Health inspection·April 4, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on observation, interview and policy review, the facility failed to provide a dignified dining experience for Resident #68. This affected one resident (#68) of one reviewed for dignity. The facility census was 78. Residents Affected - Few Findings include: Review of the medical record for Resident #68 revealed an admission date of 04/27/23 with diagnoses including non-traumatic subarachnoid hemorrhage, muscle weakness, hereditary motor and sensory neuropathy, Alzheimer's disease, hemiplegia affecting right dominant side, dysphagia (difficulty swallowing), and personal history of transient ischemic attack and cerebral infarction. Review of the quarterly Minimum Data Set (MDS) Assessment, dated 01/18/24, revealed Resident #41 had severe cognitive impairment and was dependent on staff for eating assistance. On 04/01/24 at 11:34 A.M., Resident #68 was observed sitting in a chair in the common area by the nurses' station with her lunch tray on a table in front of her. Resident #68 did not attempt to feed herself and no staff attempted to assist her with the meal at that time. On 04/01/24 at 11:47 A.M., State Tested Nurse Aide (STNA) #502 began assisting Resident #68 with eating her meal. STNA #502 stood beside Resident #68 while assisting with feeding. On 04/01/24 at 11:51 A.M., interview with STNA #502 verified she stood beside Resident #68 to provide feeding assistance because it made it easier to go back and forth between residents while assisting with feeding. On 04/03/24 at 2:36 P.M., interview with the Director of Nursing (DON) stated the expectation for staff assisting residents with feeding is that staff would sit next to residents while providing assistance. Review of facility policy titled Assistance with Meals, dated 03/2022, revealed residents who could not feed themselves would be fed with attention to safety, comfort, and dignity, including not standing over residents while assisting them with meals. 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 5 Event ID: 366334 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 366334 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bethany Nursing Home, Inc 626 34th Street, 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)