Health inspection·October 23, 2023

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. Based on observation, staff interviews, resident interviews, agency staff interview, Community Member interview and review of policy, the facility failed to report an allegation of abuse to the state agency. This affected one (#63) of three residents reviewed for potential abuse. The facility census was 34. Findings include: Observation of the main entrance of the facility revealed the residents who smoke come out to the front of the building and sit outside of the main entrance to smoke. There is a small handicap ramp in the entrance about 4 feet wide extended from the cemented area to the parking lot. Interview on 10/23/23 at 10:00 A.M. to 10:05 A.M., with Community Member #1 revealed she does not work at the facility and received this information from a friend via text form with pictures. Community Member #1 described the picture was of a black woman in a wheelchair smoking, being pushed down the ramp into the parking lot and agency State Tested Nurse Assistant (STNA) laughing with a caption. Community Member #1 revealed she called the facility two times and reported the incident. The first time the facility took the information, the complainant informed the facility it was agency STNA #170 who works for an agency. Community Member #1 stated she called 3 weeks ago and was told by the Director of Nursing (DON); the facility took care of it. Community Member #1 could not identify the resident's name. Interview on 10/23/23 at 10:56 A.M., with the Social Services Designee #105 revealed the DON did receive a call from an anonymous caller about an agency nurse taking pictures of a resident and posting them on social media. Interview on 10/23/23 at 11:00 A.M., with the DON confirmed she received an anonymous call about Agency STNA #170. The anonymous caller accused STNA #170 of taking a picture of a blind black lady while smoking in her wheelchair and posted it on social media. The DON explained, because they do not have a blind black lady in the facility, she did not investigate the allegation. She interviewed the seven smokers and they all denied getting their picture taken. She reported the incident to the contracted staffing agency. The DON stated the Human Resources Manager #120 confirmed the agency also received the same complaint and will address the situation. The DON confirmed she did not report the abuse allegation to the state agency, file a Self-Reported Incident or investigate the allegation of abuse. She has no documentation of any interviews with her residents who smoke. Interview on 10/23/23 from 11:10 A.M. to 11:30 A.M., with Resident #64, who smokes, stated witnessing Resident #63, as the person who was in a wheelchair and a STNA let go and Resident #63 slid down Page 1 of 4 365666 365666 10/23/2023 Indian Lake Rehabilitation Center 14442 State Route 33 West Lakeview, OH 43331

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the little ramp into the parking lot, but the STNA stopped her. Resident #64 denied knowing if anyone took a picture of it. Interview on 10/23/23 from 11:10 A.M. to 11:30 A.M., with Resident #61 stated recalled the incident when a female resident was in her wheelchair and the STNA let go of the chair and it wheeled down the ramp into parking lot. She could not recall the resident's name or if anyone took a picture. Interview on 10/23/23 from 11:10 A.M. to 11:30 A.M., with Resident #63, (who matched description provided by Community Member #1) revealed the resident is cognitively impaired and gets people and times confused. Resident #63 stated she does go out to smoke in a wheelchair; however, she could not recall if she was pushed in her wheelchair by an STNA down a ramp while smoking. Interview on 10/23/23 at 12:18 P.M., with the Human Resource Manager #120, from the contracted staffing agency, confirmed she received a call from the facility's DON about STNA #170 taking pictures while working. She confirmed her agency also received a call from an anonymous person who identified STNA #170 as taking pictures of a resident at the facility. Human Resource Manager #120 stated the agency followed up with STNA #170, who wrote a statement on 09/18/23 at 2:45 P.M., explaining she would never take a picture of a resident, make fun of them, or post it on social media. Human Resource Manager #120 stated she believes family members have made falls accusations about STNA #170. STNA #170 was educated over the phone on the agency use of cellphones, taking pictures and social media. Review of the policy titled, Ohio Resident Abuse Policy, dated 08/30/23, revealed it is the facility's policy to investigate all allegations, suspicions and incidents of abuse, neglect involuntary seclusion, exploitation of residents, misappropriation of resident property and injuries of unknown origin. Facility must immediately report all such allegations to the Administrator/Abuse Coordinator. The Administrator/ Abuse Coordinator will immediately begin an investigation and notify the applicable local and state agencies in accordance with the procedures in the policy. For this policy nursing home staff includes employees, consultants, contractors, volunteers, and other care givers who provide care and services to the residents on behalf of the facility. Abuse includes mental abuse, including abuse facilitated or enabled using technology. This deficiency represents noncompliance investigated under Complaint Number OH00147011. 365666 Page 2 of 4 365666 10/23/2023 Indian Lake Rehabilitation Center 14442 State Route 33 West Lakeview, OH 43331

