Health inspection·November 3, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed record review, facility policy review, and interview the facility failed to notify Resident #200's family and physician of changes in the resident's condition. This affected one resident (#200) of three residents reviewed for change in condition. Findings include: Review of Resident #200's hospital documentation dated 09/15/23 indicated the [AGE] year-old female presented with ongoing pain following a fall. The resident fell at home 09/14/23 and was evaluated in the emergency department (ER). She was diagnosed with a left superior pubic ramus fracture and possible left inferior pubic ramus fracture. The resident was neurovascularly intact, alert and oriented, and able to bear some weight but with pain. Review of Resident #200's closed medical record revealed the resident was admitted to the facility on [DATE] with diagnosis including a fracture of the superior rim of the left pubis, weakness and major depressive disorder. A plan of care, created 09/19/23 revealed Resident #200 was at risk for falls due to her history of falls prior to admission, her mental status and her general weakness. Interventions included but were not limited to, staff to report any falls to family/physician. Review of Resident #200's progress note dated 09/18/23 at 4:15 P.M., 09/19/23 at 6:24 A.M., 09/20/23 at 3:08 P.M., 09/21/23 at 3:37 A.M., 09/22/23 at 11:38 P.M., 09/23/23 at 12:50 P.M. and 09/24/23 at 6:42 A.M. noted the resident was alert and oriented (times two to three). Review of Resident #200's Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited moderate cognitive impairment and required extensive two person assist for bed mobility, dressing, toilet use, personal hygiene and bathing as well as limited two person assist for transfers. Review of Resident #200's progress note dated 09/24/23 at 2:48 P.M. revealed the resident was alert with periods of confusion. The note did not indicate if this was a change for the resident or the resident's baseline orientation. Review of Resident #200's progress note dated 09/25/23 at 6:16 A.M. revealed the resident was agitated and confused during the shift, yelling at the State Tested Nursing Assistant (STNA) to get out of her apartment and calling the police that someone put something in her drink. Record review Page 1 of 12 365655 365655 11/03/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0580 revealed no evidence the resident's physician or family were notified of this change in behavior. Level of Harm - Minimal harm or potential for actual harm Review of Resident #200's progress note dated 09/25/23 at 6:00 P.M. indicated the STNA reported the resident was sitting in front of the bathroom. No injuries were noted. No change in range of motion (ROM) to all extremities or neurological checks were identified and the supervisor was notified. Review of the progress note revealed no evidence the resident's physician or family were notified of incident. Residents Affected - Few A fall evaluation form completed by the facility on 09/25/23 revealed the resident had ROM of four quadrants without pain or limitation and the daughter was notified of the fall. Review of Resident #200's progress note dated 09/27/23 at 7:29 A.M. indicated at 4:00 A.M. the resident came out of her room and thought it was morning. The resident was re-educated, and she had returned to her room. At 5:00 A.M. the resident came out of the room and stated the STNA kicked her a**. When questioned, the resident stated it happened right at the time of the interview. The resident then lowered herself to the floor and started to crawl across the floor. Staff tried to encourage the resident to return to the wheelchair. She refused and started to roll down the hall. The Registered Nurse (RN) Supervisor was notified and able to get the resident back to her room. The resident refused the 6:45 A.M. neurological check and refused lab work. Record review revealed no evidence the resident's physician or family were notified of this change in behavior. Review of Resident #200's progress note dated 09/27/23 at 11:52 A.M. revealed the resident was sent to the hospital via the emergency technicians (EMT) per the family's request for evaluation and treatment. Review of Resident #200's progress note dated 09/27/23 at 5:00 P.M. revealed the daughter stated they were taking the resident home from the hospital and she would not return to the facility. Interview on 11/03/23 at 6:26 A.M. with Licensed Practical Nurse (LPN) #803 indicated she took care of Resident #200 on (09/27/23) the day that she was sent out. She confirmed around 4:00 A.M., the resident came out of the room and was observed putting herself on the ground from the wheelchair. LPN #803 indicated both herself, STNA #804 and STNA #805 picked the resident back up and put her in a wheelchair. LPN #803 indicated she had assessed her following this incident and the resident had no concerns with pain or injuries. LPN #803 indicated around five minutes later, the resident placed herself on the floor again and was screaming. LPN #803 stated the resident would not let the STNAs and the nurse pick her up to place her back in the wheelchair. LPN #803 indicated she called the nursing supervisor to come see the resident, but Central Supply #808 came to the floor first and picked the resident up and placed her back in the wheelchair. Interview on 11/03/23 