Heather Knoll Retirement Village
Inspection Findings
F-Tag F0842
F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
record review and interview, the facility failed to ensure Resident #1's medical record was accurate and complete. This finding affected one (Resident #1) of three resident records reviewed for accurate documentation. The facility census was 110.Findings include:Review of Resident #1's medical record revealed the resident was admitted on [DATE REDACTED] and discharged on 06/02/25 with diagnoses including chronic diastolic congestive heart failure, anxiety disorder and syncope and collapse.Review of Resident #1's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE REDACTED] revealed the resident exhibited intact cognition, was always incontinent of bowel and bladder and was not on a toileting program.Review of Resident #1's Emergency Department Encounter note dated 06/02/25 revealed the resident presented to
the emergency department with a chief complaint of altered mental status. The emergency medical squad (EMS) reported that the nursing facility called because she was not acting like herself and they found her to be unresponsive when the family arrived. The husband stated that he visited the nursing home on [DATE REDACTED] and the resident was acting confused and told the staff, but she had not been evaluated at that time.Interview on 08/15/25 at 12:11 P.M. with Licensed Practical Nurse (LPN) #810 revealed she vaguely remembered Resident #1's husband reporting concerns about confusion and she had assessed the resident on that date. LPN #810 confirmed she did not document the assessment of the resident at that time but did not identify a change in the resident's condition.An additional interview on 08/15/25 at 3:03 P.M. with LPN #810 confirmed she remembered Resident #1's husband coming to her on 06/01/25 around lunchtime with concerns that the resident had a decline. LPN #810 confirmed she assessed the resident and did not find any changes in condition but neglected to document the assessment in the resident's medical record.This deficiency is an incidental finding discovered during the course of the complaint investigation.
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
Event ID:
HEATHER KNOLL RETIREMENT VILLAGE in TALLMADGE, OH inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in TALLMADGE, OH, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from HEATHER KNOLL RETIREMENT VILLAGE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.