Health inspection·November 7, 2023

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 record review, interview and facility policy, the facility failed to ensure that Resident #33 was free from verbal abuse. This affected one resident (Resident #33) out of five residents reviewed for abuse. This had the potential to affect all 30 residents that resided in the facility. The facility census was 30. Findings include: Review of the medical record revealed Resident #33 was admitted to the facility on [DATE] and discharged on 11/02/23. Review of the admission Minimum Data Set (MDS) 3.0 assessment was not completed. Review of the admission assessment dated [DATE] revealed Resident #33 was oriented to person, place, time, and orientation. Review of the concern form dated 11/02/23 revealed family of Resident #33 alleged that on 11/01/23 State Tested Nursing Assistant (STNA) #108 was a kind of rough and rude. The investigation portion of concern on the form revealed Director of Nursing (DON) met with STNA #108 and discussed the incident. STNA #108 confirmed that she had a bad day, didn't perform her best and admitted to being rude to staff and residents. Review of personnel record for STNA #108 revealed a hire date of 04/06/23 with no documentation of that a background check was completed. This was verified by the DON on 11/06/23 at 4:13 P.M. Further review of the personnel record for STNA #108 revealed that she received a 90-day evaluation on 10/03/23 that stated in the area of attitude, attitude and language on the floor needs improvement and in the area of social skills, can be careless with language on the floor around residents. DON verified the evaluation on 11/06/23 at 4:13 P.M. Review of the separation letter dated 11/03/23 for STNA #108 revealed that STNA was terminated due to multiple call offs and repeated negative language and attitude resulting in other staff complaints, unprofessionalism, and substandard work performance. DON verified that she terminated STNA #108 on 11/06/23 at 4:13 P.M. Review of facility policy dated 2023 titled, Abuse, Neglect and Exploitation, residents have the right to be free from verbal, physical and sexual abuse. This deficiency represents non-compliance investigated under Complaint Number OH00147266. Page 1 of 4 366036 366036 11/07/2023 Glendora Health Care Center 1552 North Honeytown Road Wooster, OH 44691

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview and facility policy, the facility failed to implement its abuse policy to appropriately protect Resident #33 from verbal abuse. This affected one resident (Resident #33) out of five residents reviewed for abuse. The facility census was 30. Residents Affected - Few Findings include: Review of the medical record revealed Resident #33 was admitted to the facility on [DATE] and discharged on 11/02/23. Review of the admission Minimum Data Set (MDS) 3.0 assessment was not completed. Review of the admission assessment dated [DATE] revealed Resident #33 was oriented to person, place, time, and orientation. Review of the concern form dated 11/02/23 revealed family of Resident #33 alleged that on 11/01/23 State Tested Nursing Assistant (STNA) #108 was a kind of rough and rude. The investigation portion of concern on the form revealed Director of Nursing (DON) met with STNA #108 and discussed the incident. STNA #108 confirmed that she had a bad day, didn't perform her best and admitted to being rude to staff and residents. Review of personnel record for STNA #108 revealed a hire date of 04/06/23 with no documentation of that a background check was completed. This was verified by the DON on 11/06/23 at 4:13 P.M. Review of the facility's undated policy entitled, Abuse, Neglect and Exploitation, revealed residents have the right to be free from abuse and that potential employees will be screened for a history of abuse by conducting background checks. This deficiency represents non-compliance investigated under Complaint Number OH00147266. 366036 Page 2 of 4 366036 11/07/2023 Glendora Health Care Center 1552 North Honeytown Road Wooster, OH 44691

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and facility policy, the facility failed to complete an investigation of an allegation of verbal abuse. This affected one resident (Resident #33) out of five residents reviewed for abuse. The facility census was 30. Residents Affected - Few Findings include: Review of the medical record revealed Resident #33 was admitted to the facility on [DATE] and discharged on 11/02/23. Review of the admission Minimum Data Set (MDS) 3.0 assessment was not completed. Review of the admission assessment dated [DATE] revealed Resident #33 was oriented to person, place, time, and orientation. Review of the concern form dated 11/02/23 revealed family of Resident #33 alleged that on 11/01/23 State Tested Nursing Assistant (STNA) #108 was kind of rough and rude. The investigation portion of concern on the form revealed Director of Nursing (DON) met with STNA #108 and discussed the incident. STNA #108 confirmed that she had a bad day, didn't perform her best and admitted to being rude to staff and residents. Further review of the personnel record for STNA #108 revealed that she received a 90-day evaluation on 10/03/23 that stated in the area of attitude, attitude and language on the floor needs improvement and in the area of social skills, can be careless with language on the floor around residents. DON verified the evaluation on 11/06/23 at 4:13 P.M. Interview on 11/06/23 at 11:00 A.M. with Resident #2 revealed that STNA #108 was rude to him and would come to his room to answer the call light and would turn it off without assisting him. Interview on 11/06/23 at 4:13 P.M. with DON revealed that she did not talk to any residents or staff after the concern was brought to her attention because she thought it was a customer service issue and not abuse. Review of facility policy dated 2023 titled, Abuse, Neglect and Exploitation, revealed when suspicion of abuse, neglect or exploitation occur, an investigation is immediately warranted. This deficiency represents non-compliance investigated under Complaint Number OH00147266. 366036 Page 3 of 4 366036 11/07/2023 Glendora Health Care Center 1552 North Honeytown Road Wooster, OH 44691

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and policy review, the facility failed that kitchen staff wore hair restraints while serving food and in the kitchen. This had the potential to affect all 30 residents who received food from the facility. No residents were identified as receiving nothing by mouth (NPO). The facility census was 30. Findings include: Observation on 11/06/23 at 8:02 A.M. revealed that [NAME] #114 was serving food without a hair restraint or beard net on and Dietary Manager #112 was walking in front of the steamtable with her hair not in a hair restraint. DM #112 and [NAME] #114 stated that they should have been wearing hair nets. Interview on 11/07/23 at 8:17 A.M. with Dietary Manager revealed that staff forgets to wear hairnets because they have so much to do in the morning like roll silverware. Review of the undated facility policy titled, Maintaining a Sanitary Tray Line, revealed that staff should wear hair restraints. 366036 Page 4 of 4