Inspection·April 11, 2024

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, resident interview, police interview, review of Resident Council meeting minutes, and review of policies, the facility failed to ensure residents were treated in a dignified manner. This affected one (#61) of three residents reviewed resident rights. The facility census was 76. Findings include: Review of the medical record for Resident #61 revealed an admission date of 02/05/24, diagnoses included major depressive disorder, post-traumatic stress disorder, erectile dysfunction, paraplegia, type II diabetes mellitus, chronic kidney disease, and autonomic dysreflexia. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #61 had moderate cognitive impairment, required moderate assistance for toilet hygiene, showering, dressing and personal hygiene and maximal assistance for transfers. Resident #61 planned to return home upon discharge. A Medicare 5-day MDS assessment dated [DATE] revealed Resident #61 was independent with self-care, mobility, and functional abilities. Interview on 04/10/24 at 10:10 A.M., with Resident #61 revealed concerns related to treatment by a nurse, Licensed Practical Nurse (LPN) #98. Resident #61 stated the nurse disrespected him and verbally assaulted him, using curse words and yelling on 04/06/24 during a verbal altercation. Interview on 04/10/24 at 11:00 A.M., with the Administrator revealed a call was received from LPN #98 on Saturday, 04/06/24, regarding the police being called due Resident #61 becoming verbally and physically aggressive toward LPN #98. Upon further interview with the Administrator, it was revealed in the process of investigating what actually occurred Resident #61 was interviewed on 04/08/24 at which time LPN #98 was placed off to further review the concerns over LPN #98 using foul language directed toward Resident #61. Interview on 04/10/24 at 4:28 P.M., with LPN #98 verified there was a verbal exchange with Resident #61 on 04/06/24 sometime between 5:00 P.M. and 5:30 P.M., and when asked about yelling and cursing, LPN #98 stated I may have, but not unsure, it may have come out in anger. Interview on 04/10/24 at 5:19 P.M., with State Tested Nursing Assistant (STNA) #99 verified to being witness of part of the verbal exchange that occurred on Saturday, 04/06/24 between Resident #61 and LPN #98. STNA #99 stated the two were arguing back and forth about a schedule book Resident #61 removed from the desk at the nurses station. STNA #99 stated she had to finally ask LPN #98 to let it (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: 365453 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 365453 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ayden Healthcare of Oregon 3953 Navarre Ave Oregon, OH 43616 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)