Health inspection·September 2, 2025

F 0689 Level of Harm - Actual harm Residents Affected - Few Unit (ICU) due to fracture of multiple ribs. Imaging tests included computed tomography (CT) of the cervical spine, chest, abdomen, pelvis, maxillofacial, and head, and x-rays of the chest, pelvis, and right knee. The resident sustained an acute mildly displaced fracture of the left sixth lateral rib. There were multiple additional remote bilateral rib fractures. Upon discharge back to the facility, the resident was prescribed oxycodone for pain control.Interview on 08/29/25 at 11:20 A.M. with Resident #4 revealed he fell from the Hoyer lift when the sling broke and he hit his head and broke his rib.Interview with CNA #72 on 08/29/25 at 1:18 P.M. revealed she and another CNA were transferring Resident #4 with the wrong type of sling when it broke during the transfer resulting in the resident falling (from the lift) and caused the resident to hit the floor. CNA #72 stated the sling was already beneath the resident (when they secured the sling to the mechanical/Hoyer lift) and they didn't change the sling to a correct one. Interview on 08/29/25 at 11:59 P.M. with the Assistant Director of Nursing (ADON) confirmed Resident #4 fell during a mechanical lift transfer due to the night shift staff placing an incorrect, thin hospital sling under him. The day shift staff utilized the incorrect sling, and it broke during the transfer resulting in Resident #4 suffering fractured ribs. Review of the manufacturer's pamphlet titled, Electric Patient Lift, revealed specific slings are made for the Electric Patient Lifts. For the safety of the patient, do not intermix slings and patient lifts of different manufacturers.Review of the facility's policy titled, Safe Resident Handling/Transfers, revision date of 07/18/25, revealed it is the policy of this facility to ensure that residents are handled and transferred safely to prevent or minimize risks for injury and provide and promote a safe, secure and comfortable experience for the resident while keeping the employees safe in accordance with current standards and guidelines. Guidelines include ensuring the sling designed for the lift is utilized with that specific lift and two staff members must be utilized when transferring residents with a mechanical lift.2. Review of Resident #1's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including dementia, convulsions, mood disorder, heart failure, hemiplegia and hemiparesis, and a history of transient ischemic attack and cerebral infarction.Review of the care plan, dated 01/13/25, revealed the resident had activities of daily living (ADL) self-care deficits related to hemiparesis and was dependent upon staff for transfers with a mechanical lift. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 06/27/25, revealed the resident was rarely understood and required physical staff assistance for transfers and mobility. The assessment indicated there was impairment on one side of the upper extremities and impairment on both sides of the lower extremities. Review of the Fall Investigation/Incident Report revealed on 07/18/25 at 7:15 A.M. Resident #1 was injured from the Hoyer lift after being placed in a chair. The resident sustained a one to one and a half inch laceration on the top, left area of her head. The wound continued to bleed and 911 was called. Interview with Certified Nursing Assistant (CNA) #62 stated she was moving the mechanical lift away from the chair when the metal part made contact with the resident's head and caused the laceration. The resident received four staples in the ED. The immediate intervention implemented was to fit the mechanical lift cradle swing bar (swivel bar) with padding (as included with the lift as a main component of the assembly) to prevent further injury.Review of a nursing progress note, dated 07/18/25 at 10:16 A.M., revealed Resident #1 was injured this morning while getting out of bed via Hoyer lift and sustained a 1-1.5-inch laceration to the head. The wound was bleeding continuously, and the resident was sent to the emergency department (ED). The resident's daughter was notified. Review of the After Visit Summary from the ED dated 07/18/25 revealed the resident was seen due to a head injury and laceration of the scalp. Imaging tests included computed tomography (CT) of the cervical spine and head, and x-rays of the chest, right femur, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365988 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 365988 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Willow Brook Christian Home 55 Lazelle Rd 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)

F 0689 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete right forearm, right hip with pelvis, right humerus, and right tibia fibula. The laceration was closed with four staples. Diphtheria, Tetanus Toxoid, and Acellular Pertussis immunization was administered.Interview with CNA #62 on 08/29/25 at 1:21 P.M. revealed she and CNA #68 transferred the resident from her bed to the wheelchair. At this point, CNA #68 left the room. While moving the mechanical lift away from the wheelchair, CNA #62 stated the metal edge of the cradle hit the resident in the head and she immediately started bleeding from the laceration. CNA #62 stated she applied a towel to the resident's head and called for the nurse. CNA #62 stated to prevent this from happening again she will always have two staff present until the mechanical lift is moved away from the resident. Interview on 08/29/25 at 1:32 P.M. with the Assistant Director of Nursing (ADON) confirmed Resident #1 was struck in the head with the cradle of the mechanical lift when CNA #62 was moving the mechanical lift away from the resident's wheelchair. The ADON stated the intervention put into place following the accident was for padding to be placed on the swing arm of the mechanical lift, as advised in the manufacturer's instructions.Observation on 08/29/25 at 1:45 P.M. of the mechanical lift revealed a swivel bar fabric protective cover that resembled the wrap illustrated in the Electric Lift Patient Manual.Review of the manufacturer's pamphlet titled, Electric Patient Lift, revealed the lift included a swivel bar protective covering as part of the main assembly components.This deficiency represents non-compliance investigated under Complaint Number 2566262. Event ID: Facility ID: 365988 If continuation sheet Page 3 of 3