Health inspection·December 9, 2025

F 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of medical records, observation, interview, policy review and review of provided videos and pictures, the facility failed to ensure residents with trauma received the appropriate treatment and services to attain or maintain his or her highest practicable physical, mental, and psychosocial well-being. This affected one resident (#55) out of three residents reviewed for abuse.Findings Include:Review of Resident #55's medical Record revealed an admission date of 06/05/25 and medical diagnosis of covid-19, weakness, need for personal assistance with care, pain due to trauma, cerebral vascular accident, abnormal gait and mobility, dysphagia, traumatic subarachnoid hemorrhage without loss of consciousness, wedge compression fracture of fifth lumbar vertebra, hyperlipidemia, cervical disc degeneration, depression, anxiety, dementia mild with mood disturbance, muscle wasting and atrophy. Review of the undated document titled Care for [Resident #55] revealed the residents family brought up some care related concerns and that the resident preferred not to have male care givers. Review of Resident #55's Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview of Mental Status score of 06 revealing severe cognitive impairment and the need for personal assistance requiring one to two staff members for activities of daily living and incontinence care. Review of Resident #55's care plan dated 06/07/25, revealed the resident was resistive to care with interventions to reassure the resident, leave and return 5 to 10 minutes later and try again. Further review of the care plan, last updated 11/17/25, revealed the resident had a self-care performance deficit related to dementia and preferred female caregivers only related to showers and checks/changes due to a past assault when she was in the community. Interventions included one to two staff assistance with showering/bathing, bed mobility, dressing, eating, personal hygiene/oral care, toilet use, and transfers. Review of Resident #55's psychiatric note dated 09/15/25 revealed per the residents family she had history of trauma growing up as well as when a man entered her home when she was a new mother, and she encountered a stranger in her staircase in her home. Review of Resident #55's lab draw dated 10/24/25 revealed the resident had a lab draw to the back of the left hand. Review of Resident #55's November and December 2025 physician orders revealed an order dated 10/11/25 for Aspirin 81 milligrams (mg) oral tablet with instructions to give one table in the morning as an antiplatelet. Review of Resident #55's Medication Administration Record (MAR) for November 2025 revealed the resident received Aspirin 81 mg's daily. Review of Resident #55's lab draw dated 11/07/25 revealed the resident had a lab draw to the back of the right hand.Review of Resident #55's fall report dated 11/15/25 revealed the resident had an unwitnessed fall and sustained no injuries. Review of Resident #55's skin assessment dated [DATE] revealed no documented skin issues, including no documented bruising. Review of the facility Self-Reported Incident (SRI) dated 11/17/25 revealed on 11/17/25 the facility was contacted by Resident #55's Power of Attorney (POA) with concerns of abuse provided by two male Page 1 of 3 365436 365436 12/09/2025 Mother Angeline McCrory Manor 5199 East Broad Street Columbus, OH 43213

