the local health department contacted the facility to follow up with the facility with education to the facility about the program expectations. b. On 10/03/23 the IDN stated the Administrator called back and stated she had received the email (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 3 Event ID: 366479 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 366479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Timberland Ridge Nursing & Rehabilitation 3558 Ridgewood Road Fairlawn, OH 44333 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)