Health inspection·May 1, 2023

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview the facility failed to ensure call lights were within resident reach. This affected one resident (Resident #76) of 32 residents observed for call light accessibility. The facility census was 148. Residents Affected - Few Findings include: Record review revealed Resident #76 was admitted to the facility on [DATE] with diagnoses including schizoaffective disorder, hypertension, type two diabetes mellitus, major depressive disorder, and chronic obstructive pulmonary disease. Observation on 04/24/23 at 10:37 A.M. revealed Resident #76's call light was coiled up and zip tied together, hanging against the wall and out of the resident's reach. Interview at the time of the observation with Resident #76 revealed she did not know how long the call light had been hanging that way. Interview on 04/24/23 at 10:40 A.M. with Licensed Practical Nurse (LPN) #556 confirmed Resident #76's call light was coiled up and zip tied hanging against the wall, out of Resident #76's reach. LPN #556 verified Resident #76 would not have access to the call light in an emergency and did not know how long it was coiled up and zip tied. This deficiency represents non-compliance investigated under Complaint Number OH00135062. Page 1 of 10 365655 365655 05/01/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm Based on self-reported incident review, medical record review, policy review and staff interview, the facility failed to ensure narcotic medications were not misappropriated by staff members. This affected three residents (Residents #68, #99 and #111) of five residents reviewed for misappropriation. The facility census was 148. Residents Affected - Few Findings include: Review of the facility Self-Reported Incident (SRI) #230289 with a created date of 12/19/22 revealed Licensed Practical Nurse (LPN) #701 alleged Registered Nurse (RN) #658 was possibly misappropriating resident narcotic medications. Further review of SRI #230289 and the facility investigation found that RN #658 misappropriated narcotic medications from Residents #68, #99 and #111. Further review of SRI #230289 revealed RN #658 was also identified in an SRI for another facility in 2017 with the allegation of misappropriation of resident narcotics. The SRI was substantiated and RN #658 was terminated from the other facility 1. Facility investigation determined RN #658 misappropriated three narcotic medications on 12/17/22 from Resident #68. Review of Resident #68's medical record including controlled drug receipt/record disposition form revealed misappropriation of narcotic medications on: a. RN #658 forged the signature of LPN #701, who was not working the resident unit at the time of administration, on Resident #68's controlled drug receipt/record/disposition form. Oxycodone (narcotic opioid analgesic medication) five milligrams (mg) was administered on 12/17/22 at 10:45 (no indication A.M. or P.M.). b. RN #658 forged the signature of LPN #604, who was not working the day of administration, on Resident #68's controlled drug receipt/record/disposition form Oxycodone five mg was administered on 12/17/22 at 4:45 (no indication of A.M. or P.M.). c. RN #658 documented on Resident #68's controlled drug receipt/record/disposition form Oxycodone five mg was administered on 12/17/22 at 10:45 (no indication of A.M. or P.M.). Medication was previously documented as administered, see example 1 a. 2. Facility investigation determined RN #658 misappropriated narcotic medication on 12/16/22 for Resident #99. Review of the Resident #99's controlled drug receipt/record/disposition form revealed a fictitious/unknown staff member signed out Oxycodone five mg for Resident #99 on 12/16/22 at 8:00 P.M. RN #658 was working Resident's #99's unit at the time of documented administration. 3. Facility investigation determined that on 12/17/22 at 3:00 P.M. and 10:00 P.M. LPN #604 administered hydrocodone/acetaminophen (narcotic opioid analgesic medication) to Resident #111. The facility determined that LPN #604 was not working at the time of documented administration and also that Resident #111 was on a leave of absence from the facility during the time of administration. RN #658 forged the signature of a different staff member, LPN #604, when administering. On 04/27/23 at 10:20 A.M. interview with the Administrator and Director of Nursing verified RN #658 365655 Page 2 of 10 365655 05/01/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0602 Level of Harm - Minimal harm or potential for actual harm was misappropriating resident narcotic medications by signing out resident narcotic medications using other staff names when the staff were not in the building, working the unit of the resident for administration, using a fictitious/unknown staff member name and documenting administration of narcotic pain medications to residents while on leave from the facility. Continued interview revealed RN #658 resigned before the facility could get her statement for the investigation. Residents Affected - Few Review of the facility policy Abuse Prevention Program with a revision date of 02/07/17 indicated this facility desires to prevent abuse, neglect, exploitation, mistreatment and misappropriation of resident property by establishing a resident sensitive and resident secure environment. 