Health inspection·May 28, 2024

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, observation, review of a facility investigation, and facility policy review, the facility failed to ensure residents were properly transferred by mechanical lift. This affected two residents (#22 and #44) of three residents reviewed for transfers. The facility census was 53. Actual Harm occurred on 05/05/24 when two State Tested Nursing Assistants (STNA's) were transferring Resident #22, who had severely impaired cognition and was dependent on staff for transfers, via mechanical lift to her wheelchair and failed to operate the mechanical lift properly, resulting in Resident #22 falling and sustaining a spiral femur fracture requiring surgery and hospitalization. The resident was assessed to exhibit severe pain with leg movement following the incident and signs/symptoms of pain/distress throughout the morning of 05/06/24 before being transferred to the hospital. Findings included: 1. Record review revealed Resident #22 was admitted to the facility on [DATE] with diagnoses including localized edema, anxiety disorder, Alzheimer's Disease, and polyosteoarthritis. Additional diagnoses added in May 2024 included fracture of unspecified part of neck of left femur, history of falling, altered mental status, pain in left hip, fall from other furniture initial encounter, other acute post-procedural pain, and anemia. Review of a care plan revised on 06/23/21 revealed Resident #22 had an activity of daily living (ADL) self-care performance and mobility deficit related to weakness, right artificial hip, anxiety, lower back pain, and severe cognitive impairment with a goal of participating in self-care to optimum level as evidenced by clean, odor free and dressed daily. Interventions included transfers with a hoyer lift and two staff to get out of bed in the morning and a sit to stand with two person assist for all other transfers. Review of a nursing note dated 05/05/24 at 4:56 P.M. by Licensed Practical Nurse (LPN) #201 revealed at 4:00 P.M. a State Tested Nurse Aide (STNA) came to this nurse to report the hoyer lift had started to tip while transferring resident, STNAs were able to lower resident to the floor slowly while securing the lift. Resident was given a head-to-toe assessment with no injuries noted, then placed into wheelchair, STNAs were given an in-service on hoyer lift safety during transfers for the fall intervention. Review of a nursing note dated 05/06/24 at 6:19 A.M. by Registered Nurse (RN) #221 revealed Resident #22 was showing signs of severe pain when her left leg was moved, with the on-call providers paged twice and no response. After 6:00 A.M. the facility nurse practitioner was notified with orders for (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 4 Event ID: 366300 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 366300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canton Christian Home 2550 Cleveland Avenue NW Canton, OH 44709 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)