Health inspection·February 29, 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. THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Residents Affected - Few Based on record review, staff interview, resident interview, review of the facility's Self-Reported Incident (SRI) 243880 and related investigation materials, the facility failed to ensure Resident #39 was treated with respect and dignity. This affected one (#39) of three residents reviewed. The facility census was 44. Findings Include: Review of the medical record for Resident #39 revealed an admission date of 01/05/23 with diagnoses including heart failure, muscle weakness, scoliosis, spondylosis with myelopathy, atrial fibrillation, hypertension, cerebral infarction, and age-related osteoporosis. Review of the care plan, revised 08/01/23, revealed Resident #39 required assistance with activities of daily living (ADLs). Interventions included cushion to wheelchair while out of bed, pendant call light which resident prefers to keep at bedside instead of wearing it, camera in room per Power of Attorney (POA) request, do not leave unattended in shower, and keep call light in reach. Further review of the care plan revealed Resident #39 had a behavior problem and would refuse care if staff deviated from her preferred timeline. Review of the quarterly Minimum Data Set (MDS) Assessment, dated 01/01/24, revealed Resident #39 had no cognitive impairment and required substantial assistance with ADLs. Review of the physician's orders for February 2024 identified orders for a camera in the room at the request of the POA, pads applied under both breasts, and cushion to wheelchair when out of bed. Review of the facility's self-reported incident (SRI) reference number 243773 and subsequent investigation, dated 02/03/24, revealed the facility determined State Tested Nurse Aide (STNA) #200 was unprofessional and verbally inappropriate with Resident #39. Review of the progress note, dated 02/07/24 at 3:37 P.M., revealed there was an incident over the weekend of Resident #39 being left unattended in her bathroom. Resident #39 stated the incident with the agency nurse was upsetting at the time, but Resident #39 did not feel that safety was an issue and stated her care was generally good as provided by facility staff. Interview on 02/28/24 at 12:00 P.M. with Resident #39 stated STNA #200 yelled at her after STNA Page 1 of 6 366385 366385 02/29/2024 Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087

F 0550 #200 left her in her shower chair for a long time. Level of Harm - Minimal harm or potential for actual harm Interview on 02/28/24 at 12:15 P.M. with the Administrator stated Resident #39's family sent the facility video snippets from the in-room camera regarding the incident. The Administrator stated the video files verified STNA #200 was verbally inappropriate toward Resident #39. Residents Affected - Few The deficient practice was corrected on 02/20/24 when the facility implemented the following corrective actions: • On 02/03/24, STNA #200 was added to the do not return list for agency staffing. • On 02/03/24, a police report was filed regarding the incident. • On 02/03/24, the facility opened a SRI and the incident was thoroughly investigated. • On 02/07/24, all staff were in-serviced on abuse and dignity via the facility's electronic education portal. • On 02/07/24, Resident #39 was offered counseling services related to the incident and she declined such services. • On 02/07/24, agency staff orientation packets were implemented to include a copy of the resident rights and the facility's abuse policy. • Beginning 02/07/24, ongoing weekly audits began to ensure agency staff received orientation packets. • On 02/09/24, Resident #39 was assessed by a physician. This deficiency represents non-compliance investigated under Complaint Number OH00150857. 366385 Page 2 of 6 366385 02/29/2024 Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087

