Altenheim

F 0684 Level of Harm - Actual harm

were identified so that appropriate measures could be taken to alter the plan of care and/or implement a treatment protocol if necessary. Existing wound were assessed by the wound nurse and wound provider on

a weekly basis as appropriate for new areas, stagnant or declining wounds for effectiveness of current interventions and/or treatment. Weekly assessment findings would be recorded and entered in PCC.

Residents Affected - Few

Review of the facility's undated Treatment and Interventions policy revealed unless otherwise specified by

the provider, the facility's treatment protocols for each skin integrity type would be in accordance with current standards of practice. Generally, dressing would not be removed until the ordered dressing was due to be changed unless there were signs of dressing contamination or observations that indicate a clinical problem. Integrity of wound dressings would be monitored with each interaction and be replaced in they were not intact/placed as ordered.

1. 2. Review of the medical record for Resident #90 revealed an admission date of 07/08/24 with diagnoses

including dementia, chronic kidney disease and a pressure ulcer to the left heel and right heels.

Review of the physician's orders for Resident #90 revealed an order to cleanse the left heel wound with normal saline, pat dry, swab with Betadine, cover with an abdominal (ABD) pad and wrap with kerlix every day and as needed dated 07/17/25.

Review of the care plan dated 07/19/25 for Resident #90 revealed she was at risk for impaired skin integrity and had an unstageable pressure ulcer (type of pressure ulcer when the stage is not clear due to the base of the wound being obscured by dead tissue in the wound) to her left heel. Interventions included to perform treatments as ordered by the physician.

Review of the treatment administration record (TAR) for Resident #90 for September 2025 and October 2025 revealed nursing staff had not completed the treatment to her left heel wound on 09/06/25, 09/10/25, 09/12/25, 09/15/25, 09/26/25, 09/29/25, 10/04/25, 10/05/25, 10/10/25, 10/13/25, 10/18/25 and 10/19/25.

Interview on 10/21/25 at 1:32 P.M. with the Director of Nursing verified Resident #90's treatments to her left heel were not performed on the dates listed above.

Review of the facility policy titled, Treatment and Interventions, undated, revealed unless specified by the provider, the facility's treatment protocols for each skin injury type will be in accordance with current standards of practice.

This deficiency represents non-compliance investigated under Complaint Number 2601761.

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

10/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Altenheim

18627 Shurmer Road Strongsville, OH 44136

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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Based on record review and interview, the facility failed to ensure staff performed urinary catheter care and monitored urine output as ordered by the physician. This affected two (Residents #79 and #120) of three residents reviewed for urinary catheters. The facility census was 120.Findings include:1. Review of the medical record for Resident #79 revealed an admission date of 09/30/25 with diagnoses including urinary retention, obstructive and reflux uropathy (blockage in the urinary tract that prevents urine from flowing normally). Review of the physician's orders for Resident #79 revealed an order for foley catheter care each shift dated 09/30/25. Review of the baseline care plan dated 09/30/25 for Resident #79 revealed she had a foley catheter and staff would provide catheter care as ordered. Review of the treatment administration

record (TAR) for October 2025 revealed staff had not completed foley catheter care including monitoring urinary output on night shift on 10/03/25, 10/09/25, 10/10/25 and on dayshift on 10/10/25 and 10/17/25.

Interview on 10/21/25 at 1:32 P.M. with the Director of Nursing verified Resident #79's foley catheter care was not performed on the dates listed above. Review of the facility policy titled, Urinary Catheter Care, dated April 2013, revealed care should be provided every shift and as needed. 2. Review of the medical

record for Resident #120 revealed an admission date of 12/17/22 with diagnoses including dementia and obstructive and reflux uropathy (blockage in the urinary tract that prevents urine from flowing normally).

Review of the care plan dated 06/07/23 for Resident #120 revealed he had alteration in elimination related to having a catheter. Interventions included for staff to perform suprapubic catheter care as ordered and monitor output as needed. Review of the physician's orders for Resident #120 revealed an order for suprapubic catheter (a catheter inserted directly into the bladder) care each shift dated 02/05/25 that was discontinued on 07/07/25. A new order on 07/22/25 was noted to monitor foley output every shift. Review of

the treatment administration record (TAR) for May 2025, June 2025 and July 2025 revealed staff had not completed suprapubic catheter care for Resident #120 on dayshift on 05/01/25, 06/09/25 and on nightshift

on 05/02/25, 05/08/25, 05/09/25, 05/14/25, 05/22/25, 05/27/25, 05/28/25, 06/02/25, 06/11/25, 06/24/25, 06/27/25, 06/30/25 and 07/02/25. Review of the TAR for July 2025, August 2025 and September 2025 also revealed Resident #120 did not have his foley output monitored on nightshift on 07/22/25, 07/23/25, 07/31/25, 08/03/25, 08/06/25, 08/07/25, 08/19/25, 08/20/25, 08/26/25, 08/28/25, 08/29/25, 09/05/25, 09/08/25, 09/16/25, 09/17/25, 09/19/25, 09/22/25, 09/25/25, 09/26/25 and on dayshift on 07/25/25 and 08/16/25. Interview on 10/21/25 at 1:32 P.M. with the Director of Nursing verified Resident #120's suprapubic catheter care and output was not monitored on the dates listed above. Review of the facility policy titled, Urinary Catheter Care, dated April 2013, revealed care should be provided every shift and as needed. This deficiency represents non-compliance investigated under Complaint Number 2601761.

