Inspection·May 6, 2024

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Residents Affected - Few Based on record review, interview and facility policy review, the facility failed to ensure a Resident #88 had adequate supply of oxygen to attend an outside doctor's appointment. This affected one resident (#88) of three residents reviewed for respiratory services and had the potential to affect all residents that required oxygen. The facility identified 15 residents (#5, #6, #10, #15, #18, #32, #34, #41, #44, #76, #78, #81, #86, #87, and #88) who were dependent on oxygen. The facility census was 86. Findings include: Review of the closed medical record revealed Resident #88 was admitted to the facility on [DATE] and was discharged on 04/19/24. Pertinent diagnoses included chronic respiratory failure, chronic obstructive pulmonary disease, urinary tract infection, anxiety, and obstructive uropathy. Significant orders included, change disposable oxygen equipment weekly, and oxygen at two liters via nasal cannula (a device to deliver oxygen through the nose) as needed to keep oxygen saturation above 92%. Review of the admission assessment dated [DATE] revealed Resident #88 was alert and oriented to person, place, and time. Resident #88 was noted to have oxygen on via nasal cannula at 3.4 liters per minute with an oxygen saturation rate of 98%. Review of the care plan dated 04/02/24 revealed Resident #88 had oxygen related to chronic obstructive pulmonary disease. Interventions included to give medications as ordered by the physician and monitor for signs of respiratory distress. A review of progress notes dated 03/29/24, 04/05/24 and 04/10/24 revealed Resident #88 to be on oxygen at three liters per minute via nasal cannula. Review of the medical record revealed Resident #88 had an appointment with the urologist on 04/11/24 at 10:30 A.M. On 05/06/24 at 9:40 A.M. an interview with Licensed Practical Nurse (LPN) # 205 revealed Resident #88 had a doctor's appointment on 04/11/24 at 10:30 A.M. Between 10:00 A.M. and 10:30 A.M. the facility received a phone call from Resident #88's daughter stating Resident #88's oxygen tank was empty. LPN #205 stated she immediately got an oxygen tank and delivered it to Resident #88 at his doctor's appointment, approximately 15 minutes away. LPN #205 stated Resident #88 was not in distress upon her arrival. (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: 366491 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 366491 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Strongsville Healthcare and Rehabilitation 18936 Pearl Road Strongsville, OH 44136 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)