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. THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Residents Affected - Few Based on record review, staff interview, resident interview, review of the facility's Self-Reported Incident (SRI) 243880 and related investigation materials, the facility failed to protect Resident #18 from abuse by a person who was impersonating a scheduled staffing agency worker. This affected one (#18) of three residents reviewed for abuse. The facility census was 44. Findings Include: Review of the medical record for Resident #18 revealed an admission date of 09/18/23 with diagnoses including congestive heart failure, anxiety disorder, major depressive disorder, and unspecified psychosis. Review of the quarterly Minimum Data Set (MDS) Assessment, dated 12/19/23, revealed Resident #18 was cognitively intact and required substantial assistance or total dependence on staff for activities of daily living (ADLs). Review of the behavior care plan, revised on 12/22/23, revealed Resident #18's son reported Resident #18 made up stories and had beliefs in false realities, Resident #18 would not use the call light for assistance, experienced hallucinations and delusions at times, and was accusatory toward staff. Interventions included administer medications as ordered, monitor for medication side effects, explain all procedures prior to starting, discuss behavior and reinforce why behavior was inappropriate, monitor behaviors, and anticipate and meet the resident's needs. Review of the psychiatry note, dated 01/15/24, revealed Resident #18 believed the year to be 1943 and had confusion. The note indicated Resident #18 was evaluated for new onset hallucinations. Review of the nurse aide tasks revealed Resident #18 needed two staff present with all care effective 02/06/24. Review of the progress note, dated 02/06/24 at 7:07 A.M., revealed Resident #18 reported to nursing staff that the STNA was rough during care and a skin tear to the right elbow was identified. Review of the skin evaluation, dated 02/06/24, revealed Resident #18 had a skin tear to the right elbow that was in-house acquired on 02/06/24. Review of the progress note, dated 02/06/24 at 8:29 A.M., revealed Resident #18 told the unit manager that she had been experiencing night terrors and that she had been assaulted by the aide which resulted in a blood bath in the room. Resident #18 accused an aide of beating her on her hands and knees. Resident #18 was unable to state how the skin tear to the right elbow occurred. Review of the progress note, dated 02/07/24 at 3:54 P.M., revealed Resident #18's allegation of abuse had been reported to the police. Review of the psychiatry note, dated 02/20/24, revealed Resident #18 stated she got into it with an 366385 Page 3 of 6 366385 02/29/2024 Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few aide the previous day and the aide dragged her and kept hitting her, and further stated that staff beat her up. The note indicated Resident #18 had skin discoloration consistent with blood thinner use. Resident #18 believed year to be 1944 and had confusion. The note indicated Resident #18 was delusional at times and accusatory toward staff. Review of the facility's self-reported incident (SRI) reference number 243880, dated 02/06/24, revealed Resident #18 alleged an agency aide was rough with her. Resident #18 was assessed at the time of the allegation and a skin tear to the right elbow was identified. Through the course of the facility's investigation, the facility realized that the person (later identified as STNA #201) had impersonated the scheduled agency aide (STNA #202) and worked a shift in the facility. The facility further identified that STNA #201 had recorded Resident #18 on their personal device while providing resident care. As a result of this incident, the facility implemented a policy that all agency aides were required to provide photo identification upon arriving for their scheduled shift. Audits were completed to ensure compliance and the agency staff orientation packet was updated. Both STNA #201 and STNA #202 were added to the facility's do not return list for agency staffing. The facility concluded that abuse had occurred. Interview on 02/28/24 at 12:15 P.M. with the Administrator verified STNA #201 presented herself to the facility as STNA #202 and worked the scheduled agency staffing shift. During the shift, STNA #201 provided incontinence care to Resident #18 which resulted in a skin tear. Through the course of their investigation, the facility identified that STNA #201 had recorded the incontinence care provided to Resident #18 on their personal device. The Administrator stated the facility realized STNA #201 had impersonated STNA #202 when they were shown a picture of STNA #202 and it was not the same person who had worked the shift in their facility. The Administrator said the person who showed up for the shift was an actual STNA, just not the one that was scheduled to be there. She said they later found out that STNA #201 and STNA #202 had planned the switch and they were going to split the money earned for working the shift. Interview on 02/28/24 at 4:03 P.M. with the Administrator stated STNA #201 showed facility staff the video recorded on their personal device, the video was viewed, and the video was promptly deleted from the device and from the cloud storage associated with the device. The Administrator said STNA #201 reported she took the recording to protect herself. The Administrator also reported that was the first time that aide had been scheduled for a shift in the facility. Interview on 02/29/24 at 11:39 A.M. with STNA #204 stated STNA #201 was providing care to Resident #18 and yelled down the hall about audio and video recording. STNA #204 said when she entered Resident #18's room to answer the call light a few minutes later, STNA #201 was recording the resident care she was providing to Resident #18 and Resident #18 accused STNA #201 of assault and tearing her skin. She stated STNA #201 left the room at that time and STNA #204 and Licensed Practical Nurse (LPN) #205 finished resident care for Resident #18. Interview on 02/29/24 at 12:34 P.M. with LPN #205 stated she was at the nurses station with another staff member when she saw STNA #201 enter Resident #18's room to provide resident care. While STNA #201 was in the room, the call light came on and STNA #204 went to provide assistance. She stated STNA #204 came back out and said a nurse was needed in Resident #18's room. She said Resident #18 accused STNA #201 of assaulting her and hitting her, and a skin tear was identified while assessing Resident #18 for injury. LPN #205 said she was aware there was a video recording, but her main priority was caring for Resident #18 at the time of the incident. LPN #205 said she later watched the video STNA #201 had recorded and Resident #18 was crying out in the video and accusing STNA #201 of hurting 366385 Page 4 of 6 366385 02/29/2024 Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087

F 0600 her. Level of Harm - Minimal harm or potential for actual harm On 02/29/24 at 1:04 P.M., an attempt was made to interview Resident #18 regarding the incident that occurred on 02/06/24, however, Resident #18's story about what happened kept changing and there was no consistency. Resident #18 also stated that she sometimes experienced hallucinations. Residents Affected - Few Review of the staff schedules for 02/06/24 revealed STNA #202 was scheduled for the shift that was worked by STNA #201. Review of facility policy titled Abuse, Mistreatment, Neglect, Exploitation and Misappropriation of Resident Property, dated 2016, revealed the facility would ensure the safety of all residents in their facility. The deficient practice was corrected on 02/20/24 when the facility implemented the following corrective actions: • On 02/06/24, Resident #18 was assessed for injury and received treatments as needed. • On 02/06/24, all residents who received care from STNA #201 were interviewed and assessed. • On 02/06/24, a police report was filed for the incident. • From 02/06/24 to 02/07/24, hourly rounds were initiated for Resident #18 for increased supervision. • On 02/07/24, all facility staff were educated on abuse, audio and video recording, resident rights, and resident dignity via the facility's electronic training system. • Both STNA #201 and STNA #202 were added to the do no return list for agency staffing. • Beginning on 02/07/24, all agency staff were required to provide photo identification prior to working their shift at the facility. On-going audits were completed daily to ensure facility staff verified the identity of all agency staff prior to allowing them to work in the facility. • 366385 Page 5 of 6 366385 02/29/2024 Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087

F 0600 Level of Harm - Minimal harm or potential for actual harm On 02/12/24 the facility checked the nurse aide registry, abuse registry, state sex offender registry, and national sex offender registry for STNA #201. This deficiency represents non-compliance investigated under Complaint Number OH00150857. Residents Affected - Few 366385 Page 6 of 6