at 6:36 A.M. with STNA #805 indicated (on 09/27/23) Resident #200 threw herself on the floor and herself as well as LPN #803 and STNA #804 picked the resident up and placed her in the wheelchair. STNA #805 indicated five minutes later the resident was on the floor again and would not let the staff pick her up so Central Supply #808 came on the floor and picked her up and put her back in the wheelchair. Interview on 11/03/23 at 7:45 A.M. with the Administrator confirmed Resident #200 had a change in mental status/falls and the physician or family were not notified timely of these changes/incidents. Review of the Change in a Resident's Condition or Status policy revised 08/2008 indicated the 365655 Page 2 of 12 365655 11/03/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0580 Level of Harm - Minimal harm or potential for actual harm facility shall promptly notify the resident, his or her attending physician, and the resident representative of changes in the resident's medical/mental condition and/or status, changes in the level of care, billing/payments, resident rights etc. This deficiency represents non-compliance investigated under Complaint Number OH00147385. Residents Affected - Few 365655 Page 3 of 12 365655 11/03/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0659 Provide care by qualified persons according to each resident's written plan of care. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed record review, job qualification review, and interview the facility failed to ensure Resident #200 was transferred by an employee who was qualified to do so following a fall. This affected one resident (#200) of three residents reviewed for falls. Residents Affected - Few Findings include: Review of Resident #200's closed medical record revealed the resident was admitted on [DATE] and discharged to the hospital on [DATE]. Resident #200 had diagnoses including a fracture of the superior rim of the left pubis, weakness and major depressive disorder. Review of Resident #200's Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited moderate cognitive impairment and required extensive two person assist for bed mobility, dressing, toilet use, personal hygiene and bathing as well as limited two person assist for transfers. Review of Resident #200's progress note dated 09/27/23 at 7:29 A.M. indicated at 4:00 A.M. the resident came out of her room and thought it was morning. The resident was re-educated, and she had returned to her room. At 5:00 A.M. the resident came out of the room and stated the State Tested Nursing Assistant (STNA) kicked her a**. When questioned, the resident stated it happened right at the time of the interview. The resident then lowered herself to the floor and started to crawl across the floor. Staff tried to encourage the resident to return to the wheelchair. She refused and started to roll down the hall. The Registered Nurse (RN) Supervisor was notified and able to get the resident back to her room. The resident refused the 6:45 A.M. neurological check and refused lab work. Review of Resident #200's progress note dated 09/27/23 at 11:52 A.M. revealed the resident was sent to the hospital via the emergency technicians (EMT) per the family's request for evaluation and treatment. Interview on 11/03/23 at 6:26 A.M. with Licensed Practical Nurse (LPN) #803 indicated she took care of Resident #200 on (09/27/23) the day that she was sent out. She confirmed around 4:00 A.M., the resident came out of the room and was observed putting herself on the ground from the wheelchair. LPN #803 indicated both herself, STNA #804 and STNA #805 picked the resident back up and put her in a wheelchair. LPN #803 indicated she had assessed her following this incident and the resident had no concerns with pain or injuries. LPN #803 indicated around five minutes later, the resident placed herself on the floor again and was screaming. LPN #803 stated the resident would not let the STNAs and the nurse pick her up to place her back in the wheelchair. LPN #803 indicated she called the nursing supervisor to come see the resident, but Central Supply #808 came to the floor first and picked the resident up and placed her back in the wheelchair. Interview on 11/03/23 at 6:30 A.M. with STNA #804 indicated on 09/27/23 Resident #200 had come out of her room in her wheelchair and stated that STNA #805 had beat her up. She indicated the resident then placed herself on the floor and was yelling. STNA #804 confirmed Central Supply #808 put Resident #200 back in the chair the second time the resident was on the floor and the nursing supervisor came up and assessed the resident. Interview on 11/03/23 at 6:36 A.M. with STNA #805 indicated on 09/27/23 Resident #200 threw herself 365655 Page 4 of 12 365655 11/03/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0659 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few on the floor and herself as well as LPN #803 and STNA #804 picked the resident up and placed her in the wheelchair. STNA #805 indicated five minutes later the resident was on the floor again and would not let the staff pick her up so Central Supply #808 came on the floor and picked her up and put her back in the wheelchair. Interview on 11/03/23 at 7:09 A.M. with Central Supply #808 indicated he went upstairs to deliver linens and observed Resident #200 on the floor screaming. He stated at that point, he observed the nursing staff standing near the resident