Health inspection·December 26, 2023

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to provide showers as scheduled. This affected two residents (Resident #24 and Resident #47) of five residents reviewed for showers. Findings include: 1. Review of the medical record for Resident #24 revealed an admission date of 07/20/23. Diagnoses included complete traumatic metacarpophalangeal amputation of right middle finger, COVID-19 and need for personal care. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed he was cognitively intact. Review of the shower sheets for November and December 2023 revealed he had showers on 11/18/23 and 12/05/23. Interviews on 12/26/23 from 8:47 A.M. through 9:10 A.M. with Resident #24 revealed they did not receive showers on a consistent basis. Interview on 12/26/23 at 3:11 P.M. with the Director of Nursing (DON) revealed showers should be documented in the shower book. The DON verified there were only shower sheets for the aforementioned dates for Resident #24. 2. Review of the medical record for Resident #47 revealed an admission date of 11/20/23. Diagnoses included Contusion on scalp, end stage renal disease and type 2 diabetes mellitus. Review of the 5-day MDS dated [DATE] revealed she was cognitively intact. Review of the shower sheets for Resident #47 for December 2023 revealed they had shower sheets for 12/02/23 and 12/06/23. Interviews on 12/26/23 from 8:47 A.M. through 9:10 A.M. with Resident #47 revealed they did not receive showers on a consistent basis. Interview on 12/26/23 at 3:11 P.M. with the DON revealed showers should be documented in the shower book. The DON verified there were only shower sheets for the aforementioned dates for Resident #47. Review of the facility policy titled Bathing-Personal Care, dated August 2022 revealed residents should be offered to be bathed twice a week and as needed. (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: 366495 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 366495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Brooklyn 4700 Idlewood Drive Brooklyn, OH 44144 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)