Inspection·November 8, 2023

F 0606 Not hire anyone with a finding of abuse, neglect, exploitation, or theft. Level of Harm - Minimal harm or potential for actual harm Based on record review, interview and policy review, the facility failed to terminate employment for a State Tested Nursing Assistant (STNA) who had a finding entered in the State Nurse Aide Registry concerning abuse, neglect, or misappropriation. This resulted in one employee, STNA #101, working at the facility while he was not eligible to work in a long-term care facility. This had the potential to affect all residents in the facility. The facility census was 85. Residents Affected - Many Findings include: Review of the personnel file for STNA #101 revealed a hire date of 12/01/22. Review of the background check log revealed STNA #101's background check was submitted 11/22/22, completed 12/07/22 and received at the facility on 12/14/22. STNA #101 was hired to work. Review of the Ohio Department of Health Nurse Aide Registry form dated 11/23/22 revealed STNA #101 was eligible to work and his registry was in good standing. Review of the Criminal History Record Check dated 12/07/22 and stamped by the facility Received 12/14/22 revealed STNA #101 was arrested for theft and forgery 10/30/22 and the case was pending in the local county common pleas court. Review of a court document dated 11/23/22 revealed the defendant, STNA #101, withdrew his plea of not guilty and would apply for the diversion program. Review of the form Employee Disciplinary Record dated 01/09/23 revealed STNA #101 was suspended due to violating the Employee Handbook, Page 6: Rule 3 - your hiring is subject to receipt of a satisfactory criminal background check. STNA #101 would be allowed to return to work when the disqualifying item was removed from his background check. Review of an email correspondence dated 01/20/23 between the Administrator and the facility's corporate office revealed the Administrator requested guidance regarding STNA #101's background check and involvement in a diversion program. Review of the email correspondence dated 02/21/23 revealed a response from the Legal/HR department stating the use of a diversion program was fairly common and because there was no conviction (pending outcome of diversion program) it was okay for STNA #101 to work at the facility. Review of a letter dated 01/25/23 from the facility to the local county Probation Department revealed STNA #101 was hired on 12/01/22 and worked until 01/09/23. Review of the Ohio Department of Health Nurse Aide Registry form dated 02/21/23 revealed STNA #101 (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: 365389 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 365389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Defiance The 1701 S Jefferson Ave Defiance, OH 43512 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)