DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION		 (X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER		 (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY COMPLETED
361714 A. BUILDING __________
B. WING ______________ 		04/28/2022
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
GENERATIONS CARE OH LLC 24700 CENTER RIDGE ROAD SUITE G20, WESTLAKE, OH, 44145
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
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 reverse for further 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
(X4) ID
PREFIX
TAG		 SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY SHOULD BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)
L0579      
35036 Based on review of facility policy, review of Centers for Disease Control and Prevention (CDC) guidelines, and staff interview, the facility policy failed to follow CDC current guidelines for staff work restrictions if staff tested positive for Covid-19. The facility census was seven. Findings: include: Interview on 04/19/22 at 1:11 PM, Staff B revealed the facility has a new policy which was staff could return five days after a Covid-19 positive result and must be free of symptoms. Interview on 04/19/22 at 1:18 PM, Staff C stated the current policy was staff could return to work five days after a Covid-19 positive test without any symptoms. Review of the agency policy titled "Mandatory Vaccination Covid-19 Screening Policy," dated 02/08/22, revealed staff were required to notify the agency promptly if they tested positive for Covid-19. The agency would immediately remove an employee form the workplace if they received a positive Covid-19 test or had been diagnosed by a licensed healthcare provider with Covid-19. Employees with a positive Covid-19 test result would report the dated of symptoms onset and begin quarantine per CDC guidelines. The return to work criteria for people who were mildly ill with a laboratory confirmed infection and not moderately or severely immunocompromised included isolation could be discontinued at least five days after symptom onset, after resolution of fever for at least 24 hours, (without the use of fever-reducing medications), and with improvement of other symptoms. These people should continue to wear a well-fitted mask around others at home in public for an additional five days after the five day isolation period. The return to work criteria for people who test positive and are asymptomatic and not moderately or severely immunocompromised included isolation could be discontinued at least five days after the positive viral test. These people should continue to properly wear a well-fitted mask around others at home and in public for five additional day after the five day isolation period, if a person developed symptoms after testing positive their five day isolation period would start over. Review of the CDC guideline titled "Interim Guidance for Managing Health Care Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2," updated 01/31/22 revealed work restrictions for health care personnel with Covid-19 infection with conventional staffing levels included 10 days or seven days with a negative test, if asymptomatic with mild to moderate illness with improving symptoms. For a contingency staffing shortage, work restrictions for health care personnel with Covid-19 infection are five days with/or without a negative test if asymptomatic with mild to moderate illness with improving symptoms. For crisis staffing there are no work restrictions for Covid-19 positive health care personnel with prioritization considerations. Interview on 04/28/22 at 1:03 PM, Staff A confirmed the current policy was for five days isolation for Covid-19 positive staff. She thought she was following health care personnel isolation guidelines. Staff A stated she felt since she only had one nurse and there was a shortage of staff in healthcare in general the agency was always in contingency and crisis status. Staff A did state they had an emergency plan to work in collaboration with other agency's if the facility did not have staffing to cover shortages This citation substantiates Complaint Number OH00131074.