Health inspection·January 21, 2025

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 interview, record review, and policy review, the facility failed to ensure residents received appropriate and timely care after a fall resulting in a fracture. This affected one resident (Resident #19) of three residents reviewed for care. The facility census was 65. Residents Affected - Few Findings Include: Medical record review revealed Resident #19 was admitted to the facility on [DATE] with diagnoses including dementia without behavioral disturbance, repeated falls, urinary retention, bradycardia, arthritis, and high blood pressure. Review of Resident #19's physician's orders revealed an order dated 05/08/23 for hydrocodone acetaminophen 5-325 milligrams (mg) (an opioid pain medication) three times daily. Review of the Medicare quarterly Minimum Data Set 3.0 assessment, dated 11/21/24, revealed Resident #19 was severely cognitively impaired, needed moderate assistance from staff for toileting and maximum assistance for showering. Review of the nurses' notes revealed on 12/25/24 at 8:01 P.M. Registered Nurse (RN) #219 found Resident #19 on the floor. RN #219 assessed Resident #19 and the resident complained of pain to her right hip with movement and was unable to move her right leg from front to back or up and down. Resident #19 was able to move all her other extremities. RN #219 assisted Resident #19 to her recliner and then notified Nurse Practitioner (NP) #400 who ordered a right hip x-ray. Further review of the nurses' notes revealed on 12/26/24 at 7:50 A.M. RN #224 administered Resident #19's scheduled pain medication. RN #224 along with two other aides transferred Resident #19 to her bed. At 12:00 P.M. radiology arrived to take the x-ray. At 12:16 P.M. RN #224 notified NP #400 Resident #19 had a fractured femur and NP #400 gave an order to transfer Resident #19 to the hospital. At 12:53 P.M. Resident #19 left for the hospital and were she was admitted to the hospital for hip surgery. Review of the fall investigation dated 12/25/24 revealed on 12/25/24 at 7:20 P.M. Registered Nurse #219 was administering evening medications when she entered Resident #19's room and found the resident on the floor. RN #219 asked Resident #19 what happened, and the resident said she was trying to get to her bed. Resident #19 was lying on the floor between her recliner and wheelchair. Resident #19 complained of pain to her right hip area. RN #219 notified NP #400 regarding the fall. NP #400 ordered a right hip x-ray. Radiology was notified at 8:09 P.M. (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 2 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 01/21/2025 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)