Inspection·April 3, 2023

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few resident with Resident #134 with no injuries noted. The resident's Physician was notified with no new orders. Resident #134 does have a medical diagnosis of/but not limited to Alzheimer ' s disease, Dementia without behavioral disturbances, Pseudobulbar affect, major depressive disorder, anxiety disorder, mental disorder, insomnia, and constipation. STNA #165 was interviewed with no negative findings. STNA #165 stated Resident #134 was incontinent of bowel and bladder, however when toileted, she will have a bowel movement, but needed a lot of time to do so. STNA #165 stated resident had a large bowel movement and was cleaned up and assisted back to her wheelchair to visit with her daughter. STNA #165 stated the resident's daughter seemed upset on 03/11/23 about Resident #134 being on the toilet. Staff in the facility were interviewed with no negative findings. Several staff who worked on the resident's unit stated Resident #134 would have a bowel movement on the toilet, but does require a lot of time to do so. Residents on the unit of the allegation that were not able to be interviewed, received head to toe assessments with no negative findings. Social Service Director (SSD) followed up with Resident #134 on 03/14/23 and resident's mood and behavior remained within normal limits. SSD stated Resident #134 was in a pleasant mood with no change in baseline of mood or behavior. Facility Conclusion/Disposition Section revealed this allegation was unsubstantiated, Evidence indicates abuse, neglect or misappropriation had not occurred. The facility had found no evidence to conclude that neglect occurred with Resident #134. Interview on 03/31/23 at 3:02 P.M. with Unit Manager #77 who indicated he was the unit manager for the unit where Resident #134 resided and Admissions/Discharge Coordinator #61 revealed he had worked here for about 21 years. Unit Manager #77 indicated he was not in the room when the incident with Resident #134 occurred, but completed a head-to-toe assessment on the resident when she was supposedly left in the bathroom for a extended period of time The head to toe assessment revealed no concerns regarding any form of injury and the resident appeared to be at her baseline regarding mood and behaviors. He spoke with STNA #165 who was providing care and was told the resident was placed on the toilet to have a bowel movement with the use of a mechanical sit to stand lift and was left there for a little while due to it taking her a little while to have a bowel movement, which Resident #134 ended up having a bowel movement. STNA #165 claimed she had left Resident #134 in the bathroom with the door closed to attend to another resident and to give Resident #134 time to use the bathroom and ended up getting tied up in an incident where another resident had to be transferred out to the hospital and had not realized how long Resident #134 had been on the toilet, but that she did not plan for her to be on the toilet for a long period of time. Interview on 03/31/23 at 3:19 P.M. with STNA #165 revealed she was the STNA who was providing care to Resident #134 on the day the incident occurred where she was in the bathroom for an extended period of time. STNA #165 claimed there was only two STNAs, herself and another STNA, there that day to care for all the residents on the Special Care Unit and most of the residents required two staff assistance for care. STNA #165 claimed she liked to try to get all of her residents onto the toilet, if she could because it helps them use the bathroom easier if they are sitting on the toilet. Resident #134 required some time on the toilet to be able to actually use the bathroom. Since there was only two STNAs to provide care, she used this time to provide care for other residents and to allow some privacy for Resident #134. Resident #134 had a sit-to-stand mechanical lift placed in front of her which is a mechanical lift like machine that has a sling that goes back behind the resident and then up under their arms and then attached to two extended metal arms of the machine. The resident was also able to hold onto the extended metal arms when the lift is in use. The Resident would then place their feet on the foot plate section of the lift and their knees and shins placed on the patted part of the lift that is intended to keep the residents' knees from buckling when the lift (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365864 If continuation sheet Page 2 of 3 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 365864 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Gables of Marysville Health and Rehabilitation 390 Gables Drive Marysville, OH 43040 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was assisting to raise the resident. STNA #165 claimed when Resident #134 was left on the toilet the sit-to-stand was still placed in front of her with the extended metal arms lowered into the lowest position, so they were down beside the residents sides keeping her from falling from side to side, the residents feet were still placed on the foot board and her knees were placed up against the padded part intended for her legs and knees. The machine was locked in place, so it was not able to slide or roll away from the resident. Resident #134 was secured while on the toilet with this lift from both sides and the front. There was no way for her to fall and STNA #165 felt she was safe to be left on the toilet alone with the lift secured in place. STNA #165 claimed she really meant no harm for the resident, only wanted to provide her enough time and privacy to use the bathroom. STNA #165 also claimed that she knows she was supposed to use two staff members for a mechanical lift but due to there only being two STNAs to care for the unit, most of the time she had to use the lift alone and she did transfer Resident #134 by herself on that day. Interview on 03/31/23 at 3:30 P.M. with STNA #17 who was working on 03/11/23 with STNA #165, verified she had not assisted STNA #165 at any point during the day to transfer Resident #134 and STNA #165 had used the sit-to-stand lift alone. Review of the daily posted staffing scheduled dated 03/11/23 from 6:00 A.M. through 2:30 P.M. there was one nurse and three STNAs where one STNA was noted to only be scheduled until 11:00 A.M., after that leaving only two STNAs on the Special Care Unit until the next shift was scheduled to arrive at 2:00 P.M. Review of facility policy titled Using a Mechanical Lifting Machine, undated revealed all resident care will be provided in a safe, appropriate and timely manner in accordance with the individual resident's care plan. General Guidelines. 2) At least two (2) trained staff members are needed to safely move a resident with a mechanical lift. Staff should review the resident's care plan prior to care/treatment to assess for any special needs. This deficiency represents non-compliance investigated under Complaint Number OH00141425. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365864 If continuation sheet Page 3 of 3