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on observation, staff interviews, resident interviews, agency staff interview, Community Member interview and review of policy, the facility failed to investigate and an allegation of abuse. This affected one (#63) of three residents reviewed for potential abuse. The facility census was 34. Residents Affected - Few Findings include: Observation of the main entrance of the facility revealed the residents who smoke come out to the front of the building and sit outside of the main entrance to smoke. There is a small handicap ramp in the entrance about 4 feet wide extended from the cemented area to the parking lot. Interview on 10/23/23 at 10:00 A.M. to 10:05 A.M., with Community Member #1 revealed she does not work at the facility and received this information from a friend via text form with pictures. Community Member #1 described the picture was of a black woman in a wheelchair smoking, being pushed down the ramp into the parking lot and agency State Tested Nurse Assistant (STNA) laughing with a caption. Community Member #1 revealed she called the facility two times and reported the incident. The first time the facility took the information, the complainant informed the facility it was agency STNA #170 who works for an agency. Community Member #1 stated she called 3 weeks ago and was told by the Director of Nursing (DON); the facility took care of it. Community Member #1 could not identify the resident's name. Interview on 10/23/23 at 10:56 A.M., with the Social Services Designee #105 revealed the DON did receive a call from an anonymous caller about an agency nurse taking pictures of a resident and posting them on social media. Interview on 10/23/23 at 11:00 A.M., with the DON confirmed she received an anonymous call about Agency STNA #170. The anonymous caller accused STNA #170 of taking a picture of a blind black lady while smoking in her wheelchair and posted it on social media. The DON explained, because they do not have a blind black lady in the facility, she did not investigate the allegation. She interviewed the seven smokers and they all denied getting their picture taken. She reported the incident to the contracted staffing agency. The DON stated the Human Resources Manager #120 confirmed the agency also received the same complaint and will address the situation. The DON confirmed she did not report the abuse allegation to the state agency, file a Self-Reported Incident or investigate the allegation of abuse. She has no documentation of any interviews with her residents who smoke. Interview on 10/23/23 from 11:10 A.M. to 11:30 A.M., with Resident #64, who smokes, stated witnessing Resident #63, as the person who was in a wheelchair and a STNA let go and Resident #63 slid down the little ramp into the parking lot, but the STNA stopped her. Resident #64 denied knowing if anyone took a picture of it. Interview on 10/23/23 from 11:10 A.M. to 11:30 A.M., with Resident #61 stated recalled the incident when a female resident was in her wheelchair and the STNA let go of the chair and it wheeled down the ramp into parking lot. She could not recall the resident's name or if anyone took a picture. Interview on 10/23/23 from 11:10 A.M. to 11:30 A.M., with Resident #63, (who matched description provided by Community Member #1) revealed the resident is cognitively impaired and gets people and times confused. Resident #63 stated she does go out to smoke in a wheelchair; however, she could not recall if she was pushed in her wheelchair by an STNA down a ramp while smoking. 365666 Page 3 of 4 365666 10/23/2023 Indian Lake Rehabilitation Center 14442 State Route 33 West Lakeview, OH 43331

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 10/23/23 at 12:18 P.M., with the Human Resource Manager #120, from the contracted staffing agency, confirmed she received a call from the facility's DON about STNA #170 taking pictures while working. She confirmed her agency also received a call from an anonymous person who identified STNA #170 as taking pictures of a resident at the facility. Human Resource Manager #120 stated the agency followed up with STNA #170, who wrote a statement on 09/18/23 at 2:45 P.M., explaining she would never take a picture of a resident, make fun of them, or post it on social media. Human Resource Manager #120 stated she believes family members have made falls accusations about STNA #170. STNA #170 was educated over the phone on the agency use of cellphones, taking pictures and social media. Review of the policy titled, Ohio Resident Abuse Policy, dated 08/30/23, revealed it is the facility's policy to investigate all allegations, suspicions and incidents of abuse, neglect involuntary seclusion, exploitation of residents, misappropriation of resident property and injuries of unknown origin. Facility must immediately report all such allegations to the Administrator/Abuse Coordinator. The Administrator/ Abuse Coordinator will immediately begin an investigation and notify the applicable local and state agencies in accordance with the procedures in the policy. For this policy nursing home staff includes employees, consultants, contractors, volunteers, and other care givers who provide care and services to the residents on behalf of the facility. Abuse includes mental abuse, including abuse facilitated or enabled using technology. This deficiency represents noncompliance investigated under Complaint Number OH00147011. 365666 Page 4 of 4