Health inspection·February 8, 2024

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, interview, and facility policy review the facility failed to implement their abuse policy regarding an allegation of potential staff-to-resident abuse for Resident #77. This affected one resident (#77) of seven residents reviewed for abuse. The facility census was 97. Residents Affected - Few Findings include: Review of the medical record for Resident #77 revealed an admission date of 04/07/23 with diagnoses including Amyotrophic Lateral Sclerosis (ALS) a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord, arthritis, depression, and hypertension. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #77 was cognitively intact. She required set up help for eating, oral hygiene, and personal hygiene, substantial or maximum assistance for showing or bathing, and was dependent on staff for toileting. Interview on 02/06/24 at 11:35 A.M. with Resident #77 revealed State Tested Nurse's Aide (STNA) #203 had been rough with her twice on 01/30/24. She revealed STNA #203 attempted to move the Hoyer pad (universal full body lift sling, used for bed positioning bathing assistance and transfers for disabled or dependent residents) from underneath her, causing her left arm to be pulled along with the pad. She reported her arm still hurt as a result. She revealed she told the nurse of the incident. Interview on 02/06/24 at 12:40 P.M. with STNA #202 revealed she worked with Resident #77 on 01/30/24. She revealed Resident #77 told her she did not want STNA #203 to give her a shower because she was rough with her. STNA #202 revealed she told Registered Nurse (RN) #206 about Resident #77's concerns. STNA #202 revealed many residents told her STNA #203 was rough with care. STNA #202 revealed she overheard Resident #77 tell STNA #203 she was hurting her during her shower on 01/30/24. Interview on 02/06/24 at 12:49 P.M. with STNA #203 revealed Resident #77 did not report any concerns to her regarding the care or services she provided on 01/30/24. Interview on 02/06/24 at 2:34 P.M. with RN #205 revealed she received a call from Resident #77's friend on 01/31/24 in which the resident's friend told her Resident #77 said her arm was caught underneath her and rolled behind her during care the prior day. RN #205 revealed she spoke to Resident #77 but did not specifically ask her about this incident. Interview on 02/07/24 at 8:56 A.M. with the Administrator revealed the facility was aware of Resident #77's friends' concern regarding potentially rough care for the resident on 01/30/24, but there was no investigation completed of the concern. (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 9 Event ID: 366113 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 366113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Liberty Health Care Center Inc 1355 Churchill Hubbard Rd Youngstown, OH 44505 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)