and the resident on the floor. He stated he went over and picked the resident up and placed her in the wheelchair. Interview on 11/03/23 at 7:45 A.M. with the Administrator indicated confirmed Central Supply #808 was not trained to transfer residents from the floor to the wheelchair. Review of the Central Supply Minimum Qualifications form dated 12/22/94 indicated the position included locations and work areas in which an incumbent in this position was expected to work in the inventory service area and throughout the facility. Essential functions of the job include maintaining the inventory levels by stocking shelves, organizing supplies, purchasing and maintaining vendor relationship, recommend and follow budget, maintain records of purchase, passing out medical, personal, general and incontinent supplies, unloading supplies deliveries and maintaining security on the locked cabinet. This deficiency represents non-compliance investigated under Complaint Number OH00147385. 365655 Page 5 of 12 365655 11/03/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed record review, hospital record review, facility policy review and interview the facility failed to implement comprehensive and individualized fall/safety interventions to prevent falls including a fall with injury for Resident #200. Actual Harm occurred on 09/27/23 when Resident #200, who had moderate cognitive impairment and required extensive two-person assistance for bed mobility and transfers was transferred to the emergency room per family request due to changes in condition. Record review revealed the resident sustained three falls between 09/25/23 and 09/27/23 without evidence of adequate interventions being in place at the time of the falls. Following a second fall on 09/27/23, the resident was picked up off the floor by Central Supply #808, an employee who was not qualified/trained to provide direct resident care. The resident was subsequently diagnosed with non-displaced left rib fractures and re-injury of a previous pelvic fracture. This affected one resident (#200) of three residents reviewed for falls. Findings include: Review of Resident #200's closed medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including a fracture of the superior rim of the left pubis, weakness and major depressive disorder. Hospital documentation dated 09/15/23 (prior to admission) revealed the resident had presented to the hospital with pain following a fall at home on [DATE]. The resident was diagnosed with a left superior pubic ramus fracture and possible left inferior pubic ramus fracture. Review of Resident #200's hospital admission orders dated 09/18/23 indicated she had a primary diagnosis of left pelvic fracture with a secondary diagnosis of falls. A fall risk assessment, dated 09/18/23 revealed the resident was at high risk for falls. A plan of care, created 09/19/23 revealed Resident #200 was at risk for falls due to her history of falls prior to admission, her mental status and her general weakness. The goal developed was for the resident to remain free from significant injury due to her risk of falls. Interventions included the resident needed assistance with transfers, does reposition in wheelchair and does try to ambulate without assistance; staff to report any falls to family/physician and fall interventions, which may include vital signs, neurological exams, medication reviews, lab work, x-rays and any intervention that may be ordered by the physician. Review of Resident #200's Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited moderate cognitive impairment and required extensive two person assist for bed mobility, dressing, toilet use, personal hygiene and bathing as well as limited two person assist for transfers. Review of Resident #200's progress note dated 09/25/23 at 6:00 P.M. indicated the STNA reported the resident was sitting in front of the bathroom. The note indicated no injuries were noted. The resident had no change in range of motion (ROM) to extremities, neurological checks were initiated and the supervisor was notified. In addition, record review revealed no evidence comprehensive or 365655 Page 6 of 12 365655 11/03/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0689 individualized fall/safety interventions were initiated following this incident. Following the fall, the resident was encouraged to call for (staff) assistance. Level of Harm - Actual harm Residents Affected - Few Review of Resident #200's progress note dated 09/26/23 at 9:15 A.M. indicated the resident was extremely confused, stated she had $25.00 under her breakfast tray for her groceries. The son indicated the resident did not have money. Review of Resident #200's progress note dated 09/26/23 at 2:26 P.M. indicated the resident was confused and forgetful and propelled herself in the wheelchair without difficulty. Review of Resident #200's progress note dated 09/26/23 at 4:15 P.M. indicated the police officer came to the facility due to the resident calling them and she had reported that her children were stealing her clothing and her belongings. The staff were unable to redirect the resident and the supervisor was aware. Review of Resident #200's progress note dated 09/26/23 at 5:02 P.M. indicated the resident called the police and stated her children were taking her belongings and selling them. The resident was confused to the month but was aware of the year and that she was at the nursing