Health inspection·August 11, 2023

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on facility self-reported incident review, record review, policy review, resident interview and staff interview the facility failed to ensure Resident #1 was free from staff to resident verbal abuse. This affected one resident (#1) of three residents reviewed for abuse. The facility census was 150. Findings include: Review of facility self-reported incident (SRI) #237331 revealed on 07/21/23 a verbal altercation occurred between Resident #1 and Licensed Practical Nurse (LPN) #205. The incident was immediately reported to the shift supervisor who notified the facility Administrator and Director of Nursing (DON). The incident was reported to Ohio Department of Health on 07/21/23. Further review of the facility SRI and facility investigation revealed a statement from Resident #1 was obtained on 07/24/23 which indicated LPN #205 entered her room with medications, inhaler, and cup of water. Resident #1 indicated LPN #205 brought very little water, and Resident #1 told LPN #205 with an attitude she needed additional water. LPN #205 gave the resident attitude back. Resident #1 yelled at LPN #205 to leave her room, but LPN #205 would not leave. Resident #1 stated she got up out of bed and she pushed LPN #205. Resident #1 indicated staff members entered the room to check on the incident. LPN #205 refused to provide any additional details in her statement at this time. Review of State Tested Nurse Aide (STNA) #211's witness statement obtained on 07/21/23 indicated she was at the unit nurse's station when she heard Resident #1 screaming at the top of her lungs. STNA #211 indicated when she arrived at the room, LPN #205 and Resident #1 were arguing back and forth about water. She further indicated they called each other [expletive], fat [expletive], and kept going. She indicated LPN #205 did not walk away, she stayed and argued with Resident #1. She further indicated that LPN #205 told Resident #1 she belonged on the Taft unit (secured behavior unit). Review of STNA #219's witness statement obtained on 07/21/23 indicated she was at the unit nurse's station when she heard Resident #1 screaming. STNA #219 indicated Resident #1 and LPN #205 were going back and forth, Resident #1 called LPN #205 a fat [expletive]. STNA #219 and STNA #211 got in between Resident #1 and LPN #205. Resident #1 got out of her bed and attacked LPN #205. LPN #205 stood there and told Resident #1 your [expletive] hits don't hurt and that [expletive] needs to be on Taft (secured behavior unit). Page 1 of 3 365655 365655 08/11/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of LPN #205's undated witness statement indicated she entered Resident #1's rooms with her medications and inhaler. Resident #1 said something she couldn't hear and asked her what she said. Resident #1 then screamed at her she needed more water. LPN #205 indicated she told Resident #1 she didn't need to scream at her. Resident #1 then threw the water on LPN #205 and called her a fat [expletive]. LPN #205 asked Resident #1 if she was going to take her medications and Resident #1 threw her medications on the floor, jumped out of her bed, and started to attack LPN #205. LPN #205 indicated Resident #1 was punching and grabbing her. Resident #1 grabbed her arm and twisted it behind her telling her I'm going to break this mother [expletive]. Resident #1 called LPN #205 a fat [expletive] and continued to hit her. STNAs #211 and #219 entered the room at some point, but she was unsure of when. LPN #205 indicated she did not call Resident #1 any names until she started hitting her. Review of Resident #1's medical record revealed an admission date of 02/13/14 with diagnoses including schizoaffective disorder, anxiety disorder, and major depression. Further review of Resident #1's medical record including the Minimum Data Set (MDS) 3.0 annual assessment dated [DATE] revealed an independent cognition level. Interview with Resident #1 on 08/11/23 at 11:08 A.M. revealed a few weeks ago she had a verbal altercation with a nurse during evening medication pass. She didn't bring in enough water and she yelled at the nurse, the nurse wouldn't leave, so she jumped out of bed and pushed her. They called each other names back and forth until the STNAs broke it up. Interview with the facility Administrator on 08/11/23 at 10:45 A.M. verified a verbal abuse incident between Resident #1 and LPN #205. Review of the facility policy titled Abuse Prevention Program, dated 02/2017, revealed the facility affirms the right of our residents to be free from abuse, neglect, exploitation, misappropriation of property, or mistreatment. This facility therefore prohibits abuse, neglect, exploitation, misappropriation of property, and mistreatment of the residents. The deficient practice was corrected on 08/02/23 when the facility implemented the following corrective actions: • LPN #205 was suspended on 07/21/23 and terminated on 07/25/23. • Staff witness statements were obtained on 07/21/23. • An SRI was created on 07/21/23. • An SRI investigation was completed on 07/28/23. 365655 Page 2 of 3 365655 08/11/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0600 • Level of Harm - Minimal harm or potential for actual harm Resident #1 was provided with counseling services. • Residents Affected - Few Resident #1's psychologist and psychiatrist were made aware of the incident. • All staff abuse prevention education was completed by 07/26/23. • All current residents in the facility were interviewed for abuse/mistreatment by 08/02/23. • On-going audits and monitoring were completed for abuse/mistreatment. This deficiency represents non-compliance investigated under Complaint Number OH00145146. 365655 Page 3 of 3