Inspection visit
Inspection
1 citation recorded
Inspector’s narrative
What the inspector wrote
This survey cited 1 deficiency. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
Based on record review, observation and interviews, the facility did not ensure Resident #23 was treated
with respect and dignity. This affected one resident (#23) of three residents reviewed for resident rights. The
facility census was 44.
Findings include:
Review of Resident #23's medical record revealed an admission date of 05/30/18 with diagnoses including
Parkinson's disease, schizophrenia, major depressive disorder, hearing loss, dementia severe with other
behavioral disturbance, dependence on wheelchair, anxiety disorder, urgency of urination, agitation, and
schizoaffective disorder. Resident #23 had a legal guardian.
Review of the Minimum Data Set (MDS) 3.0 assessment, dated 07/14/23, revealed the resident had severe
impairment in cognition, no rejection of care, was always incontinent and required two-person extensive
assistance with transfers.
Review of Resident #23's plan of care, date initiated 06/01/18 and revised on 06/15/23, revealed Resident
#23 had intermittent behaviors including cursing, name calling/racial slurs, refusing care, throwing items,
breaks furniture, spitting/hitting staff/other residents, repetitive verbalizations often centered around toileting
needs saying she needed to go to the bathroom after just being toileted related to her cognitive impairment,
poor impulse control, ineffective coping and mental illness.
Plan of care interventions included giving her as many choices as possible about care and activities, if she
was angry and making negative statements, try to calm/comfort her. If she requested toileting immediately
after staff take her, try to engage her in other things to take her mind off of the fixation. Provide positive
feedback for good behavior. When resident became agitated, intervene by guiding away from source of
distress, engage calmly in conversation and if response was aggressive, staff to walk away and approach
later.
Review of a self-reported incident (SRI) dated 07/25/23 revealed the facility filed the SRI and opened an
investigation in response to an allegation of abuse/neglect reported to the Director of Nursing by Resident
#23's sister. Resident #23's sister referred to camera footage from the camera in Resident #23's room
showing State Tested Nursing Assistant (STNA) #906 slamming doors, banging a wheelchair against the
wall and yelling into the camera that the sister needed to tell Resident #23 to stop calling them names and
Resident #23 was in the room while this was going on in the room. A second STNA #905 came into the
room to provide care and gave a statement that Resident #23 told her STNA #906 was slamming doors.
The facility requested the cameral footage which was noted on the follow- up
(continued on next page)
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
Page 1 of 3
Event ID:
365370
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
365370
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
08/03/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Momentous Health at Richfield
4360 Brecksville Rd
Richfield, OH 44286
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 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
investigation report as received at approximately 2:00 P.M. on 07/25/23. The facility unsubstantiated the
allegation of neglect/abuse.
Review of camera video footage date marked 07/24/23, time marked 1:23 A.M. to 5:56 A.M. and submitted
to the surveyor by Resident #23's guardian clearly showed Resident #23 at 2:22 A.M. sitting on the side of
her bed. STNA #906 walked into the room, picked up Resident #23's legs, positioned her on the bed and
clearly said I'm not pulling you up, you not about to break my back. STNA #906 also looked directly into the
camera and said since you like to video tape everything, make sure you understand and uh, you better talk
to your sister about calling people out of their name. STNA #906 was pointing back towards the resident,
and she had an angry look on her face with an angry tone of voice.
Review of camera video footage date marked 07/24/23 at 5:56 A.M. revealed Resident #23 sitting on her
bed while State Tested Nursing Assistant (STNA) #905 was putting pants on her. STNA #906 was also on
the video in the room and took hold of a large object with handles resembling a wheelchair and pushed it
into other objects in the room making a banging noise loud enough that STNA #905 stopped what she was
doing to look at STNA #906. The STNAs proceeded to hook Resident #23's sling into a mechanical lift, then
STNA #906 turned around, aggressively swung the room door open so hard it made a loud banging sound.
Resident #23 called out an expletive towards STNA #906. STNA #905 told her you need to stop it and
Resident #23 replied you heard her then said another expletive. STNA #906 came back into the room and
again swung the door hard enough the door made a very loud banging sound. Neither of the STNA's tried
to calm or comfort Resident #23. STNA #906 did not speak to the resident at all during this video footage
while STNA #905 continued to lift her off the bed using the mechanical lift.
Review of the personnel file for STNA #906 revealed her employment with the facility was terminated on
08/02/23 due to a violation of resident rights and company policy.
Observation was conducted on 08/03/23 at 9:40 A.M. of Resident #23 in her room. She was alert,
appropriately dressed and pleasantly confused. There was a ring camera in her room directed towards her
bed.
Interview was conducted on 08/03/23 at 8:49 A.M. with the guardian of Resident #23 who verified she had
sent the camera video footage into the facility and alleged neglect of Resident #23 who was her sister. The
guardian said she believed Resident #23 was symptomatic for a urinary infection due to her behaviors and
that she needed to be calmed which STNA #905 and #906 were not trying to calm her. The guardian
expressed that by STNA #906 slamming the door in her sister's room that would cause fear in her sister
which would have caused her to cuss more at the staff because cussing was her defense mechanism.
Interview was conducted on 08/03/23 at 12:12 P.M. with the Director of Nursing (DON) who verified the
contents of the SRI dated 07/24/23 involving Resident #23, STNA #906 and STNA #905.
Interview was conducted on 08/03/23 at 1:55 P.M. with STNA #906 who stated since Resident #23 had a
camera put in her room, the resident had become mean to staff. STNA #906 verified she cared for the
resident and verified she yelled into the camera because the resident started calling her names around
5:00 A.M. She said the resident was in rare form that night and asked to go to the bathroom many times.
Interview was conducted on 08/03/23 at 2:09 P.M. with STNA #905 who verified she had worked with
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365370
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
365370
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
08/03/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Momentous Health at Richfield
4360 Brecksville Rd
Richfield, OH 44286
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 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
STNA #906 that evening of the referenced camera video footage. STNA #905 described STNA #906's
behavior around Resident #23 as angry and unprofessional.
Interview was conducted on 08/03/23 at 4:44 P.M. with Corporate Operations Officer (COO) #910 who
verified STNA #906 was terminated from her employment with the facility because of her conduct related to
the incidents involving Resident #23.
This deficiency represents non-compliance investigated under Complaint Number OH00144905.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365370
If continuation sheet
Page 3 of 3
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Back to topCitations
1 citation recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F550 - Resident Rights
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
FAQ · About this visit
Common questions about this visit
What happened during the August 3, 2023 survey of MOMENTOUS HEALTH AT RICHFIELD?
This was a inspection survey of MOMENTOUS HEALTH AT RICHFIELD on August 3, 2023. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at MOMENTOUS HEALTH AT RICHFIELD on August 3, 2023?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her right..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.