Strongsville Healthcare and Rehabilitation

Inspectors wroteBased on record reviews, observations, interviews, and review of facility policies, the facility failed to ensure proper implementation of required infection control practices. Specifically, the facility did not ensure staff consistently followed Enhanced Barrier Precautions (EBP) for residents with indwelling devices, did not properly don and doff required Personal Protective Equipment (PPE) when caring for a resident on droplet isolation for COVID 19, did not use appropriate protective clothing during laundry handling, and did not maintain required procedures to prevent the growth of Legionella bacteria within the facility's water system. These deficient practices affected two residents (Residents #24 and #53) and had the potential to affect all residents in the facility. The facility census was 95.

Inspectors wroteBased on staff interview, review of staff education, review of Centers for Medicare and Medicaid (CMS) Regulatory Update dated 05/31/23 titled Educate and Offer and review of the facility policy, the facility failed to educate/offer all eligible staff the COVID 19 vaccination. This had the potential to affect all 95 residents residing at the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure accurate comprehensive assessments were completed as required. This finding affected three residents (Residents #107, #109 and #111) and had the potential to affect all six residents (Residents #103, #105, #107, #108, #109 and #111) who were transferred to the facility from a sister facility following a fire. The facility census was 95.

Inspectors wroteBased on record review and interview, the facility failed to ensure comprehensive assessments were completed timely. This finding affected three (Residents #107, #109 and #111) and had the potential to affect all six residents (Residents #103, #105, #107, #108, #109 and #111) who were transferred to the facility from a sister facility following a fire. The facility census was 95.

Inspectors wroteBased on record review, interview, and review of the facility policy, the facility failed to ensure care planning conferences were completed at least quarterly. This affected two (Residents #10 and #111) of five residents reviewed for care planning. The facility census was 95.

Inspectors wroteBased on interview and record review, the facility failed to ensure accurate care plans were initiated and updated for two residents (Resident #20 and #24) of 25 residents reviewed for care planning. The facility census was 95.

Inspectors wroteBased on review of medical records, hospital records, and staff interviews, the facility failed to ensure that appropriate immediate care was provided to Resident #84 following a fall. Staff moved the resident despite her complaints of pain and before notifying the physician or Certified Nurse Practitioner (CNP) for further direction. Resident #84 was later found to have sustained multiple fractures. This affected one resident (Resident #84) of four residents reviewed for accidents. The facility census was 95.

Inspectors wroteBased on record review, observation, interview, and review of the facility policy, the facility failed to ensure expired medications were discarded and insulin vials were appropriately dated and discarded as appropriate. This finding affected two (Residents #4 and #19) of two residents identified during the audit of three medication administration carts. The facility census was 95.

Inspectors wroteBased on medical record review, resident interview, and staff interview, the facility failed to honor resident preferences for getting out of bed. This affected one (Resident #37) of three residents reviewed for resident rights. The census was 87. Findings Include:Resident #37 was admitted to the facility on [DATE]. Her diagnoses were heart failure, chronic obstructive pulmonary disease, mild protein calorie malnutrition, infection and inflammatory reaction due to internal left knee, acute and chronic respiratory failure, acute kidney failure, pulmonary hypertension, encephalopathy, anemia, atrial fibrillation, cardiomegaly, major depressive disorder, muscle weakness, other bacterial infections of unspecified site, dysphagia, pneumonitis, and diverticulitis of intestine. Review of her minimum data set (MDS) assessment, dated 08/02/25, revealed she was cognitively intact. [...]

Inspectors wroteBased on observation, record review, interview and review of the facility's' payroll-based journal (PBJ) data, the facility failed to ensure sufficient staffing to meet the needs of residents. This affected seven residents (#1, #6, #8, #34, #49, #76, #82) of eight residents reviewed for sufficient staffing and had the potential to affect all residents. The facility census was 93.

Inspectors wroteBased on observation, interview, record review and facility policy review, the facility failed to ensure Resident #76 had access to a call light within their functional abilities. This affected one resident (#76) of three reviewed for call light accessibility and had the potential to affect six residents (#18, #21, #27, #61, #74 and #76) identified by the facility as using a modified call light. The facility census was 93.

Inspectors wroteBased on record review, interview and facility policy review, the facility failed to ensure Residents #6, #74, and #76 received showers on a consistent basis. This affected three residents (#6, #74 and #76) of three residents reviewed for showers and had the potential to affect all residents. The facility identified all residents required assistance with showers. The facility census was 93.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure call lights were answered in a timely manner. This affected five residents (#1, #8, #34, #49 and #82) of six residents reviewed for timely call light response. The facility census was 93.

Inspectors wroteTHE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NONCOMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on observation, medical record review, review of local police report, resident, family, and staff interviews, local police detective interview, review of the National Weather Service forecast, review of the facility Elopement Policy and Procedure, review of camera footage, the facility failed to provide adequate supervision to prevent Resident #37, who had a diagnosis of dementia, post- traumatic stress disorder (PTSD) and severe cognitive impairment, from leaving the facility without staff knowledge. This resulted in Immediate Jeopardy and the potential for serious harm, injury, or death when Resident #37 was seen (by camera footage) on 11/23/24 at 11:07 P.M. [...]

