Gardens Of Euclid Beach

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

not made aware by the facility that Resident #13 had a coffee ground emesis, had been hypotensive and tachycardic that day. All he was told was that the resident had vomited and then felt better. If he had been notified of the resident's condition he would have advised Resident #13 be sent to the emergency room (ER) for evaluation since he was a full code. 2.Resident #85 was admitted to the facility on [DATE REDACTED] with diagnoses including diabetes, COPD, heart disease, high blood pressure, and hemiplegia and hemiparesis to the left nondominant side following a stroke. Review of the physician's orders for Resident #85 revealed

an order dated [DATE REDACTED] for the resident to be a full code. Review of the comprehensive quarterly MDS 3.0 assessment, dated [DATE REDACTED], revealed Resident #85 was independent for all personal care, had no pain, and did not have a life expectancy of less than six months. The resident had now wounds and was receiving no special treatment of any sort. Review of the nursing progress notes for Resident #85 revealed on [DATE REDACTED] at 10:20 A.M. LPN #634 was in the resident's room during morning medication administration. Resident #85 complained of chest pain and constipation. LPN #634 checked the resident's vital signs and obtained a blood pressure of 140/80, a heart rate of 84, and an oxygenation level of 96% on room air. LPN #634 advised the resident to go to the emergency room (ER) by 911. Resident #85 refused saying he knew his pain was due to being constipated. The resident was offered an as needed breathing treatment and Miralax for the constipation. LPN #634 documented on [DATE REDACTED] at 11:03 A.M. that she was notified by housekeeping Resident #85 was on the floor in the bathroom. Upon entering the bathroom LPN #634 found the resident lying face down on the floor and was unresponsive. LPN #634 attempted to obtain vitals without success but the resident did have a weak pulse. LPN #634 initiated cardiopulmonary resuscitation (CPR) and 911 was called. The resident was placed on 10 liters of oxygen via a nonrebreather mask and also suctioned him at 11:10 A.M. Emergency Medical Services (EMS) arrived at 11:16 A.M. and took over CPR from LPN #634. He waws transferred to the ER at 11:26 A.M. No documentation was found indicating the facility notified MD #614 of the resident's complaint of chest pain. Interview with MD #614 on [DATE REDACTED] at 11:35 A.M. revealed he had not been notified Resident #85 was having chest pain 40 minutes prior to being found unresponsive. MD #614 did have a history of being noncompliant with care but said he should have been notified the resident was having chest pain. Review of the facility's Change in a Resident's Condition or Status, last updated [DATE REDACTED], revealed the nurse will notify the resident's physician when there has been a(an): accident or incident involving the resident; discovery of injuries of an unknown source; adverse reaction to medication; a significant change in the resident's physical/emotional/mental condition; a need to alter the resident's medical treatment significantly; refusal of treatment or medications two or more consecutive times; a need to transfer the resident to a hospital/treatment center; discharge without proper medical authority; and a specific instruction to notify the physician of changes in the resident's condition. A significant change of condition is a major decline or improvement in the resident's status that: will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions; impacts more than one area of the resident's health status; requires interdisciplinary review and/or revision to the care plan; and ultimately is based on the judgment of the clinical staff and the guidelines outlined in the Resident Assessment Instrument. This deficiency represents noncompliance investigated under Complaint Number 1381901.

Event ID:

Facility ID:

If continuation sheet

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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Gardens of Euclid Beach

16101 Euclid Beach Blvd Cleveland, OH 44110

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 0677

08/24/25 during the last 30 days from 08/03/25 to 09/03/25.

Level of Harm - Minimal harm or potential for actual harm

An interview with Licensed Practical Nurse (LPN) #510 on 08/26/25 at 10:25 A.M. confirmed there was a shower book kept on the second floor of the facility for residents who lived on both the first and second floor. If a resident received a shower, a shower sheet was filled out and kept in the shower book.

Residents Affected - Some

An interview on 08/28/25 at 8:00 A.M. with Certified Nursing Assistant (CNA) #541 revealed the shower book should have a shower schedule for each resident. After completing a shower, staff would fill out a shower sheet and complete the shower task in the EMR under the shower/bath tab. The shower sheet was given to the nurse. If the CNA noticed anything abnormal with the resident during the shower, the nurse would be notified to observe the resident.