F 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few caregivers (Certified Nursing Assistant (CNA) #4 and Agency Nurse #687) during incontinence care on 11/17/25 at approximately 5:45 A.M. The facility placed both caregivers on administrative leave pending the investigation. A skin assessment was performed on 11/17/25 by Unit Manager #141 and Assistant Director of Nursing (ADON) #71 and revealed unmeasured black round marks on the back of Resident #55's bilateral hands and no fresh, bright red or maroon bruising were noted to the bilateral hands arms, or wrist. Additional assessments revealed Resident #55 denied pain or discomfort, nor did she express non-verbal pain indicators. The facility also contacted the local Police Department and filed a police report. Review of the preliminary police report #250847274, dated 11/17/25 revealed the residents responsible party noticed two male employees, and RN and an aide, at the residential home were her mother resided, changed her clothing and generally tended to her. It noted Resident #55 had a past trauma event involving males in general and also had dementia. Resident #55 was advising the two males to stop what they were doing and stated that they were hurting her. The resident's family believed this was assault and had the video saved from the incident. Review of Resident #55's video footage dated 11/17/25 at approximately 6:00 A.M. revealed two male caregivers (CNA #4 and Agency Nurse #687) providing incontinence care for Resident #55. Resident #55's bed was against the wall and the two male caregivers backs were facing the camera. The resident was addressed by name, was told by staff to hold their hand while they performed incontinence care. Resident #55 objected to incontinence care and yelled no multiple times. The two caregivers proceeded with incontinence care and the resident then yelled, you are breaking my hand. The video then showed a night gown was removed from the resident and placed on the top of the bed, then shortly after, a female staff (RN #95) arrived and she provided the remaining care to the resident while the two male caregivers left the room.Review of photos provided anonymously dated 11/18/25 revealed Resident #55 had black bruises to the back of the bilateral hands, bruises the front and back of the right wrist, a bruise to the right wrist, and a bruise to the right forearm. Resident #55's face was in the photos showing the back of the bilateral hands and arms. Review of Resident #55's skin assessment dated [DATE] revealed a skin tear to the right lower leg (from a previous unrelated injury) and no documentation of bruising to the resident's hands and arms. Review of the unsigned and undated witness statement filled out for CNA #4 by Assistant Director of Nursing (ADON) #71 revealed during evening report on 11/16/25, CNA #4 introduced himself to Resident #55's family and was handed clothes and told to change the resident. The resident did not object to being changed and allowed CNA #4 to provide incontinence care at midnight and 3:00 A.M. without issue. On the last round the resident said no and held a blanket to herself. CNA #4 contacted the supervisor, RN #95 and were told the supervisor would be down. RN #687 assisted the CNA with incontinence care by holding the resident's hands and RN #95 changed the residents shirt. Review of Agency Nurse #687's witness statement revealed the nurse observed CNA #4 provide incontinence care throughout the evening [indicating from 11/16/25 into 11/17/25] to Resident #55 without issue. At approximately 4:00 A.M. [on 11/17/25] the resident was noted to be soiled and had soaked through her depends and onto her nightgown. Resident #55 allowed CNA #4 to provide incontinence care but refused to allow her night gown to be changed. Further review revealed the nurse did not feel comfortable leaving the resident in soiled clothes due to the behavior the daughter exhibited the night before during shift change. While providing care to the resident, the resident refused care and a short break in care was performed to call the night shift supervisor. Afterwards the residents soiled night gown was removed from the resident and the night shift supervisor arrived and finished changing the resident. The witness statement did not specify the behavior that the residents daughter exhibited the night before. Interview on 12/03/25 at 10:51 A.M. with Unit Manager #141 confirmed when 365436 Page 2 of 3 365436 12/09/2025 Mother Angeline McCrory Manor 5199 East Broad Street Columbus, OH 43213

F 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #55 was admitted the family requested no male caregivers. The request was accommodated until the resident was moved from the fourth floor to the second floor and then the resident had a male caregiver again. The family was aware and didn't express concerns at that time. The resident was later moved to the third floor and continued receiving assistance from male caregivers without incident until 11/17/25. Observation on 12/03/25 at 12:23 P.M. of Resident #55 revealed a small red area with dark edges to the right forearm and slight discoloration to the back of the left hand but no bruising or dark marks to the back of the bilateral hands or wrist. Resident #55 was unable to provide any information regarding the 11/17/25 incident. During an interview on 12/04/25 at 9:35 A.M. with CNA #4 revealed they had no recollection of the 11/17/25 event with Resident #55 and could not recall giving a witness statement of the event. Interview on 12/04/25 at 11:09 A.M. with the Director of Nursing (DON) and review of the video from 11/17/25 at approximately 6:00 A.M. of Resident #55 receiving incontinence care, confirmed the presence of two male caregivers (CNA #4 and Agency RN #687), the resident refusing care and the care givers continuing to provide incontinence care by lifting a gown over the residents head, and the resident and yelling you are breaking my hand. The DON confirmed that resident care plans are to be followed and when Resident #55 told the caregivers no, they should have stopped and came back shortly after to continue providing care. Interview on 12/04/25 at 3:49 P.M. with the DON and review of Resident #55's photos provided confirmed they were dated 11/18/25 and confirmed the presence of dark areas on the back of the right hand, the back of the left hand, the right thumb, and the right forearm and confirmed the facility did not have supportive documentation showing the bruises were present during the 11/15/25 or 11/19/25 skin assessment. The facility suspected the dark area on the back of the right hand was from a lab draw performed on 11/07/25. The facility suspected the dark area on the back of the left hand was from a lab draw performed on 10/24/25. The facility suspected the dark area on the right thumb and the dark area to the right forearm were from a fall on 11/15/25. Review of facility policy, Dementia Care implemented 01/11/25 revealed care and services will be person-centered and reflect each resident's individual goals while maximizing the resident's dignity autonomy, privacy, socialization, independence, choice, and safety.This deficiency represents non-compliance investigated under Complaint Number 2676381. 365436 Page 3 of 3