Health inspection·February 29, 2024

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of the facility's Self-Reported Incident (SRI), review of the facility policy, and staff interview, the facility failed to report resident-to-resident physical abuse to the State Survey Agency, the Ohio Department of Health. This affected two (Residents #1 and #2) of four residents reviewed for abuse. The facility census was 55. Findings include: Record review for Resident #1 revealed the resident was admitted to the facility on [DATE]. Diagnoses included chronic kidney disease, dementia, depression, anxiety, and psychotic disorder. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #1 had impaired cognition. Review of Resident #1's progress notes dated 01/27/24 at 7:42 P.M. revealed Resident #1 walked past Resident #3's room and while standing in the hallway, Resident #3 struck Resident #1 in the mouth causing an abrasion to her lip. Resident #1 was assessed by the nurse and the resident's family representative was notified. Record review for Resident #3 revealed the resident was admitted to the facility on [DATE]. Diagnoses included dementia, altered mental status, and schizoaffective disorder. Review of the MDS assessment dated [DATE] revealed Resident #3 had impaired cognition. Review of Resident #3's progress notes dated 01/27/24 at 5:50 P.M. revealed Resident #3 was observed striking another resident, Resident #1, when the other resident walked by the room. Resident #3 was placed into one-to-one monitoring. On 01/27/24 at 8:25 P.M., Resident #3 was transferred to the hospital for a geriatric psychiatric evaluation. Review of the facility's Self-Reported Incident (SRI) from 01/27/24 to 01/28/24 revealed there was no SRI initiated for the resident-to-resident physical abuse between Residents #1 and #3 on 01/27/24. Interview on 02/29/23 at 2:22 P.M. with the Administrator, Director of Nursing (DON), and Corporate Administrator #500 revealed on 01/27/24, it was reported by the nurse on duty Resident #3 had struck Resident #1 in the face when she approached his door. Per the Administrator, a full investigation into the incident was completed, the residents were separated immediately, assessed for injuries, the families were notified, the physicians were notified, and the police came and made a report. The Administrator stated she could not substantiate abuse due to the cognition of both residents. The Administrator verified the facility did not submit an SRI to the State Survey Agency, Ohio Department Page 1 of 2 365595 365595 02/29/2024 Momentous Health at Franklin 421 Mission Lane Franklin, OH 45005

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few of Health per policy and regulation. The Administrator verified the incident between Resident #3 and Resident #1 was a resident-to-resident allegation of abuse that was not reported to the State Survey Agency. Review of the facility policy titled 'Abuse Prevention,' dated 08/20/21, revealed all incidents of abuse will be reported to the State agencies in a timely manner. This deficiency represents non-compliance investigated under Complaint Number OH00151084. 365595 Page 2 of 2