An interview with CNA #563 on 08/28/25 at 8:18 A.M. revealed a shower aide was assigned to showers and worked Monday through Friday for eight hours. CNA #563 stated she worked some weekends and picked up as an aide too. CNA #563 stated the shower schedule was in the shower book. CNA #563 stated she filled out a refusal form if a shower was refused by the resident and filled out a shower sheet every time she gave a shower. CNA #563 stated she provided showers for all the residents on the second floor which consisted of four halls so she could have 12 showers to do in one shift. CNA #563 stated she had been pulled to go out on appointments with residents during the month of August and had not been able to complete her showers. In her absence, the aides were supposed to complete their resident showers if she was not there. Sometimes they are short staffed and have three aides instead of five so she gets pulled to be an aide rather than the shower aide. CNA #563 stated the aides were instructed that when there was no assigned shower aide, they are all responsible to complete their resident's shower.

An interview on 09/03/25 at 11:00 A.M. with a follow up interview at 1:30 P.M. with DON #581 confirmed

she had provided the complete book of shower sheets and was unable to provide additional evidence of showers provided to Resident #3, #29, #45, #49, #53, #63, #41, #7, #44, #1, #2, and #5. DON #581 verified

the information in the shower book and in the EMR under the task tab revealed what was charted was what was completed.

Review of the facility policy, Shower/Tub Bath, dated 10/2010, revealed the purpose of this procedure was to promote cleanliness, provide comfort to the resident and to observe the condition of the resident's skin.

The following information should be recorded on the resident's Activity of Daily Living (ADL) record and/or

in the resident's medical record: date and time the shower/tub was performed, name and title of the individual who assisted the resident with the shower/tub bath, all assessment data obtained during the shower/tub bath, how the resident tolerated the shower/tub bath, if the resident refused, what intervention was taken and the signature with title of the person recording the data.

This deficiency represents noncompliance investigated under Complaint Number 1381901.

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

Event ID:

Facility ID:

If continuation sheet

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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Gardens of Euclid Beach

16101 Euclid Beach Blvd Cleveland, OH 44110

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 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

Interview with CNA #566 on [DATE REDACTED] at 4:21 P.M. revealed she worked the 3:00 P.M. to 11:00 P.M. on [DATE REDACTED]. CNA #566 said she was in a room with another resident when a code was called. She stated she took the crash cart to Resident #13's room. She stated she did not remember if anyone was performing CPR. CNA #566 did not how long the code lasted or who called 911. CNA #566 revealed she was not certified in CPR. An interview was conducted on [DATE REDACTED] at 1:16 P.M. with LPN #510 who revealed she was working in the facility at the time Resident #13 had a change of condition, but she was not his nurse. When asked if chest compressions or breaths were performed on Resident #13, LPN #510 stated she was not sure. She stated she was at the resident's bedside, left the room, and passed the hospice nurse who was just walking into the room. LPN #510 stated she checked Resident #13's code status, called 911 and the DON, but did not recall what time. LPN #510 stated she got the crash cart, set the crash cart in the doorway of Resident #13's room, and left. She stated she did not know what happened after that. A follow up interview on [DATE REDACTED] revealed LPN #510 clarified she had taken the crash cart to the room then started getting the paperwork together that EMS would need when they arrived. She stated she did not participate

in a code. LPN #510 stated she believed the resident was a full code and checked the electronic medical

record to confirm that. LPN #510 said when someone codes, she always checks the resident's code status

before starting CPR. LPN #510 said no one directly asked her to lie and say CPR was started on the resident. Review of the facility policy Emergency Procedure-Cardiopulmonary Resuscitation (CPR) last revised [DATE REDACTED] revealed the facility would identify a CPR team for each shift in the case of an actual cardiac arrest. To the extent possible, designate a team leader on each shift who was responsible for coordinating