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

10/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Altenheim

18627 Shurmer Road Strongsville, OH 44136

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 0880

Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or potential for actual harm

Based on record review, observation and interview, the facility failed to implement proper infection control policies and procedures including surveillance of facility infections and contact isolation precautions (wearing gown and gloves) when in Resident #60's room. This affected one (Resident #60) of three residents reviewed for isolation precautions but had the potential to affect all residents related to not performing proper infection control surveillance. The facility census was 120.Findings include:1. Review of

the monthly infection control surveillance logs from September 2024 through October 2025 revealed the facility did not have surveillance for the months of August 2025, September 2025 and October 2025.

Interview on 10/21/25 at 12:00 P.M. with the Assistant Director of Nursing (ADON) #750 verified she had not started working on August 2025, September 2025 and October 2025 infection control surveillance logs.

She stated she tracked infections but was unable to answer how she monitored for trending infections when

the logs were not being kept up to date. Additional interview on 10/21/25 at 12:50 P.M. revealed ADON #750 ran a report at the end of each month for orders of new antibiotics and she utilized the information for her infection control surveillance log. Review of the facility policy titled, Antibiotic Stewardship Program, dated 05/15/24, revealed the infection prevention and control nurse would track and monitor facility infections and the amount of antibiotics used in the facility.2. Review of the medical record for Resident #60 revealed an admission date of 11/14/21 with diagnoses including chronic kidney disease, heart failure, diabetes mellitus, dementia and Extended Spectrum Beta Lactamase (ESBL) resistance (bacteria that is resistant to common antibiotics).Review of the physician's orders for Resident #60 revealed she had a peripherally inserted central catheter (PICC) dated 10/10/25. Resident #60 had an order dated 10/10/25 for contact precautions for ESBL.Observation on 10/20/25 at 10:45 A.M. revealed a sign on Resident #60's door alerting staff and visitors that she was on contact isolation. The instructions stated everyone must clean hands when entering room and wash hands with soap and water when leaving the room and put on a gown and gloves at the door. There was personal protective equipment (PPE) noted sitting by Resident #60's door including gloves and gowns. Licensed Practical Nurse (LPN) #536 performed hand hygiene and put on gloves. She then went into Resident #60's room and performed care on her PICC line. LPN #536 did not have a gown on during the observation. LPN #536 verified she should have donned a gown prior to going into Resident #60's room. Review of the facility policy titled, Infection Control, dated January 2012, revealed contact precautions were needed for multi-drug resistant organisms. Contact isolation included utilizing gown and gloves.This deficiency represents non-compliance investigated under Complaint Number

1. 2601761. Residents Affected - Many

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

10/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Altenheim

18627 Shurmer Road Strongsville, OH 44136

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 0881

Implement a program that monitors antibiotic use.

Level of Harm - Minimal harm or potential for actual harm

Based on record review and interview, the facility failed to implement their antibiotic stewardship program to ensure appropriate use of antibiotics. This affected one (Resident #120) of three residents reviewed for antibiotic usage. The facility census was 120.Findings include:Review of the medical record for Resident #120 revealed an admission date of 12/17/22 with diagnoses including dementia, pressure ulcers, history of urinary tract infections and cellulitis of the right great toe, Review of the facility infection control surveillance for September 2024 through July 2025 revealed Resident #120 had been on antibiotics on 10/15/24 (for urinary tract infection), 11/01/25 (for urinary tract infection), 11/20/25 (for clostridium difficile, or infection of

the colon that causes diarrhea), 02/18/25 (for cellulitis of the toe), 03/06/25 (for infection to the right toe), 03/31/25 (for increased white blood count), 04/03/25 (for continued increased white blood count), 06/09/25 (for conjunctivitis, or infection of the eye), and 07/10/25 (for osteomyelitis, or infection of the bone).Review of Resident #120's assessments revealed he did not have antibiotic time out assessments (standardized tool and criteria that assesses the symptoms of the resident and usage of the antibiotic) performed on 11/20/24, 02/18/25, 03/31/25-04/03/25, and 06/19/25.Interview on 10/21/25 12:50 P.M. with the Assistant Director of Nursing (ADON) #750 verified staff had not performed the antibiotic time out assessments for Resident #120 on 11/20/24, 02/18/25, 03/31/25-04/03/25, and 06/19/25. She stated the facility utilized the antibiotic time out assessments to ensure residents' symptoms warranted antibiotic usage and was part of their antibiotic stewardship program.Review of the facility policy titled, Antibiotic Stewardship Program, dated 05/15/24, revealed the infection prevention and control nurse would track all antibiotic starts as infection surveillance and monitor adherence to criteria during the evaluation and management of treated infections.This deficiency represents non-compliance investigated under Complaint Number 2601761.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet