Health 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. Page 1 of 3 366087 366087 10/16/2023 Vista Center, The 100 Vista Drive Lisbon, OH 44432

F 0550 Level of Harm - Minimal harm or potential for actual harm During an interview on 10/16/23 at 11:40 A.M., the DON verified STNA #198's behavior toward Resident #4 was inappropriate. This deficiency represents non-compliance investigated under Master Complaint Number OH00146860 and Complaint Number OH00146635. Residents Affected - Few 366087 Page 2 of 3 366087 10/16/2023 Vista Center, The 100 Vista Drive Lisbon, OH 44432

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on record review, review of the facility's Self-Reported Incident (SRI) Tracking Number 239908, and interview, the facility failed to maintain complete and accurate medical records. 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 overhead 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. Review of the nursing progress notes revealed no documentation of the incident that occurred on 10/06/23. During interview on 10/16/22 at 11:40 A.M., the Director of Nursing (DON) confirmed there was no evidence or documentation in Resident #4's medical record of the incident which occurred on 10/06/23 when STNA #198 yelled at the resident. The DON confirmed that the incident should have been documented in the nursing progress notes and it was not. The following deficiency is based on incidental findings discovered during the course of this complaint investigation. 366087 Page 3 of 3