the rescue effort and directing other team members during the rescue effort. The CPR team in this facility shall include at least one nurse, one LPN and two CNAs. If an individual was found unresponsive, briefly assess for abnormal or absence of breathing. If sudden cardiac arrest was likely, begin CPR. Instruct a staff member to activate the emergency response system (EMS) and call 911. Instruct a staff member to retrieve

the automatic external defibrillator (AED). Verify the code status of the resident. Continue with CPR until EMS arrives. Review of the facility policy Charting and Documentation last revised [DATE REDACTED] revealed documentation of procedures and treatments would include care-specific details, including: the date and time the procedure/treatment was provided; the name and title of the individual(s) who provided the care;

the assessment data and/or any unusual findings obtained during the procedure/treatment; how the resident tolerated the procedure/treatment; whether the resident refused the procedure/treatment; notification of family, physician, or other staff, if indicated; and the signature and title of the individual documenting. This deficiency represents noncompliance investigated under Master Complaint Number 2612264 and Complaint Numbers 2578214 and 1381901.

Event ID:

Facility ID:

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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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Gardens of Euclid Beach

16101 Euclid Beach Blvd Cleveland, OH 44110

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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

#58 coded. LPN #532 said the resident was in respiratory distress and RN #511 gave her an inhaler, then

an aerosol treatment, then had to retrieve oxygen the resident wanted from the second floor. LPN #532 said

the next thing she knew RN #511 returned to the second floor calling for help. LPN #532 said she and an unidentified aide went back to the first floor with RN #511. RN #511 and LPN #532 grabbed the crash cart and went to the resident's room while the aide called 911. LPN #532 said she thought Resident #58 had a pulse still as the pulse oximeter was picking up an oxygenation level. She stated RN #511 did not check for

a pulse before starting CPR. LPN #532 said CPR continued until EMS arrived and took over. They transported Resident #58 to the ER where she was pronounced expired. Interview with DoR #565 on [DATE REDACTED] at 10:50 A.M. revealed he had worked with Resident #58 on [DATE REDACTED] and denied the resident had any concerns, complaints of shortness of breath, not feeling well, or chest pain. The DoR revealed the resident presented as per her normal and there was nothing out of the ordinary with the resident. The DoR revealed he was surprised when he heard the next day the resident had passed away. Interview with LPN #510 on [DATE REDACTED] at 11:15 A.M. revealed she recalled Resident #58. The LPN revealed the resident was on

the first floor in the new unit that opened sometime in [DATE REDACTED]. LPN #510 said the resident was alert, independently mobile, and knew what she wanted. Resident #58 never complained about being short of breath, not feeling well, or chest pain. Interview with MD #614 on [DATE REDACTED] at 11:35 A.M. revealed he was the only physician for the [TRUNCATED]

Event ID:

Facility ID:

If continuation sheet

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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Gardens of Euclid Beach

16101 Euclid Beach Blvd Cleveland, OH 44110

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 0685 Level of Harm - Minimal harm or potential for actual harm

then. Interview on [DATE REDACTED] at 2:47 P.M. with RDCS #601and RDO #599 confirmed they were unable to provide a facility policy related to vision appointments, ancillary appointments or physician orders being followed.This deficiency represents noncompliance investigated under Complaint Number 1381901 and Complaint Number 1381896.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet

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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Gardens of Euclid Beach

16101 Euclid Beach Blvd Cleveland, OH 44110

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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

listed included complete a smoking evaluation per facility guidelines, and the resident will follow the facility smoking policy. Review of the 08/09/25 quarterly MDS 3.0 assessment revealed Resident #49 had intact cognition and was independent for ADL. Interview on 08/28/25 at 8:30 A.M. with Resident #49 who was sitting in his wheelchair next to the nurses' station revealed he thought he was at a credit union and was looking for donations. When Resident #49 was asked where he kept his money, Resident #49 proceeded to roll up the seat cushion on the left side of his wheelchair which revealed a pack of cigarettes. DON #581 was standing at the nurses' station at the time of the observation and confirmed Resident #49 had cigarettes in his possession and was not supposed to. Review of the undated clinical nursing assistant orientation program staff sign off sheet revealed staff are oriented to resident smoking locations, times, protocols and safety as part of the 'on the floor' competencies. Review of the facility policy called Smoking Policy-Residents Acknowledgement, revised December 2016, revealed prior to and upon admission, residents shall be informed of the facility smoking policy, and designated smoking areas. Smoking is only permitted in the designated resident smoking area which is located outside of the building. Smoking is only permitted during designated times for residents that require supervision. Upon admission the resident will be evaluated to determine if he or she is a smoker or non-smoker and ability to smoke safely with or without supervision (per a completed Safe Smoking Evaluation). Any resident with restricted smoking privileges requiring monitoring shall have the direct supervision of a staff member at all times while smoking.

Residents with restricted smoking privileges are not permitted to keep cigarettes, pipes or other smoking articles in their possession. This deficiency represents noncompliance investigated under Complaint Numbers 2578214 and 1381901.

Event ID:

Facility ID:

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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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Gardens of Euclid Beach

16101 Euclid Beach Blvd Cleveland, OH 44110

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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

informed care; QAPI (Quality Assurance and Performance Improvement); compliance and ethics; emergency preparedness; and workplace hazards. The facility conducts a formal evaluation of the training program. The purpose statement noted the purpose statement of this assessment is to determine what resources are necessary to care for our residents competently during both day-to-day operations (including nights and weekends) and emergencies. Facility resources included all personnel, including managers, nursing and other direct care staff (both employees and those who provide services under contract), and volunteers, as well as their education and/or training and any competencies related to resident care. This deficiency represents noncompliance investigated under Complaint Number 1381901.

Event ID:

Facility ID:

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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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Gardens of Euclid Beach

16101 Euclid Beach Blvd Cleveland, OH 44110

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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, staff interview and review of the facility policy, the facility failed to ensure medications in the medication cart were labeled and stored in proper containers. This had the potential to affect 30 Residents (#2, #6, #8, #16, #18, #19, #20, #21, #22, #23, #25, #26, #30, #31, #33, #35, #36, #37, #39, #42, #43, #44, #45, #46, #47, #49, #50, #52, #60, and #61) who received medications from the medication carts reviewed.

The facility census was 53. Findings include:Observation on 08/20/25 at 3:15 P.M. of the medication cart on

the sycamore hall revealed there were 15 loose pills of various shapes and colors in the bottom of the medication cart. Interview on 08/20/25 at 3:15 P.M. with Registered Nurse (RN) #606 and Licensed Practical Nurse (LPN) #559 confirmed 15 loose pills of various shapes and colors in the bottom of the medication cart for the sycamore hall. RN #606 & LPN #559 confirmed they were not able to identify the 15 pills nor to whom the 15 pills were prescribed. Observation on 08/20/25 at 3:21 P.M. of the crystal [NAME] hall medication cart revealed there were 20 loose pills of various shapes and colors in the bottom of the medication cart. Interview on 08/20/25 at 3:21 P.M. with LPN #607 confirmed 20 loose pills of various shapes and colors in the bottom the nurse of the crystal [NAME] hall medication cart. LPN #607 confirmed

she was not able to identify the 20 pills nor to whom the 20 pills were prescribed. Observation on 08/20/25 at 3:47 P.M. of the carousel hall revealed there were 5 loose pills of various shapes and colors in the bottom of the medication cart. Interview on 08/20/25 at 3:47 P.M. with LPN #578 confirmed five loose pills of various shapes and colors in the bottom of the medication cart for the carousel hall cart confirmed she was not able to identify the five pills nor to whom the five pills were prescribed. Review of the facility policy titled, Storage of Medications, dated 04/07, revealed drugs and biologicals should be stored in the packaging in which they are received and the nursing staff is responsible for maintaining medication storage. This deficiency represents non-compliance investigated under Complaint Number 2578214.

Event ID:

Facility ID:

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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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Gardens of Euclid Beach

16101 Euclid Beach Blvd Cleveland, OH 44110

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 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review and interview, the facility failed to ensure physician ordered labs were completed timely as required. This affected one resident (Resident #53) of 22 residents reviewed for physician orders. The facility census was 53. Findings include:Review of the medical record for Resident #53 revealed an admission date of 09/08/23. Diagnoses included hemiplegia and hemiparesis affecting the left non-dominant side, type II diabetes mellitus, history of suicidal behavior, alcohol abuse and cocaine abuse.