Inspectors wroteBased on interview, record review, review of facility video footage, review of the Ohio Department of Health (ODH) Certification and Licensure System (CALS) and review of the facility policy, the facility failed to ensure an allegation of potential neglect was reported to the State Survey Agency as required. This affected one (Resident #37) of six residents reviewed for neglect.

Inspectors wroteTHE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NONCOMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on observation, record review, review of an employee personnel file, review of video surveillance, review of a policy report, review of facility policy and interview, the facility failed to ensure Resident #1, a resident with cognitive impairment, was free from staff to resident abuse when Certified Nursing Assistant (CNA) #813 physically abused the resident while providing care. This resulted in Immediate Jeopardy and actual physical and psychosocial harm as a result of the physical abuse incident which occurred on 10/29/24 at approximately 9:30 P.M. [...]

Inspectors wroteBased on observation, record review, policy review, and interview, the facility failed to ensure Resident #1's care planned interventions were implemented related to wandering behavior and her safety was maintained at all times to prevent elopement from the facility. This finding affected one (Resident #1) of three residents reviewed for accidents and hazards.

Inspectors wroteTHE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. 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.

Inspectors wroteBased on observation and interview the facility failed to ensure a home like dining atmosphere on the Memory Care unit. This affected 16 residents (#61, #64, #26, #65, #36, #83, #60, #20, #75, #57, #62, #55, #71, #78, #18, and #59) of 18 residents residing on the unit. The facility census was 86. Findings Include: Observation on 02/28/24 at 12:25 P.M., 16 residents (#61, #64, #26, #65, #36, #83, #60, #20, #75, #57, #62, #55, #71, #78, #18, and #59) were in the dining room eating their lunch. Also present in the dining room were three visiting family members. Maintenance #625 was standing directly across from the dining room. A large white round area was present on the wall. Maintenance #625 had a vacuum which he turned on and started sweeping the wall. After a few minutes the vacuum was turned off. Interview with Maintenance #625 on 02/28/24 at 12:30 P.M. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure tray ticket accuracy and preferences were followed affecting three residents (#23, #61, and #70) observed during dining observations and had the potent to affect four residents (#4, #36, #58, and #74)identified by the facility who received a pureed diet. The facility census was 86. Findings Include: 1. Review of the medical record for Resident #23 revealed an admission date of 03/29/23. Diagnoses included dementia without behavioral disturbance, diabetes mellitus due to underlying condition with diabetic neuropathy, dysphagia (difficulty swallowing), and muscle weakness. Review of the February 2024 physician orders for Resident #23 revealed an active order dated 03/30/23 for low concentrated sweets diet, pureed texture, and thin liquids consistency. 2. [...]

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to ensure Resident #12 and Resident #46's rooms were kept clean and sanitary environment. This affected two residents (#12 and #46) of four residents reviewed for physical environment. The facility census was 86. Findings Include: 1. Observation on 02/26/24 at 9:00 A.M. of Resident #46's room revealed food crumbs on the floor around the bed and recliner. The bathroom had feces on the floor that appeared someone had stepped in it and tracked it in bathroom, feces on the front of toilet seat, the toilet lid, and on the wall behind the toilet. Observation on 02/27/24 at 10:26 A.M. of Resident #46 room revealed all above concerns from the day before were still present. The bathroom and room had not been cleaned. Interview on 02/27/24 at 10:35 A.M. [...]

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to respond to Resident #61's change in condition. This affected one resident (#61) of 21 residents reviewed for change in condition. The facility census was 86. Findings Include: Resident #61 was admitted to the facility on [DATE] with diagnoses including dementia without behaviors, cirrhosis of the liver, diabetes, heart disease, hypothyroidism, and high blood pressure. Review of the quarterly comprehensive Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #61 was severely cognitively impaired and required extensive care of one to two people for all personal care, including eating. Interview with Resident #61's significant other, who is the resident's Power of Attorney (POA), on 02/26/24 at 12:15 P.M. revealed the resident declined significantly over the last four days. [...]

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to ensure appropriate diagnoses for the use of psychotropic medications and failed to ensure behaviors were tracked for one resident (#61) of five residents reviewed for psychotropic medication usage. The facility census was 86. Findings Include: Resident #61 was admitted to the facility on [DATE] with diagnoses including dementia without behaviors, cirrhosis of the live, diabetes, heart disease, hypothyroidism, and high blood pressure. Review of the quarterly comprehensive Minimum Data Set 3.0 assessment, dated 01/01/24, revealed Resident #61 was severely cognitively impaired and required extensive care of one to two people for all personal care, including eating. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure Resident #50 was free from significant medication errors. This affected one resident (#50) of three residents medication administration. The facility census was 87.