365655 Page 3 of 10 365655 05/01/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review and interview the facility failed to ensure residents received the assistance needed for activities of daily living (ADLs). This affected two residents (Resident #89 and #143) of three residents reviewed for ADLs. The census was 148. Residents Affected - Few Findings Include: 1. Review of the medical record for Resident #89 revealed an admission date of 09/14/22. Diagnoses included the need for assistance with personal care, vitreous hemorrhage (blood in the space between the eye's lens and retina), bilateral cataracts, bipolar disorder, anxiety disorder, major depressive disorder, and diabetes with neuropathy. Review of the quarterly Minimum Data Set (MDS) assessment, dated 01/31/23, revealed the resident had moderately intact cognition, severely impaired vision, and minimally impaired hearing. Behaviors included delusions and verbal behavioral symptoms directed at others. The resident required the extensive assistance of two staff for transfers. The resident was totally dependent for locomotion, dressing, and personal hygiene. The extensive assistance of one staff was needed for eating and toilet use. Bathing did not occur. Interview on 04/24/23 at 12:07 P.M. with Resident #89 revealed he was blind, very hard of hearing, couldn't walk, and had such bad neuropathy in his hands he couldn't feel anything. The resident stated he hadn't had a shower, or had his hair washed in seven weeks. Review of the point of Care History from 03/01/23 through 04/30/23 revealed no record of the resident receiving a shower or bath. Review of the Bath/Shower sheets for March and April 2023 for Resident #89 revealed in March there were two days where the state tested nursing assistant (STNA) and nurse had signed. In April the was one refusal and two days with only a nurse signature and treatment in place was noted. It was not clear if Resident #89 was bathed or showered those days. Interview on 05/01/23 at 1:22 P.M. with Registered Nurse (RN) #518 verified showers had not occurred as scheduled for Resident #89 after reviewing the Bath/Shower sheets and the point of care history. 2. Review of the medical record for Resident #143 revealed an admission date of 10/04/22. Diagnoses included cerebral infarction, polyarthritis, and the need for assistance with personal care. Review of the quarterly Minimum Data Set (MDS) assessment, dated 04/06/23, revealed the resident had moderately impaired cognition. Interview and observation on 04/24/23 at 11:38 A.M. with Resident #143 revealed the resident's fingernails were long on both hands. The fingernails on the left hand were thick, long and dark colored. The resident stated he had tried to cut them with his toenail cutter but could not get through them. Interview on 04/26/23 at 10:03 A.M. with LPN #615 verified Resident #143's fingernails on his left hand were thick and long and the fingernails on his right hand needed to be soaked and cut. 365655 Page 4 of 10 365655 05/01/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0677 Level of Harm - Minimal harm or potential for actual harm Review of the Care of Fingernails/Toenails policy and procedure dated 04/07 revealed nail care included daily cleaning and regular trimming. Stop and report to the nurse supervisor if there is evidence of ingrown nails, infections, pain, or if nails are too hard or too thick to cut with ease. This deficiency represents non-compliance investigated under Complaint Number OH00135062. Residents Affected - Few 365655 Page 5 of 10 365655 05/01/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, staff interview and policy review, the facility failed to monitor resident weights as ordered by the physician. This affected one (Resident #138) of three residents reviewed for weight loss. The facility census was 148. Residents Affected - Few Findings include: Review of Resident #138's medical record revealed an admission date of 11/12/22 with diagnoses that included Alzheimer's disease with dementia, hypothyroidism and hypertension. Review of the physician's orders dated 11/12/22 revealed to obtain weekly weights for four weeks then monthly. Review of Resident #138's weight records revealed weights were obtained on 11/12/22 and then on 12/02/22. There was no evidence of any additional weights obtained between 11/12/22 and 12/02/22. On 04/27/23 at 11:35 A.M. interview with the Director of Nursing verified weights were not obtained per physician's orders following admission. Review of the facility policy Weight Assessment and Intervention with a revision date of 08/2008 indicated nursing staff will measure resident weight on admission and weekly for three weeks thereafter. If no weight concerns are noted at this point, weight will be measured monthly thereafter. This deficiency represents non-compliance investigated under Complaint Number OH00135062. 