Inspection·November 15, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on family and staff interviews, medical record review, review of the facility's Self-Reported Incidents, and review of camera footage, the facility failed to ensure a resident who was dependent on staff for activities of daily living (ADL) was safely repositioned in bed. This affected one (Resident #1) of three residents reviewed for ADL care. The facility census was 158. Residents Affected - Few Findings include: Review of Resident #1's medical record revealed Resident #1 was admitted to the facility on [DATE]. Diagnoses included dementia, depression, and anxiety. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #1 had severe cognitive impairment and required substantial/maximal assistance from staff to roll to the right and left side. Review of the facility's Self-Reported Incident (SRI) dated 11/06/23 revealed Resident #1's power of attorney (POA) (also Resident #1's grandson) reported an allegation of physical abuse towards Resident #1. The POA stated when watching the video of care provided to Resident #1 revealed on 11/04/23 (the facility had 11/04/23 but the video was marked 11/05/23), State Tested Nursing Aide (STNA) #317 repositioned Resident #1 in bed and resulted in Resident #1 hitting her head on the railing. STNA #317 did not console or check to see if Resident #1 was okay after Resident #1 hit her head on the railing during repositioning. The POA also reported STNA #317 was rough with getting Resident #1 dressed over the weekend (11/04/23 or 11/05/23) as well. STNA #317 received safe repositioning education, abuse, customer service, and adverse events. The abuse was unsubstantiated based off the review of the video and STNA #317's statement where the head bump on the railing was not intentional on 11/14/23. Further review of the facility's SRIs dated 10/122/23 revealed STNA #317 was mentioned as an alleged perpetrator in a physical abuse allegation towards another resident (Resident #102). As a result of the investigation dated 10/30/23, staff received education on how to safely transfer Resident #102. Review of the video clip from Resident #1's room dated 11/05/23 at 1:03 P.M. with Resident #1's POA revealed a nurse and STNA #317 transferred Resident #1 to her bed. The nurse leaves the room and STNA #317 pulls Resident #1's hip and right arm towards her and then Resident #1 hits her head on the siderail. Resident #1 stated ouch my head. STNA #317 does not respond to Resident #1's comment and continues to remove the Hoyer pad and does not reposition Resident #1 off the siderail. Resident #1's head was resting on the siderail when Resident #1 was turned over and Resident #1 told STNA #317 she would hit her and bite her. STNA #317 continued to remove the pad and did not check Resident #1's head for any injury. (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 3 Event ID: 366045 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 366045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Jennings Hall 10204 Granger Road Garfield Heights, OH 44125 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)