Inspection·June 16, 2025

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Residents Affected - Few Based on observation, interview, record review, review of facility self-reported incidents (SRI) and facility policy review, the facility failed to ensure Resident #4 was free from misappropriation. This affected one resident (#4) of three residents reviewed for abuse, neglect and misappropriation of property. The facility census was 44. Findings include: Review of the medical record revealed Resident #4 was admitted to the facility on [DATE] with diagnoses that included dementia, recurrent urinary tract infection (UTI), chronic kidney disease, atrial fibrillation and peripheral vascular disease. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #4 was cognitively impaired and required extensive assistance with activities of daily living. Review of a facility self-reported incident (SRI) control number 260103 dated 05/06/25 revealed Resident #4's daughter had called the facility and notified them that a check had been written from Resident #4's account in the amount of $3,225.00 dollars. The check was written to a former employee who had attempted to deposit the check. Resident #4's daughter had been notified by the bank of the attempted deposit. The SRI referenced that the police were involved and were investigating. The facility substantiated that misappropriation occurred. Review of the facility's SRI investigation dated 05/06/23 revealed on 05/06/25 the Resident #4's daughter was notified by the bank that check #4413 was attempted to be deposited on 05/02/25 by mobile deposit and was pending. On 05/06/25 at 3:30 P.M. Resident #4's daughter notified the facility of the incident. The facility filed a SRI and notified the local police department. The check was dated 05/02/25 and was made out to former Certified Nursing Assistant (CNA) #100 with a signature of Resident #4. The back of the check was signed by STNA #100 and there was a handwritten statement that the check was for mobile deposit only. Review of the CNA #100's employee status revealed she was hired on 02/09/24 and terminated on 01/19/25 for unrelated attendance concerns. Review of the local police report dated 05/06/25 revealed the police arrived at the facility at 4:53 P.M. and filed a report of theft with a note stating Resident #4 had a check stolen from her room. Interview on 06/12/25 at 11:10 A.M. with Resident #4's daughter stated a former CNA had taken one (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: 366266 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 366266 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Enniscourt Nursing Care 13315 Detroit Ave Lakewood, OH 44107 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)