facility. Record review revealed no evidence of new fall/safety interventions being initiated following the changes in behavior/increased confusion exhibited by the resident on 09/26/23. Review of Resident #200's progress note dated 09/27/23 at 7:29 A.M. indicated at 4:00 A.M. the resident came out of her room and thought it was morning. The resident was re-educated, and she had returned to her room. At 5:00 A.M. the resident came out of the room and stated the STNA kicked her a**. When questioned, the resident stated it happened right at the time of the interview. The resident then lowered herself to the floor and started to crawl across the floor. Staff tried to encourage the resident to return to the wheelchair. She refused and started to roll down the hall. The Registered Nurse (RN) Supervisor was notified and able to get the resident back to her room. The resident refused the 6:45 A.M. neurological check and refused lab work. Record review revealed no evidence this incident was investigated or evidence interventions were initiated to prevent additional falls/promote resident safety. Review of Resident #200's progress note dated 09/27/23 at 11:52 A.M. revealed the resident was sent to the hospital via the emergency technicians (EMT) per the family's request for evaluation and treatment (due to the resident not acting herself). The resident did not return to the facility after being transferred to the emergency room. Review of Resident #200's hospital documentation dated 09/27/23 indicated the resident arrived to the emergency room on [DATE] at 12:30 P.M. and was evaluated in the trauma bay by the physician. The resident was able to move all of her extremities but had decreased range of motion in the bilateral lower extremities secondary to pain. X-ray of the chest did show possibility of rib fractures as well as a re-injury of her known pelvic fracture. Dedicated rib x-rays were obtained which showed evidence of non-displaced left rib fractures. Review of the hospital radiology report (one view chest x-ray), dated 09/27/23 at 12:38 P.M. indicated a slight cortical step-off of the left lateral 6th through 8th ribs. The impression included findings were suspicious for a nondisplaced left lateral 6th through 8th ribs and consider a rib series for further evaluation. 365655 Page 7 of 12 365655 11/03/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0689 Level of Harm - Actual harm Residents Affected - Few Review of the hospital radiology report (two view rib x-ray), dated 09/27/23 at 2:15 P.M. indicated the resident had a slight cortical step-off of the left lateral second rib. Subtle cortical irregularity of the left lateral 4th and 5th ribs may be overlap of adjacent ribs on the x-ray. Previously described left lateral 6th through 8th rib step-off was not appreciated on this exam. The impression was a nondisplaced left lateral second rib fracture and questionable left 4th and 5th rib fractures versus artifacts. Interview on 11/03/23 at 6:26 A.M. with Licensed Practical Nurse (LPN) #803 indicated she took care of Resident #200 on (09/27/23) the day that she was sent out. She confirmed around 4:00 A.M., the resident came out of the room and was observed putting herself on the ground from the wheelchair. LPN #803 indicated both herself, STNA #804 and STNA #805 picked the resident back up and put her in a wheelchair. LPN #803 indicated she had assessed her following this incident and indicated the resident had no concerns with pain or injuries. LPN #803 indicated around five minutes later, the resident placed herself on the floor again and was screaming (this incident was not documented in the medical record progress note). LPN #803 stated the resident would not allow the STNAs and the nurse to pick her up to place her back in the wheelchair following the second fall. LPN #803 indicated she called the nursing supervisor to come see the resident, but Central Supply #808 came to the floor first and picked the resident up and placed her back in the wheelchair. Interview on 11/03/23 at 6:30 A.M. with STNA #804 indicated Resident #200 had come out of her room (on 09/27/23) in her wheelchair and stated STNA #805 had beat her up. She indicated the resident then placed herself on the floor and was yelling. STNA #804 confirmed Central Supply #808 put Resident #200 back in the chair the second time the resident was on the floor (on this date). Interview on 11/03/23 at 6:36 A.M. with STNA #805 indicated on 09/27/23 Resident #200 threw herself on the floor and LPN #803, STNA #804 and STNA #805 picked the resident up and placed her in the wheelchair. STNA #805 indicated five minutes later the resident was on the floor again and would not let the nursing staff pick her up so Central Supply #808 came and picked her up and put her back in the wheelchair. Interview on 11/03/23 at 7:09 A.M. with Central Supply #808 indicated he went upstairs to deliver linens and observed Resident #200 on the floor screaming. He stated at that point, he observed the nursing staff standing near the resident and the resident on the floor. He stated he went over and picked the resident up and placed her in the wheelchair. When questioned, he stated he picked up Resident #200 from the floor under both arms and placed her in her wheelchair. Interview on 11/03/23 at 7:17 A.M. with LPN Unit Manager (UM) #810 indicated she was called to the second floor because Resident #200 was crawling around on the