Health inspection·August 9, 2023

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, review of the facility's Self-Reported Incidents (SRI), and policy review, the facility failed to implement their abuse policy when an allegation of physical and verbal abuse of a resident was not reported to the State Survey Agency, the Ohio Department of Health (ODH) and the facility did not not notify the family/Power of Attorney (POA) of the abuse allegation. This affected one (Resident #68) of three residents reviewed for abuse. The facility census was 68. Residents Affected - Few Findings include: Review of Resident #68's medical record revealed an admission date of 03/15/21. Diagnoses included Parkinson's disease, dementia, and Alzheimer's disease. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #68 had a low cognitive function. Review of the Administrator's investigation dated 06/28/23 revealed a Housekeeper reported an employee sitting in front of Resident #68 with their legs positioned over the recliner, in order to not allow Resident #68 to get up. The Housekeeper also reported another employee called Resident #68 crazy in front of Resident #68. There was no documentation in the medical record or the Administrator's investigation dated 06/28/23 that the family/POA was no notified of the allegations of abuse involving Resident #68. Review of the facility's SRIs dated 06/28/23 to 08/06/23 revealed there was no allegation of physical and verbal abuse of Resident #68 reported to ODH. Interview with the Administrator on 08/07/23 at 2:24 P.M. revealed on 06/28/23 he received an allegation of abuse from a housekeeper regarding employees abusing Resident #68. The Administrator stated he completed an investigation and made a decision that it was unsubstantiated within 24 hours so felt he did not need to report the allegation of abuse to ODH. Interview with the Director of Nursing (DON) on 08/08/23 at 2:29 P.M. verified the facility did not notify Resident #68's family/POA of the abuse allegations involving Resident #68. Review of the facility policy titled Abuse and Neglect, revised 11/01/22, revealed Hillsdale Country Living will report all allegations of abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property immediately, but not later than two hours after the allegation is made, if the event that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events do not result in serious bodily injury to the Administrator of the facility and to other officials (ODH) in accordance with State law Page 1 of 3 366149 366149 08/09/2023 Williams CO Hillside Country L 09 876 County Rd 16 Bryan, OH 43506

F 0607 Level of Harm - Minimal harm or potential for actual harm through established procedures. Following an investigation, a finalized report will be submitted to the ODH within five working days of the initial report. Notify the resident representative, as applicable, as soon as possible. This deficiency represents non-compliance investigated under Complaint Number OH00144651. Residents Affected - Few 366149 Page 2 of 3 366149 08/09/2023 Williams CO Hillside Country L 09 876 County Rd 16 Bryan, OH 43506

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, review of the facility's Self-Reported Incidents (SRI), and policy review, the facility failed to report an allegation of physical and verbal abuse of a resident to the State Survey Agency, the Ohio Department of Health (ODH). This affected one (Resident #68) of three residents reviewed for abuse. The facility census was 68. Findings include: Review of Resident #68's medical record revealed an admission date of 03/15/21. Diagnoses included Parkinson's disease, dementia, and Alzheimer's disease. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #68 had a low cognitive function and required a two-person assist for all activities of daily living (ADL) except eating. Review of the Administrator's investigation dated 06/28/23 revealed a Housekeeper reported an employee sitting in front of Resident #68 with their legs positioned over the recliner, in order to not allow Resident #68 to get up. The Housekeeper also reported another employee called Resident #68 crazy in front of Resident #68. Review of the facility's SRIs dated 06/28/23 to 08/06/23 revealed there was no allegation of physical and verbal abuse of Resident #68 reported to ODH. Interview with the Administrator on 08/07/23 at 2:24 P.M. revealed on 06/28/2,3 he received an allegation of abuse from a housekeeper regarding employees abusing Resident #68. The Administrator stated he completed an investigation and made a decision that it was unsubstantiated within 24 hours so felt he did not need to report the allegation of abuse to ODH. Review of the facility policy titled Abuse and Neglect, revised 11/01/22, revealed Hillsdale Country Living will report all allegations of abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property immediately, but not later than two hours after the allegation is made, if the event that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events do not result in serious bodily injury to the Administrator of the facility and to other officials (ODH) in accordance with State law through established procedures. Following an investigation, a finalized report will be submitted to the ODH within five working days of the initial report. This deficiency represents non-compliance investigated under Complaint Number OH00144651. 366149 Page 3 of 3