Inspection·October 16, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the medical record, review of medical literature, policy review, and interview with the staff the facility failed to provide a physician ordered treatment for a resident's hormone condition. This affected one resident (#66) of three reviewed for care and treatment. Residents Affected - Few Findings included: Review of the closed medical record revealed Resident #66 was admitted to the facility on [DATE]. Diagnoses included normal pressure hydrocephalus, chronic obstructive pulmonary disease, adult failure to thrive, depression, hypertension, anxiety disorder, overactive bladder, and syndrome of inappropriate secretion of the antidiuretic hormone (SIADH). Review of medical literature from the Cleveland Clinic revealed SIADH happens when a person's body makes excess amounts of antidiuretic hormone (ADH) causing a person's body to retain too much water and can lead to hyponatremia (low levels of sodium in the blood). The condition is treatable. The resident was discharged to the hospital on [DATE] per the family request. Review of the plan of care dated 05/29/24 revealed Resident #66 had altered health maintenance related to progressive physical and mental status, congestive heart failure, failure to thrive, SIADH, anxiety, depression, hypertension, normal pressure hydrocephalus, overactive bladder, and cognitive decline. Interventions included to administer medications as ordered Review of the physician's orders revealed Resident #66 had an order for urea sodium oral packet (for SIADH) once daily for low sodium dated 05/26/24. The order was discontinued on 07/08/24. Review of the medication administration note dated 05/26/24 at 6:30 A.M. revealed the urea sodium oral packet was on order from the pharmacy. Review of the May 2024 medication administration record revealed the urea sodium oral packet was never obtained from the pharmacy to be administered. Review of the medication administration note dated 06/08/24 at 9:33 A.M. revealed the urea sodium oral packet was not available. Review of the medication administration note dated 06/09/24 at 9:19 A.M. revealed the urea sodium oral packet was on order from the pharmacy. (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 10/16/2024 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)