Review of the physician order dated 11/21/23 for Resident #53 revealed an order for a BMP (Basic Metabolic Panel) and CBC (Complete Blood Count) to be completed every three months with no further directions specified. Review of the medical record for Resident #53 revealed no evidence of a BMP or CBC being completed on 07/15/25 as ordered. Review of the care plan last reviewed on 07/23/25 for Resident #53 revealed resident at risk for adverse effects related to use of psychoactive medications and diagnosis of depression. Resident #53 also had a diagnosis of depression related to pain management needs.

Intervention for both listed included obtain lab results as ordered and notify the physician of abnormal values. Review of the 08/15/25 annual Minimum Data Set (MDS) 3.0 assessment for Resident #53 revealed

a Brief Interview for Mental Status (BIMS) score of nine out of 15 which indicated moderate cognitive impairment. Resident #53 was also noted to have a diagnosis of depression and received antidepressant, antiplatelet and anticonvulsant medications. Interview on 08/25/25 at 3:14 P.M. with Regional Director of Clinical [NAME] (RDCS) #601 confirmed the BMP and CBC was last completed on 04/15/25 but was unable to provide evidence that the BMP and CBC were completed as physician ordered on 07/2025.

Interview on 09/03/25 at 2:47 P.M. with RDCS #601and Regional Director of Operations (RDO) #599 confirmed they were unable to provide a facility policy related to physician orders being followed. This deficiency represents noncompliance investigated under Complaint Number 1381901.

Event ID:

Facility ID:

If continuation sheet

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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Gardens of Euclid Beach

16101 Euclid Beach Blvd Cleveland, OH 44110

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 0813 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

An interview on 08/28/25 at 10:04 A.M. with Resident #43 revealed she was unaware if anyone was monitoring her room refrigerator and had never observed someone checking the refrigerator.

1. 3. Review of the medical record for Resident #9 revealed an admission date of 09/09/24. Diagnoses

included gastroparesis, chronic obstructive pulmonary disease and type II diabetes mellitus. Review of the 06/18/25 quarterly MDS 3.0 assessment for Resident #9 revealed intact cognition. Resident #9 was noted to receive a NAS, Reduced Concentrated Sweets diet, was independent for meals and dependent on staff for ADL.

An observation on 08/21/25 at 1:49 P.M. with RDM #598 of Resident #9's room refrigerator revealed no temperature monitoring logs on and around the refrigerator. Interview at the time of observation with Resident #9 revealed no one had checked his refrigerator “in a long time”.

An interview on 08/28/25 at 10:06 A.M. with Resident #9 revealed someone had checked his refrigerator yesterday but was unsure the last time prior to yesterday whether the temperature or the items inside were checked.

2. 4. Review of the medical record for Resident #4 revealed an admission date of 03/20/25. Diagnoses

included multiple sclerosis, morbid obesity and type two diabetes mellitus. Review of the 07/01/25 quarterly MDS 3.0 assessment for Resident #4 revealed intact cognition. Resident #4 was noted to receive a regular diet, required set-up for meals and was dependent upon staff for ADL.

An observation on 08/21/25 at 1:54 P.M. with RDM #598 of Resident #4's room refrigerator revealed no temperature monitoring log on or around the refrigerator. A 12.05-ounce (oz) plastic container of pre-prepared beef stew was found and had an expiration date of 07/03/25, an eight-ounce container of parmesan cheese was found with an expiration date of 08/19/23. Interview with RDM #598 at the time of

the observation verified the findings.

An interview on 08/28/25 at 10:08 A.M. with Resident #4 revealed she was unsure if anyone ever checked her refrigerator or monitored temperatures and stated if they had then it was not being done consistently.

Review of the facility policy titled Food Brought in for Patients and Residents, dated 11/27/17, revealed food brought to residents by family or visitors will be handled and stored in a safe and sanitary manner and may be stored in personal refrigerators in resident rooms. Food items that require refrigeration must be labeled, dated and will be held in the refrigerator for three days after the date on the label then discarded by staff.

