Inspection·October 16, 2023

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, review of the facility's Self-Reported Incident (SRI) Tracking Number 239908, and interview, the facility failed to ensure Resident #4 was treated with dignity and respect. This affected one (Resident #4) of three residents reviewed for dignity. The facility census was 49. Findings include: Review of the medical record for Resident #4 revealed an admission date of 08/25/23 with diagnoses including hemiplegia and hemiparesis, cerebral vascular infarction, chronic obstructive pulmonary disease (COPD), muscle wasting, adult failure to thrive, and moderate protein-calorie malnutrition. Review of the admission Minimum Data Set (MDS) 3.0 assessment for Resident #4, dated 09/01/23, revealed the Brief Interview for Mental Status (BIMS) score of 15, which indicated the resident was cognitively intact. The assessment revealed there were no behaviors or rejection of care. The resident required extensive, one-person physical assistance for bed mobility, transfers, toileting, and personal hygiene. Review of the Self-Reported Incident (SRI) Tracking Number 239908, revealed on 10/06/23, the Administrator overheard state-tested nursing assistant (STNA) #198 yelling at Resident #4 from the hallway. Upon hearing the noise, the Administrator went to the resident's room. STNA #198 was no longer yelling but was immediately removed from the facility and instructed not to return. The allegation of verbal abuse was unsubstantiated but the STNA was not permitted to return to the facility. During interview on 10/12/23 at 12:02 P.M., the Administrator stated that she heard someone yelling from down the hallway and went immediately to Resident #4's room. Upon arrival to the room, STNA #198 was no longer yelling at the resident. The Administrator stated she could not discern what was said to the resident during the yelling. STNA #198 stated that Resident #4 called her the N-word and she got upset and started yelling. STNA #198 was told that her behavior was unacceptable and was immediately removed from the facility. The Administrator stated that Resident #4 appeared fine following the incident and stated that he was unbothered by it. Resident #4 denied using the N-word. The Administrator verified STNA #198's behavior towards the resident was inappropriate. During interview on 10/12/23 at 12:15 P.M., Resident #4 stated that he needed to go to the bathroom and asked for help when STNA #198 began yelling and said to him, you are not the only person in the facility and will need to wait. Resident #4 stated STNA # 198 told the Administrator he called her the N-word, however, he did not. When the resident was asked how he felt following the incident, he stated that he didn't like it, but that he looked over it. (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: 366087 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 366087 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center, The 100 Vista Drive Lisbon, OH 44432 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)