Heights Rehabilitation And Healthcare Center, The

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

BOM did not give him headphones. 7. Review of the medical record for Resident #67 revealed an admission date of 01/08/24 with diagnoses which included dementia, diabetes, symptoms and signs involving cognitive functions and awareness, restlessness and agitation, mental disorder, encephalopathy, and systolic congestive heart failure. Review of the MDS 3.0 quarterly assessment dated [DATE REDACTED] revealed Resident #67 was moderately cognitively impaired. Resident #67 had a legally appointed guardian.Review of the RFMS Statement Landscape from January 2025 to September 2025 for Resident #67 revealed the following:a. On 03/18/25, $1,830.00 was debited for personal need items with BOM #120 as the payee.b.

On 04/17/25, $2,359.09 was debited for a computer with BOM #120 as the payee.c. on 04/28/25, $324.68 was debited for furniture with BOM #120 as the payee.Review of the undated Amazon receipt revealed the following item was addressed to BOM #120 at the facility address: a Samsung Galaxy book 3 Pro laptop for $2,359.09.Review of the RFMS Withdrawal Record dated 04/16/25 revealed the petty cash account was credited $2,359.09 for Resident #67 ' s computer; BOM #120 was the vendor.Review of Check #1909 dated 04/17/25 revealed $2359.09 was paid to the order of BOM #120 for resident spend downs. Review of the RFMS Withdrawal Record dated 05/15/25 revealed the petty cash account was credited a total of $2,222.19 which included $1,624.93 for Resident #67 ' s clothing; BOM #120 was the vendor. This amount was a combination of items for Resident #9 and #67. Review of Check #1923 dated 05/16/25 revealed $2,421.52 was paid to order of BOM #120 for resident spend downs. Interview on 09/09/25 at 2:15 P.M. with RDO #124 (RBOM #123 present) revealed Resident #67 stated he did not receive a computer, and a computer was not located in the resident ' s room for Check #1909 dated 04/17/25. RDO #124 stated receipts were located for women ' s clothing for Resident #67 (a male resident) for Check #1923 dated 05/16/25. RDO #124 revealed Resident #67 would be reimbursed for $2359.09 and $597.26.Interview on 09/15/25 at 9:02 A.M. with Resident #67 ' s guardian revealed she did not authorize the purchase of a computer and women ' s clothing for Resident #67. The police reached out to the guardian and the guardian wanted to press charges against BOM #120 so BOM #120 couldn ' t do this again in another facility.8. Review of the medical

record for Resident #9 revealed an admission date of 02/01/24 with diagnoses which included Alzheimer ' s disease, repeated falls, dementia with agitation, need for assistance with personal care, delusional disorder, psychosis, hallucination

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Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/17/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Heights Rehabilitation and Healthcare Center, The

2801 E Royalton Rd Broadview Heights, OH 44147

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)

F 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

other nurses working on the first floor during night shift last night. When asked if RN #126 had notified the resident's physician or nurse practitioner of Resident #1 requesting her medications late, RN #126 stated that she had reached out to the DON via text message on how to proceed. Interview on 09/09/25 at 5:10 P.M. with the DON revealed Resident #1 tended to single-out one person and it happened to be RN #126 and there always was an issue with Resident #1 and RN #126. Resident #1 had care-planned interventions regarding medication administration. The DON stated that Resident #1's medications were due at midnight, and RN #126 was following the care plan to not wake Resident #1. At 4:30 A.M., Resident #1 began yelling and calling the nurse derogatory names. The DON verified another nurse in the facility could have approached Resident #1 to administer medications. She further confirmed that the RN refusing to administer Resident #1's medications, further elevated her behaviors.A follow-up interview on 09/15/25 at 8:00 A.M. with RN #126 revealed RN #126 verified it was her duty to administer medications and Resident #1 usually received her as needed medications with her scheduled medications. A follow-up interview on 09/15/25 at 12:05 P.M. with the DON verified RN #126 did not call Resident #1's physician or nurse practitioner to inquire about administering the resident's midnight medications late and verified Resident #1 could have been administered as needed pain medication. Interview on 09/15/25 at 3:20 P.M. with CNA #129 revealed Resident #1 pushed her call light around 4:00 A.M. and was very demanding and rude asking for her medications. RN #126 was on lunch at the time, so CNA #129 notified RN #126 when RN #126 returned from lunch. Review of the Disciplinary Action form dated 09/09/25 revealed RN #126 failed to administer scheduled medications causing a delay in care. It stated RN #126 failed to comply with standard nursing practices or facility policy and procedures. RN #126 was terminated from employment on 09/11/25.

Review of the facility's undated Administering Medications policy revealed medications must be administered in accordance with the orders, including any required time frames. Review of the facility's Intervention and Monitoring Behavioral assessment dated [DATE REDACTED] revealed the interdisciplinary team would evaluate behavioral symptoms in residents to determine the degree of severity, distress, and potential safety risk to the resident and develop a plan of care accordingly. Interventions would be individualized and part of an overall care environment that supported physical, functional and psychosocial needs, and strived to understand, prevent and relieve the resident's distress or loss of abilities. This deficiency represents non-compliance investigated under Complaint Number 2618274.

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