Health inspection·April 8, 2025

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 interviews, medical record review, and policy review, the facility failed to report an allegation of abuse as required. This affected one (Resident #63) of of six residents reviewed for abuse. The facility census was 143. Findings Include: Medical record review revealed Resident #63 was admitted to the facility on [DATE] with diagnoses including schizoaffective disorder, bipolar disorder, anxiety, depression, and chronic obstructive pulmonary disease. Review of the admission comprehensive Minimum Data Set (MDS) assessment, dated 01/24/25, revealed Resident #63 was cognitively intact, had delusions, verbal outbursts directed towards others, and wandered. Review of a nurse note dated 03/10/25 timed 6:45 A.M. revealed Resident #63 was verbally abusive, intrusive and arguing with staff and residents. Further review of the nurses notes from February 2025 to current revealed no information related to Resident #63 making an allegation of nursing staff twisting her arm. Interview on 04/03/25 at 9:05 A.M. with the Director of Nursing (DON), Regional Registered Nurse (RRN) #601, and the Administrator revealed an allegation was made recently (unable to provide exact date) that staff had twisted the arm of Resident #63 behind her back. Resident #63's statement kept changing about what happened and staff would not provide statements when requested because they did not believe anything had happened. The facility did not report the allegation of abuse made by Resident #63 to the State agency. Interview with the Administrator on 04/03/25 at 12:45 P.M. revealed they did no report the allegation made by Resident #63 because the resident retracted her allegation 10 minutes after making it. However, they did investigate the situation and made a soft file. Resident #63 had a habit of making false allegations. Review of a Root Cause Analysis/soft file investigation dated 03/31/25 revealed Resident #63 initially claimed two aides were taking her to her room and once they were in her room they twisted her arm behind her back. During a second interview, Resident #63 stated Certified Nurse Aide (CNA) #406 threw her walker in the hall then twisted her right arm back refracturing her arm and then walked her down to her room. The incident was reported to staff on 03/31/25 but Resident #63 said it happened (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: 365608 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 365608 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aristocrat Berea Healthcare and Rehabilitation 255 Front Street Berea, OH 44017 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)