Health inspection·August 11, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on record review, facility staff interview and facility policy review, the facility failed to ensure allegations of abuse were reported in a timely manner. This had the potential to affect 62 of 62 residents. Findings included:Review of a self-reported incident (SRI) dated 03/31/25 revealed on 03/29/25 at about 11:30 A.M., a visitor to the facility was heard speaking loudly to Resident #13 and #32, telling them they could not sit at the table they were at and it belonged to her mother and her friends. The visitor told Residents #13 and #32 no one likely them and they had been told before not to sit at this table. Licensed Practical Nurse (LPN) #101 immediately intervened and addressed the visitor who immediately reported the incident to the weekend manager and called the Administrator. After documentation from the weekend was reviewed, it was determined the incident was more than a visitor being rude. Review of a statement by Resident #1 dated 03/31/25 revealed she was sitting at a table when a family member came in and in a loud voice said, we're going to put the tables together and I think you should move. Resident #1 said she couldn't remember if anything else was said but acknowledged this was not the first time that person told her to move. Resident #1 stated she was upset and didn't want to go back to the dining room, and wondered how that person would feel if someone treated their mother like that. Resident #1 was teary-eyed during the interview. Review of a statement by Resident #2 dated 03/31/25 revealed a family member yelled at her and Resident #1 wanting them to move from a table. Resident #2 stated she was mad and didn't like the drama. Review of a witness statement dated 04/01/25 by Activities Staff (AS) #110 revealed she witnessed a family member tell Resident #1 she could not sit at the table she had already been sitting at. AS #110 stated it was very loud and upset Resident #1 who stated she felt bullied. Review of a statement dated 04/01/25 by Staff #113 revealed she walked into the dining room to help residents get set up for lunch, Resident #1 was sitting at a table and a family member started yelling at her and saying, you can't sit here, other people are sitting here, and you don't belong here. The family kept repeating those sentences. A nurse intervened and the family denied saying anything wrong. Review of a statement dated 04/01/25 by Registered Nurse (RN) #132 revealed a family member brings in treats for certain residents to the dining room and once told a resident who didn't eat her treat she could not get one next time. Review of a statement dated 04/01/25 by Certified Nursing Assistant (CNA) #121 revealed a family member brings in food for residents who sit at the same table, some get the food and some do not get the food, leaving some residents feeling left out. The family tried to tell residents where they could or could not sit and has made residents move, has been rude, and has made residents not want to eat in the dining room. Review of a statement dated 04/01/25 by CNA #125 revealed a family member tells residents where they can and can't sit while in the dining area, has been asked not to move the tables together and continues to do so. Residents were beginning to refuse to come to the dining room due to the family member being present. Review of a statement dated 04/03/25 at 12:08 P.M. by CNA #120 revealed she was walking to the dining room to speak to the nurse, and Page 1 of 2 366417 366417 08/11/2025 Copper Knoll Health & Rehab LLC 201 Courthouse Parkway Washingtn C H, OH 43160

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few she was behind a resident and her family. The family member began walking fast to go get a table and approached the table Resident #1 was at and screamed to her saying she could not sit at the table. The family member pointed her finger in Resident #1's face while yelling and did not realized staff were in the area. LPN #101 walked to the family member, who changed her whole attitude, and said the resident didn't need to move tables, but needed to move temporarily to push tables together. Interview on 08/08/25 at 2:50 P.M. with Administrator confirmed the allegation of verbal abuse was not reported in the required timeframe. Review of a policy titled Abuse, Neglect, and Exploitation dated 11/01/23 revealed reporting of all alleged violations to the Administrator, adult protective services, state agency, and all other required agencies will be completed immediately, but no later than two hours after the initial allegation is made if the allegation involves abuse or serious bodily injury, no later than 24 hours if the allegations do not include abuse or result in serious bodily injury. 366417 Page 2 of 2