Inspection·August 28, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on record review, resident interview, staff interview, and review of witness statements, the facility Administrator failed to treat Resident #21 in a dignified and respectful manner. This affected one resident (#21) of three reviewed. The facility census was 56. Findings include: Review of the medical record for Resident #21 revealed an admission date of 02/12/20 with diagnoses including anxiety disorder, major depressive disorder, congestive heart failure, chronic obstructive pulmonary disease, hypertension, and type two diabetes mellitus. Review of the quarterly Minimum Data Set (MDS) Assessment, dated 08/07/24, revealed Resident #21 had no cognitive impairment. On 08/28/24 at 9:06 A.M., an interview with Resident #21 stated the Administrator yelled at her and argued with her, which Resident #21 felt was inappropriate. On 08/28/24 at 9:55 A.M., an interview with Licensed Practical Nurse (LPN) #214 confirmed they witnessed the Administrator yelling at Resident #21, gesturing at her with her hands and pointing a finger at her. LPN #214 stated this incident occurred in the middle of the building by the nurses station. On 08/28/24 at 3:53 P.M., an interview with Regional Registered Nurse (RN) #242 stated the Administrator was verbally inappropriate with Resident #21, threatening to kick Resident #21 out of the building. Review of Resident #21's signed statement, dated 08/28/24, indicated the Administrator told Resident #21 that she was in charge and she would kick Resident #21 out. Review of LPN #214's signed statement, dated 08/28/24, confirmed the Administrator yelled at Resident #21 and the Administrator told Resident #21 that she could kick Resident #21 out of the facility. LPN #214 further stated it was a bad choice of words and uncalled for. This deficiency represents non-compliance investigated under Complaint Number OH00155871. 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 2 Event ID: 365844 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 365844 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aurora Manor Special Care Cent 101 S Bissell Rd Aurora, OH 44202 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)