Health inspection·February 26, 2024

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 medical record review, interviews, policy review, and review of the investigation notes for self-reported incident (SRI) #243949 the facility failed to prevent staff to resident abuse. This affected one resident (#32) of three residents reviewed for abuse. The facility census was 56. Findings Include: Review of the medical record for Resident #32 revealed an admission date of 01/27/24 with diagnoses including chronic osteomyelitis (infection of bone) of the left thigh, local infection of the skin and subcutaneous tissue, unstageable pressure ulcer, Sjogren syndrome (an immune system illness that mainly causes dry eyes and dry mouth), major depression, and history of respiratory failure. Review of the admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #32 had intact cognition and minimal signs of depression. Further review of the MDS assessment revealed Resident #32 was dependent for toileting, had a stage four pressure ulcer, and frequently suffered from severe pain during the five days prior to the assessment. Review of the progress note dated 02/08/24 revealed Resident #32 reported that State tested nurse aide (STNA) #351 left her on a bedpan too long and was too rough when turning her. The progress note further revealed an investigation was initiated, the STNA was suspended, the police were notified, and skin and pain assessments were completed on Resident #32 on 02/08/24 with no new findings. Review of the care plan dated 02/09/24 revealed Resident #32 had a self-care deficit in the performance of activities of daily living (ADLs) and required one-person assistance with toileting and bed mobility. Further review of the care plan revealed Resident #32 was at risk for impaired skin integrity and staff were to assist with repositioning as needed. Interview on 02/22/24 at 4:15 P.M. with Resident #32 revealed STNA #351 placed her on the bedpan wrong and when she asked to be repositioned, the STNA was rough when repositioning her and then she still felt poorly positioned and uncomfortable on the bedpan. Resident #32 stated she begged STNA #351 not to leave her like that and STNA #351 told her in an irritated tone that she would be fine as she proceeded to exit the room. Resident #32 further explained she was uncomfortable and felt she was not on the bedpan correctly, so she started yelling out for assistance when a nurse entered and helped her get better positioned on the bedpan. When STNA #351 came back, she would not remove the bedpan, telling Resident #32 she needed to get a second person to assist. Resident #32 reported STNA #351 (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 5 Event ID: 365689 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 365689 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Fairlawn The 575 S Cleveland Massillon Road Fairlawn, OH 44333 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)