Health inspection·January 27, 2026

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** THIS IS AN INCIDENCE OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY.Based on record review, staff interview, facility investigation report review, and policy review, the facility failed to provide adequate physical assistance with bed mobility. This resulted in Actual Harm to Resident #43 when one staff person was changing the bed sheets and rolled Resident #43 out of bed onto the floor, resulting in a leg fracture. Resident #43 required the assistance of two staff for bed mobility. This affected one (Resident #43) of two residents reviewed for falls. The census was 32.Findings Include:Resident #43 was admitted to the facility on [DATE]. Pertinent diagnoses included Parkinson's disease, hereditary and idiopathic neuropathy, cerebrovascular disease, spondylosis, degenerative disease of nervous system, and fibromyalgia.Review of Resident #43's minimum data set (MDS) assessment, dated 08/14/24, revealed she was cognitively intact, and required substantial/maximal assistance for rolling left and right in the bed, and returning to lying in bed. Review of Resident #43's fall risk assessment, dated 08/14/25, revealed she was at moderate risk for falling.Review of Resident #43's care plan, dated 05/26/22, revealed she was at risk for activities of daily living (ADL) decline related to impaired mobility. Interventions included the assistance of two people with all bed mobility, turning and repositioning for comfort.Review of Resident #43 Investigation Summary, dated 09/20/25, documented Registered Nurse (RN) #150 was called to Resident #43's room by Certified Nursing Assistant (CNA) #200 after Resident #43 fell from the bed. RN #150 assessed Resident #43 and she was in pain. The physician was contacted as Resident #43 had requested to go to the hospital and the physician agreed to send Resident #43 to the hospital. The investigation did not include a description of the injuries Resident #43 suffered from the fall.Review of CNA#200's written statement dated 09/20/25 revealed she was changing Resident #43's bed sheet by herself while Resident #43 was in bed. She rolled Resident #43 to the left side of the bed, away from herself to assist with changing the sheet. CNA #200 looked up after starting to change the sheet and saw Resident #43 holding on to the bed rail, and she continued changing the bed sheet. Then, CNA #200 stated she saw Resident #43 fall from the bed. CNA #200 reported the bed was in a high position while she was changing the bed sheet and Resident #43 fell.During an interview on 01/21/26 at 2:55 P.M., the Director of Nursing (DON) confirmed the facility did an investigation after the fall and confirmed CNA #200 was in Resident #43's room by herself, changing the bed sheet. Resident #43 was supposed to have two staff in the room when bed mobility tasks were being performed. She stated she was not given specific details about the nature of Resident #43's injury, only that she had fractured her leg because of the fall.During an interview on 01/22/25 at 10:28 A.M., RN #150 stated she was called to Resident #43's room by CNA #200, after Resident #43 fell from her bed. RN #150 stated the resident was in pain and did not want an X-ray performed at the facility. RN #150 stated she sent Resident #43 to the hospital after Resident #43 requested it, and after she spoke with the primary care physician. She confirmed CNA (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 4 Event ID: 365671 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 365671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Worthington Christian Village 165 Highbluffs Blvd Columbus, OH 43235 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)