Inspection·January 8, 2026

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** Based on medical record review, review of facility self-reported incident (SRI) #267409, staff interviews, and review of facility policy, the facility failed to ensure adequate supervision was provided to ensure a resident on the secured memory care unit was free from sexual abuse. This affected one resident (#68) of three residents reviewed for abuse. The facility census was 64.Findings Include:Review of the medical record for Resident #68 revealed an admission date of 06/08/21 and a discharge date of 11/22/25 with diagnoses including vascular dementia, major depressive disorder, age-related osteoporosis, idiopathic peripheral autonomic neuropathy, abnormalities of gait and mobility, generalized muscle weakness, oropharyngeal dysphagia, constipation, iron deficiency anemia, sexual dysfunction, bunions of right foot, and anxiety. Review of the most recent quarterly Minimum Data Set (MDS) assessment, dated 09/15/25, identified Resident #68 was rarely/never understood. Further review of this MDS assessment revealed Resident #68 was dependent for ambulation.Review of the medical record for Resident #68 revealed she had a guardian. Resident # 68 lived on the secured memory care unit at the facility. Review of the medical record for Resident #67 revealed an admission date of 05/26/22 and a discharge date of 12/09/25 with diagnoses including atherosclerotic heart disease of native coronary artery, schizoaffective disorder, type two diabetes mellitus (DM2), anemia, other sexual disorders, trans ischemic attack (TIA), dysphagia, dementia, urge incontinence, other abnormalities of gait and mobility, lipoprotein deficiency, generalized muscle weakness, deficiency of other specified B group vitamins, metabolic encephalopathy, pure hypercholesterolemia, nicotine dependence, constipation, pulmonary embolism, hypothyroidism, other signs and symptoms involving cognitive functions and awareness, and cognitive communication deficit. Review of the most recent quarterly MDS assessment dated [DATE] revealed Resident #67 has severely impaired cognition. Further review of this MDS assessment revealed Resident #67 was independent for ambulation.Review of the medical record for Resident #67 revealed he had a guardian. Review of facility SRI #267409 revealed that on 11/11/25 at approximately 10:30 A.M., Resident #68 was in her wheelchair in the common area of the memory care (MC) unit, and Resident #67 had his hand down the front of her shirt. The residents were immediately separated, and Resident #67 was placed on one to one (1:1) monitoring that continued until his discharge on [DATE]. Resident #67 presents with a six out of 15 on brief interview of mental status (BIMs) assessment demonstrating a severe cognitive deficit; care plan review identifies a history of sexual behaviors and poor impulse control. Resident #68 presents with a zero out of 15 on BIMs assessment demonstrating a severe cognitive deficit, care plan review identifies a history of sexual behaviors and poor impulse control. The facility determined sexual abuse was unsubstantiated as the evidence of sexual abuse is inconclusive. The SRI documented both involved residents present with a severe cognitive impairment and did not act willfully, both residents also have a history of sexual behaviors and poor impulse control. Interview on 01/07/26 at 7:15 A.M. with the Administrator and the (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: 365740 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 365740 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Majestic Care of Clyde 700 Helen Street Clyde, OH 43410 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)