Inspection·July 15, 2024

F 0602 Level of Harm - Minimal harm or potential for actual harm cash transaction at a bank ATM on 06/16/24 at 11:18 P.M. for $117.00. Resident #50 did not make the transactions as she was in the facility and presumed the fraudulent transactions were from the theft of her debit card. The DON assisted the resident with cancelling her debit card and reporting that her credit card was stolen. The statement also indicated the resident and daughter stated the purse was last seen either on 06/11/24 or 06/13/24. Residents Affected - Few The investigation included a typed timeline based on the review of camera footage throughout the facility showing State Tested Nurse Aide (STNA) #507 entered Resident #50's room from 5:33 P.M. to 5:34 P.M. STNA #507 went to the restroom on the rehab unit from 5:46 P.M. to 5:48 P.M. STNA #507 then went into Resident #50's room at 5:48 P.M. to 5:51 P.M. STNA #507 left the facility at 5:57 P.M. STNA #507 pulled out of the parking lot at 5:59 P.M. STNA #507 returned to parking lot at 6:19 P.M. STNA #507 returned to the facility at 6:24 P.M. STNA #507 left facility at 10:56 P.M. to the parking lot. STNA #507 left the parking lot at 11:13 P.M. turning right out of the parking lot. Review of Resident #507's punch detail revealed he last worked on 06/16/24 from 3:23 P.M. to 10:55 P.M. Review of the typed statement for STNA #507 dated 06/18/24 at 12:25 P.M. via phone revealed he worked on 06/16/24 from 3:00 P.M. to 11:00 P.M. on the rehab unit (Resident #50's unit). STNA #507 denied being aware Resident #50 having a purse/wallet in her room or of it going missing. Interview on 07/12/24 at 9:14 A.M. with the Administrator revealed STNA #507 was permanently suspended until final evidence was subpoenaed from the ATM videos. The Administrator stated the police were involved and there was currently an ongoing investigation. The Administrator stated they can't say STNA #507 did it, and he never admitted anything. The Administrator stated they substantiated their investigation because Resident #50's wallet was taken. The Administrator stated they suspect STNA #507 but had no hard evidence. The Administrator stated on the facility's camera footage they were able to see STNA #507 leaving around the time of the withdrawals. Interview on 07/12/24 at 10:17 A.M. with Resident #50 revealed she hated that it happened. Resident #50 stated she had a small wallet that contained her identification card, medical cards, $20 bill, check book, and bank card. Resident #50 stated her purse was in bag wrapped tight, in the drawer, close to her bed. Resident #50 stated she wasn't aware it was missing until one morning a nurse came in with her wallet and stated someone put in the lost and found. Resident #50 stated someone took money from her, but she had talked to a detective who came out. Resident #50 stated as far as she knows they were looking into everything but don't know if they came up with anything. Resident #50 stated she had to cancel the card right away. Resident #50 stated she did not know who could have done it but didn't believe it was someone working at the facility because she felt the staff were excellent. Resident #50 stated she wasn't always in her room and at times she was in therapy or outside with her sister. Resident #50 stated it was kind of scary, and her daughter was upset about the incident. Resident #50 stated she got everything back except her bankcard. Review of the facility policy Abuse, Neglect, Misappropriation of Resident Property, Exploitation, and Mistreatment Policy, revised 01/28/17, revealed the facility will not tolerate, abuse, neglect, exploitation, or mistreatment of its residents, or misappropriation of resident property by anyone. It is the facility's policy to investigate all allegations, suspicions and incidents of abuse, neglect, exploitation, mistreatment, the misappropriation of resident property and injury of unknown source and report the results of any such investigation as required by law. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365072 If continuation sheet Page 2 of 3 Printed: 05/15/2026 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 365072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anna Maria of Aurora 889 North Aurora Road Aurora, OH 44202 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 0602 The deficient practice was corrected on 07/09/24 when the facility implemented the following corrective actions: Level of Harm - Minimal harm or potential for actual harm • Residents Affected - Few All staff were educated on Abuse/Neglect/Misappropriation on 06/17/24. • Care conference forms with residents and their representatives list under question number three: security measure or intervention to reduce risk of loss currently in place now include a statement for family to monitor, advise to alert staff immediately if personal belongings are missing. Care conferences are conducted within seven days of admission to the rehab unit and weekly throughout facility. • Resident/Family Handbook on page 13 revised to include loss/missing items: the facility encourages residents to not keep valuables, jewelry and/or significant amounts of money (cash, credit cards, etc.) on their person or in their room. However, if the resident finds that something is missing (property, money, etc.) please let the nurse, nurse manager, or administrator know immediately. Residents and family can also voice their concerns by calling the facility confidential concern/grievance line. (The number was listed). • Weekly Resident Property Monitoring of four resident interviews weekly dated 06/21/24, 06/26/24, 06/28/24, 07/05/24, and 07/12/24 with no negative findings completed by Assistant Director of Nursing (ADON) #467 and Nurse Unit Manager (UM) #441. • Weekly camera monitoring of staff on various shift once weekly dated 06/25/24 of third shift on 06/18/24, 07/01/24 of second shift on 06/30/24, and 07/09/25 of first and second shifts on 07/06/24 with no negative findings completed by Human Resources (HR) #602. • Audits and monitors to continue for six weeks. Review in QAA/QAPI committee in the upcoming meeting next week. This deficiency represents non-compliance investigated under Master Complaint Number OH00155122. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365072 If continuation sheet Page 3 of 3