Health inspection·June 3, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on record review, interview and policy review, the faciliy failed to ensure residents were free from abuse. This affected one (Resident #8) of seven residents reviewed for abuse. The facility census was 116. Findings include: Record review revealed former Resident #8 was admitted on [DATE]. Diagnoses included diabetes mellitus, dementia, hypertension, and end stage renal disease. The resident was discharged [DATE] to the hospital. Review of the quarterly Minimum Data Set (MDS) assessment, dated 02/28/25, revealed Resident #8 had impaired cognition. The resident required maximum staff assistance for bed mobility, transfers, bathing, and ambulation. Review of the facility's investigation file revealed on 05/15/25 former Certified Nursing Assistant (CNA) #22 admitted to having a picture of Resident #8 on his personal cell phone. During an interview on 06/03/24 at 1:40 P.M., the Administrator confirmed that a picture of Resident #8, fully clothed, in a hoyer lift, was received from former Certified Nursing Assistant (CNA) #22's cell phone by human resources on 05/09/25. An investigation was initiated by the Administrator and CNA #22 was suspended on this same date. CNA #22 admitted to having the pictures on his phone of residents, but he said he did not take them. CNA #22 was terminated following the completion of the investigation in which it was concluded CNA #22 did have a picture of Resident #8 on his personal cell phone and had not obtained consent from Resident #8 to take the photo. Review of the personnel file of CNA #22 revealed he was terminated on 05/21/25. Review of the facility's policy titled Prevention, Identification, Investigation and Reporting of Abuse, Neglect, Mistreatment and Exploitation of a Resident of Misappropriation of Resident Property, dated 02/28/23, revealed mental abuse includes staff taking, keeping, distributing or using photographs or recording of a resident that would demean of humiliate a resident. The deficient practice was corrected on 06/02/25 when the facility implemented the following corrective actions: (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 2 Event ID: 365436 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 365436 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mother Angeline McCrory Manor 5199 East Broad Street Columbus, OH 43213 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)