365655 Page 6 of 10 365655 05/01/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0728 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training. Based on review of personnel files, review of schedules and interview, the facility failed to ensure employees who completed a Nurse Aide Training and Competency Evaluation program successfully completed state testing within the appropriate time frames. This had the potential to affect all 148 residents residing in the facility. Findings include: On 04/25/23 at 10:25 A.M., review of personnel files with Human Resources (HR) Director #520 verified Helping Hand #528 completed a nurse aide training course on 10/26/22. HR #520 stated Helping Hand #528 had taken part of the state test but had not successfully completed both portions of the two part test. HR Director #520 indicated Helping Hand #528 remained on the schedule as a nursing assistant. On 04/25/23 at 2:13 P.M., HR Director #520 provided the name of a second aide, Helping Hand #541 who completed her nurse aide training classes on 11/22/22 but broke her wrist and was off work from January 2023 to 03/22/23 and was still working as an aide. Review of schedules from 03/25/23 to 04/25/23 revealed the following: Helping Hand #528 worked as a nursing assistant on 03/26/23, 03/28/23, 03/29/23, 03/31/23, 04/03/23, 04/04/23, 04/05/23, 04/06/23, 04/07/23, 04/08/23, 04/11/23, 04/12/23, 04/14/23, 04/17/23, 04/20/23, 04/21/23, 04/22/23, 04/23/23 and 04/24/23. , Helping Hand #541 worked as a nursing assistant on 03/27/23, 03/28/23, 03/30/23, 04/01/23, 04/02/23, 04/06/23, 04/07/23, 04/10/23, 04/11/23, 04/13/23, 04/15/23, 04/17/23, 04/19/23, 04/21/23, and 04/24/23. On 05/01/23 at 12:55 P.M., Registered Nurse (RN) #508 stated when aides had worked four months after their certificate for nurse aide training programs were completed, she relied on HR Director #520 or Scheduler #509 to inform her the employee could no longer work as a nurse aide pending successful completion of the state testing. RN #508 indicated Helping Hands #528 and #541 would have worked as nursing assistants if their names were listed beside a section on the schedule. This deficiency represents non-compliance investigated under Complaint Number OH00135062. 365655 Page 7 of 10 365655 05/01/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and staff interview the facility failed to ensure the kitchen was maintained in a clean and sanitary condition. This had the potential to affect the 147 residents receiving food from the facility. The facility identified Resident #55 as receiving no food by mouth. The facility census was 148. Findings include: Observation of the kitchen during the initial tour on 04/24 23 starting at 9:41 A.M. with Dietary Manager (DM) #519 revealed the following concerns: • The tiled floors were discolored with ground in dirt and wax, giving a darkened appearance. The grout between the tiles was also darkened and needing cleaned. • The microwave was dirty with food spills inside • The dish-machine needed to be wiped down. There were crumbs and dust on top with detergent spills down the sides. • The spice table had dried spills down the side. • The stove top was dusty/dirty, and the knobs of the stove were sticky to touch. • The ice machine had a pink gritty substance on the inside of the lid. • There was a large container of cereal not labeled or dated in dry storage and a bag of frozen omelets not labeled and dated in the freezer. 365655 Page 8 of 10 365655 05/01/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0812 • Level of Harm - Minimal harm or potential for actual harm There were three sour cream containers and crates of individual chocolate milk cartons that were outdated. DM #519 verified the above findings at the time of observation. Residents Affected - Many 365655 Page 9 of 10 365655 05/01/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation and staff interview the facility failed to ensure the dumpster area was maintained in a clean and sanitary condition. This had the potential to affect all residents. The facility census was 148. Residents Affected - Many Findings include: Observation of the facility's dumpster area on 04/24 23 at 9:41 A.M. with Dietary Manager (DM) #519 revealed the following concerns: a. Three of six dumpster lids were not closed. b. There was a large bag of trash outside the dumpsters with miscellaneous gloves, papers, and other trash on the ground. DM #519 verified the above findings at the time of observation. 365655 Page 10 of 10