Health inspection·April 3, 2025

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure there were accurate advance directive orders and information in place throughout the medical records for Residents #13 and #68. This affected two (#13 and #68) of 31 residents reviewed for advance directives. The facility census was 83. Findings include: 1. Review of Resident #13's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses included chronic obstructive pulmonary disease, diabetes mellitus, and depression. Review of the Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #13 was cognitively intact. Review of the physician's orders for Resident #13 revealed an order dated 12/13/24 for a Do Not Resuscitate Comfort Care Arrest (DNRCC-A) (meaning invasive or extreme life-supporting measures were allowed under any circumstance except for cardiac or respiratory arrest) code status. Review of the electronic chart for Resident #13 revealed a DNRCC-A code status. Review of the hard medical chart for Resident #13 revealed there was no code status in the hard chart. An interview on 03/31/25 at 1:58 P.M. with Registered Nurse (RN) #352 stated she would go to the hard chart to see a signed copy of the advance directive if applicable. RN #352 verified Resident #13's hard chart did not have a code status sheet and the electronic chart stated DNRCC-A for Resident #13. 2. Review of Resident #68's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including dementia, psychosis, and anxiety disorder. Review of the Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #68 was rarely understood. Review of the physician's orders for Resident #68 revealed an order dated 12/13/24 for a Do Not Resuscitate Comfort Care (DNRCC) code status (meaning only comfort measures would be initiated in the event of a medical emergency). (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 5 Event ID: 366497 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 366497 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Tamarack Ridge Health and Rehabilitation 5113 State Route 43 Kent, OH 44240 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)