floor. She indicated when she got to the unit, Resident #200 was already in her wheelchair, and she took the resident back to her room and completed neurological checks on the resident. She stated she did not observe any injuries. LPN UM #810 indicated later in the day, Resident #200's daughter wanted to take the resident home and requested the resident go to the emergency room for treatment. LPN UM #810 confirmed the resident did not return to the facility after being transferred to the hospital. Interview on 11/03/23 at 7:45 A.M. with the Administrator indicated Resident #200's son came to the facility and wanted to know about the fall as well as the rib fracture that was sustained following the fall on 09/27/23 per the hospital documentation. The Administrator indicated the resident had a history of falls and he felt it was an old rib fracture. 365655 Page 8 of 12 365655 11/03/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0689 Level of Harm - Actual harm Residents Affected - Few Interview on 11/03/23 at 9:25 A.M. with the Administrator confirmed the facility did not identify the gradual change in Resident #200's mental status (following admission) and the facility did not have a fall investigation for resident falls that occurred after her admission on [DATE]. The Administrator verified the lack of evidence of new fall/safety interventions being initiated for the resident and also indicated he was not aware Central Supply #808 had picked the resident up off the floor when she sustained the second fall on 09/27/23. Review of the Fall Clinical Protocol policy revised 08/2008 indicated the staff and physician would continue to collect and evaluate information until either the cause of the fall was identified, or it was determined that the cause could not be found or that finding a cause would not change the outcome or the management of falling and fall risk. This deficiency represents non-compliance investigated under Complaint Number OH00147385. 365655 Page 9 of 12 365655 11/03/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident must receive and the facility must provide necessary behavioral health care and services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed record review, hospital record review, and interview the facility failed to identify and provide the necessary behavioral health care and services to Resident #200 related to a substance abuse disorder to assist the resident to attain or maintain her highest practicable physical, mental and psychosocial well-being following admission for rehabilitation/treatment of a fall with fracture. This affected one resident (#200) of three residents reviewed for safety/falls. Findings include: Review of Resident #200's hospital documentation dated 09/15/23 indicated the [AGE] year-old female presented with ongoing pain following a fall. The resident fell at home 09/14/23 and was evaluated in the emergency department (ER). She was diagnosed with a left superior pubic ramus fracture and possible left inferior pubic ramus fracture. She had a dog at home, and she did not want to leave the dog alone, so she had insisted on going home with pain medication and a walker. She returned with pain that she was unable to manage. She had now arranged for somebody to take care of her dog and would like placement in a facility to recover from her injury. The pain was in her left groin and was rated an 8 out of 10 (on a scale of one to 10). She was neurovascularly intact, alert and oriented, and able to bear some weight but with pain. The resident's social history included beer daily with an average of one drink per day and marijuana daily. Review of Resident #200's hospital documentation dated 09/18/23 revealed the resident had pubic rami fractures and had a plan for (nursing home) placement. Today she indicated she was a heavy drinker and given a dose of the anti-anxiety medication, Ativan (anti-anxiety) prior to the assessment. No signs of withdrawal were noted and the note indicated would continue to monitor. Review of Resident #200's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including a fracture of the superior rim of the left pubis, weakness and major depressive disorder. Review of Resident #200's medical record did not reveal orders for alcohol withdrawal monitoring or treatment. There was no reference to the resident receiving Ativan at the hospital in relation to the resident indicating she was a heavy drinker. Review of the resident's baseline/acute plan of care revealed no care plan had been developed for the resident's substance abuse disorder or major depressive disorder. Review of Resident #200's progress note dated 09/18/23 at 4:15 P.M. indicated the resident arrived at the facility alert and oriented times two. Review of Resident #200's progress note dated 09/19/23 at 6:24 A.M. indicated the resident was alert and oriented times two. Review of Resident #200's progress note dated 09/20/23 at 3:08 P.M. indicated the resident was alert and oriented times two. Review of Resident #200's progress note dated 09/21/23 at 3:37 A.M. revealed the resident was alert 365655 Page 10 of 12 365655 11/03/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0740 and oriented. Level of Harm - Minimal harm or potential for actual harm Review of Resident #200's progress note dated 09/22/23 at 11:38 P.M. revealed the resident was alert and oriented. Residents Affected - Few Review of Resident #200's