Health inspection·February 13, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Based on record review and interview, the facility did not ensure Resident #51 was not verbally abused by a nurse. This affected one resident (#51) of three residents reviewed for abuse. The facility census was 53. Residents Affected - Few Findings include: Review of the medical record for Resident #51 revealed an admission date of 04/17/23 with diagnoses including cerebral infarction, chronic obstructive pulmonary disease, atherosclerotic heart disease, chronic systolic congestive heart failure, cerebral aneurism non ruptured and hyperlipidemia. Review of the comprehensive Minimum Data Set (MDS) 3.0 assessment, dated 12/26/23, revealed the resident had a Brief Mental Status score of 15 out of 15 indicating intact cognition. Resident #51 had no behavioral problems, hallucinations, or delusions. Review of the Self Reported Incident (SRI), dated 01/28/24, revealed on 01/27/24, the daughter of Resident #51 reported to the facility Licensed Practical Nurse (LPN) on duty that she was very upset by the way her mother had been spoken to by LPN #105 on 01/26/24. Resident #51's daughter stated her mother, Resident #51, reported to her she had been called stupid and ignorant by LPN#105 upon receiving her evening medications. The LPN who received the allegation immediately notified the Director of Nursing (DON) who reported the incident to the facility Administrator. The facility Administrator submitted a Self Reported Incident on 01/28/2024. LPN #105 was not on duty at the time of the allegation and was not scheduled to work again until 01/29/24 at 2:00 P.M. The facility Administrator, DON, and Assistant DON interviewed Resident #51 on 01/29/24 at 9:40 A.M. During the interview, Resident #51 stated she had asked LPN #105 if her Klonopin medication was included with her medication administration and the responce from LPN#105 was Are you just stupid? Resident #51 stated she asked why she would say that and LPN #105 responded are you just dumb or retarded? You have asked me this before and I have told you that you get this medication routinely. Resident #51 stated sometimes I forget things, I have dementia. Resident #51 stated LPN #105 then went on to care for her roommate. LPN #105 later returned, got into her face and told her you don't have dementia, I looked it up. She then stated LPN #105 began questioning her why she was getting so much pain medication which Resident #51 did not understand why she was being asked this. The facility Administrator, DON, and Assistant DON then interviewed Resident #51's daughter on 1/29/24 at 10:30 A.M. who reported her mother informed her while she was visiting on 01/27/24 LPN #105 had called her stupid and retarded when she asked a question about her medications and the nurse was not very nice. Resident #51's daughter then explained the nurse had been rude to her on the day of her mother's admission to the facility. The daughter requested to speak to the facility nurse directly and was informed by administration they would be investigating and would address LPN #105. The facility requested the daughter provide a written Page 1 of 3 366191 366191 02/13/2024 Maplecrest Nursing and Hta 400 Sexton Street Struthers, OH 44471

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few statement which she did. The facility Administrator, DON, and Assistant DON interviewed LPN#105 on 01/29/24 at approximately 11:00 A.M. LPN #105 denied making any of the alleged statements or having any wrongdoing in this matter. LPN #105 stated she did not know of any reason why this resident would make up this allegation and has not had any negative interactions with the resident. When LPN #105 was asked if she had ever made a comment about or referred to a resident as retarded, she did admit she had said this in the presence of other staff members. LPN #105 was informed she was being suspended pending full investigation of the incident. A written statement regarding the incident was requested from and provided by LPN #105. Resident #51's roomate, Resident #29, when interviewed by staff reported she did hear LPN #105 call Resident #51 stupid and ask her about pain medications. Review of the written statement taken from Resident #51 after the incident revealed LPN #105 was giving medications to her and she asked LPN #105 about her pain medication Klonopin and if it was included in the medications she was receiving at this time. LPN #105 responded Are you just stupid? Resident #51 responded why? LPN #105 then responded, Are you just dumb or retarded? You have asked me this before and I have told you that you get this medication routinely Resident #51 responded sometimes I forget things, I have dementia. LPN #105 then went to another resident's room to care for her. LPN #105 then came back to Resident #51's room a few minutes later, got down close to her face, and said you don't have dementia, I looked it up than began questioning why Resident #51 was getting so much pain medication, which Resident #51 did not understand why LPN #105 was asking her this. The facility substantiated the allegation of abuse after the investigation was verified by evidence. The facility terminated LPN #105's employment while she remained on suspension during the investigation. Further review of the facility investigation and follow-up actions to the incident revealed a list of 72 staff members of which 53 had evidence via staff signatures and/or written acknowledgment of on-line training on the topic Elder Abuse: what you need to know or F600 Freedom from abuse, neglect and exploitation for the date range of training completion 01/31/24 through 02/13/24. Two of the 72 staff members were marked as on leave of absence at the time of the training and one was marked as no longer employed at the facility. In addition to the interviews with Resident #51 and #29, the facility staff interviewed 20 additional interviewable residents with no findings of verbal abuse. There was no evidence in the facility investigation that non-interviewable residents had skin assessments performed on them to ensure no form of abuse had occured with them. On 02/05/24, as part of a quality assurance audit, 19 interviewable residents were interviewed for concerns or instances of verbal abuse and no issues were identified during the interviews. An interview was conducted on 02/13/24 at 2:45 P.M., with Resident #51 who confirmed the statement she gave to the facility. Resident #51 verified she felt she was verbally abused when LPN #150 asked her if she was stupid, dumb or retarded. An interview with LPN #150 was unable to be completed, as she could not be reached for comment. An interview was conducted on 02/13/24 at 3:01 P.M. with the Administrator who verified LPN #150 was terminated from the facility due to substantiated verbal abuse of Resident #51. The Administrator verified he had submitted all evidence of corrective actions taken to the surveyor for review as of 02/13/24. Review of facility policy titled Abuse Policy and Procedure, undated, stated the facility will not condone resident abuse by anyone, including staff members and described verbal abuse as any use of 366191 Page 2 of 3 366191 02/13/2024 Maplecrest Nursing and Hta 400 Sexton Street Struthers, OH 44471

F 0600 Level of Harm - Minimal harm or potential for actual harm oral, written or gestured language that includes disparaging and derogatory terms to the resident or their families or within their hearing distance, to describe residents, regardless of their age, ability to comprehend or disability. This deficiency represents non-compliance investigated under Complaint Number OH00150429. Residents Affected - Few 366191 Page 3 of 3