Foods considered unsafe or beyond the expiration date will be discarded by staff. The policy did not specify any procedure or instructions related to maintaining and monitoring safe food temperatures in resident room refrigerators.

This deficiency represents non-compliance investigated under Complaint Number 2578214.

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

Event ID:

Facility ID:

If continuation sheet

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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Gardens of Euclid Beach

16101 Euclid Beach Blvd Cleveland, OH 44110

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 0835 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

planning, environmental and equipment concerns, activities of daily living care, treatment to maintain vision, laboratory services, accurate facility assessment, documentation issues, staff orientation and training, quality assurance committee, resident food storage, accident prevention, infection control regarding oxygen tubing, pharmacy reviews, food storage, dignity, quality of care and medication storage.

The facility failed to provide evidence that administrative staff, including the Administrator and/or DON, had effective systems in place to timely identify and correct quality, care and environmental concerns. A. The facility failed to ensure an accurate care plan was indicative of oxygen use for one resident (Resident #55) of three reviewed for oxygen use. B. The facility failed to ensure a clean and sanitary homelike environment and failed to ensure garbage was disposed of properly. This had the potential to affect all residents residing

in the facility.C. The facility failed to initiate Cardiopulmonary Resuscitation (CPR) or call emergency medical services (EMS) for Resident #13 resulting in immediate jeopardy and death. D. The facility failed to ensure showers/bathing was completed and documented as required for twelve residents (Residents #1 #2, #3, #5, #7, #29, #41, #44, #45, #53, and #63) of 44 residents who required staff assistance for showers and bathing.E. The facility failed to ensure physician ordered labs were completed timely for Resident #53.F. The facility failed to ensure medical record documentation included weekly skin assessments as ordered and care planned for 11 residents (#1, #3, #7, #9, #29, #44, #45, #49, #53, #63, and #69) and failed to ensure

the change of condition and subsequent death of Resident #76 was documented in the medical record.

This affected 12 residents (#1, #3, #7, #9, #29, #44, #45, #49, #53, #63, #69 and #76) of 22 residents reviewed for complete resident records.G. The facility failed to have an updated and accurate facility assessment to indicate sufficient staffing for the first floor. This had the potential to affect six residents identified as residing on the first floor (Residents #22, #26, #31, #35, #46 and #61).H. The facility failed to ensure Resident #29 was provided corrective lens and vision care appointments per physician orders.I. The facility failed to ensure a complete orientation of new certified nurse assistants and licensed nurses. This had the potential to affect all residents residing in the facility.J. The facility failed to ensure sufficient competent staffing on the first floor which had the potential to affect six residents (#22, #26, #31, #35, #46 and #61) who resided on the first floor of the facility.K. The facility failed to ensure quality assurance team consisted of the required members. This had the potential to affect all residents living in the facility.L. The facility failed to ensure resident personal refrigerators were monitored for temperatures and food spoilage.M. The facility failed to ensure appropriate supervision during smoking times and failed to ensure residents did not have smoking items in their personal possession which affected Resident #45 and #49.N.

The facility failed to ensure oxygen tubing was dated when changed for Resident #39 and #55.O. The facility failed to ensure pharmacy reviews were completed monthly for Resident #4 and #53.P. The facility failed to ensure the physician was notified of changes in condition for Resident #13 and #85.Q. The facility failed to ensure a catheter drainage bag was covered for Resident #27.R. The facility failed to ensure medications were properly secured.S. The facility failed to ensure appropriate quality of care for three residents (Resident #13, #58, and #74) resulting in immediate jeopardy and death. This deficiency represents non-compliance investigated under Complaint Numbers 2578214 and 1381901.

Event ID:

Facility ID:

If continuation sheet

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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Gardens of Euclid Beach

16101 Euclid Beach Blvd Cleveland, OH 44110

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)

Federal health inspectors cited GARDENS OF EUCLID BEACH in CLEVELAND, OH for a deficiency under regulatory tag F-F0921 during a complaint investigation conducted on 2025-09-23.

Category: Environmental Deficiencies

The facility was found deficient in the following area: Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of GARDENS OF EUCLID BEACH.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-09.