progress note dated 09/23/23 at 12:50 P.M. revealed the resident was alert and oriented times three. Review of Resident #200's Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited moderate cognitive impairment and required extensive two person assist for bed mobility, dressing, toilet use, personal hygiene and bathing as well as limited two person assist for transfers. Review of Resident #200's progress note dated 09/24/23 at 6:42 A.M. revealed the resident was alert and oriented. Review of Resident #200's progress note dated 09/24/23 at 2:48 P.M. revealed the resident was alert with periods of confusion. Review of Resident #200's progress note dated 09/25/23 at 6:16 A.M. revealed the resident was agitated and confused during the shift, yelling at the State Tested Nursing Assistant (STNA) to get out of her apartment and calling the police that someone put something in her drink. Review of Resident #200's progress note dated 09/25/23 at 6:00 P.M. indicated the STNA reported the resident was sitting in front of the bathroom. Review of Resident #200's progress note dated 09/26/23 at 9:15 A.M. indicated the resident was extremely confused, stated she had $25.00 under her breakfast tray for her groceries. The son indicated the resident did not have money. Review of Resident #200's progress note dated 09/26/23 at 2:26 P.M. indicated the resident was confused and forgetful and propelled herself in the wheelchair without difficulty. Review of Resident #200's progress note dated 09/26/23 at 4:15 P.M. indicated the police officer came to the facility due to the resident calling them and she had reported that her children were stealing her clothing and her belongings. The staff were unable to redirect the resident and the supervisor was aware. Review of Resident #200's progress note dated 09/26/23 at 5:02 P.M. indicated the resident called the police and stated her children were taking her belongings and selling them. The resident was confused to the month but was aware of the year and that she was at the nursing facility. Review of Resident #200's progress note dated 09/27/23 at 7:29 A.M. indicated at 4:00 A.M. the resident came out of her room and thought it was morning. The resident was re-educated, and she had returned to her room. At 5:00 A.M. the resident came out of the room and stated the STNA kicked her a**. When questioned, the resident stated it happened right at the time of the interview. The resident then lowered herself to the floor and started to crawl across the floor. Staff tried to encourage the resident to return to the wheelchair. She refused and started to roll down the hall. The Registered Nurse (RN) Supervisor was notified and able to get the resident back to her room. The resident 365655 Page 11 of 12 365655 11/03/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0740 refused the 6:45 A.M. neurological check and refused lab work. Level of Harm - Minimal harm or potential for actual harm Review of Resident #200's progress note dated 09/27/23 at 11:52 A.M. revealed the resident was sent to the hospital via the emergency technicians (EMT) per the family's request for evaluation and treatment (due to the resident not acting herself). Residents Affected - Few Interview on 11/03/23 at 6:26 A.M. with Licensed Practical Nurse (LPN) #803 indicated she took care of Resident #200 on (09/27/23) the day that she was sent out. She confirmed around 4:00 A.M., the resident came out of the room and was observed putting herself on the ground from the wheelchair. LPN #803 indicated around five minutes later, the resident placed herself on the floor again and was screaming. LPN #803 stated the resident would not allow the STNAs and the nurse to pick her up to place her back in the wheelchair following the second fall. LPN #803 indicated she called the nursing supervisor to come see the resident, but Central Supply #808 came to the floor first and picked the resident up and placed her back in the wheelchair. Interview on 11/03/23 at 6:30 A.M. with STNA #804 indicated Resident #200 had come out of her room (on 09/27/23) in her wheelchair and stated that STNA #805 had beat her up. She indicated the resident then placed herself on the floor and was yelling. Interview on 11/03/23 at 6:36 A.M. with STNA #805 indicated on 09/27/23 Resident #200 threw herself on the floor the first time and LPN #803, STNA #804 and STNA #805 picked the resident up and placed her in the wheelchair. STNA #805 indicated five minutes later the resident was on the floor again and would not let the nursing staff pick her up so Central Supply #808 came on the floor and picked her up and put her back in the wheelchair. Interview on 11/03/23 at 7:17 A.M. with LPN Unit Manager (UM) #810 indicated she was called to the second floor because Resident #200 was crawling around on the floor. She indicated when she got to the unit, Resident #200 was already in her wheelchair. Interview on 11/03/23 at 9:25 A.M. with the Administrator confirmed the facility did not identify the gradual change in Resident #200's mental status (following admission). There was no evidence the facility identified and implemented a comprehensive and individualized plan to address the resident's substance abuse disorder prior to admission to ensure the resident attained/maintained her highest physical, mental and psychosocial well-being. This deficiency is an incidental finding to Complaint Number OH00147385. 365655 Page 12 of 12