Health inspection·December 19, 2023

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 and staff interview, the facility failed to ensure residents were treated in a respectful and dignified manner. This affected one (#51) of three residents reviewed for dignity. The facility census was 49. Finding include: Review of Resident #51's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses included chronic obstructive pulmonary disease (COPD), chronic pain, and anxiety. The resident was discharged to the hospital on [DATE]. Review of nursing progress note, written by Registered Nurse (RN) #100, dated 11/17/23 at 10:25 P.M., revealed RN #100 entered Resident #51's room, and the resident asked where the nurse had been as she had been waiting on the nurse for some time. Further review revealed RN #100 informed Resident #51 her call light had come on 15 minutes earlier, the nurse aide was on break, and the nurse was assisting someone in another room. Resident #51 continued to insist that her call light was on for over an hour. RN #100 documented in the progress note, You're wrong and I'm not going to stand here and argue with you, I have your meds (medications). Resident #51 then asked RN #100 what medications he had, and RN #100 indicated he had Resident #51's morphine (narcotic pain medication) and gabapentin (nerve pain medication). RN #100 documented Resident #51 looked in the cup, and indicated she was not taking the medication, and RN #100 stated, That's fine, but I'm not the one in pain. RN #100 then let Resident #51 know he could just as easily get rid of the medication. Interview with the Administrator on 12/19/23 at 9:33 A.M., during review of Resident #51's progress notes, confirmed RN #100 documented speaking to Resident #51 in a undignified manner on 11/17/23. The interview confirmed the facility had started providing education with all the nursing staff regarding treating residents with dignity. This deficiency represents an incidental finding discovered during investigation under Complaint Number OH00149004. 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: 365475 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 365475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Liberty Nursing Center of Mansfield 535 Lexington Avenue Mansfield, OH 44907 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)