Health inspection·November 13, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of a video recording, staff interview, record review, and review of the facility policy, the facility failed to treat a resident with respect and dignity. This affected one (Resident #72) of three residents reviewed for dignity and respect. The facility census was 69. Findings include: Record review for Resident #72 revealed an admission date of 08/02/24 and a discharge date of 11/02/24. Diagnoses included dementia, diaphragmatic hernia, and muscle weakness. Review of the Medicare five-day Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #72 was severely cognitively impaired. Resident #72 had clear speech, was able to understand others and was able to make self-understood. Resident #72 had impairment on both sides of lower extremities, was dependent on staff for toileting, bed mobility, moving from a sitting to standing position, and transfers. Review of the video footage provided by the family, dated 10/11/24 at 9:30 A.M., revealed the family had a video camera in Resident #72's room. The video footage showed State Tested Nursing Assistant (STNA) #243 entered Resident #72's room and did not say anything upon entering. Resident #72 was lying in bed with her eyes closed, STNA #243 did not say anything to Resident #72, and pulled Resident #72's blanket down. Then STNA #243 stated to Resident #72 it was time to get up. Resident #72 stated No. After STNA #243 repeated the request for Resident #72 to get up, STNA #243 left the room and immediately returned to the room (time stamp was one second). STNA #243 did not talk to Resident #72, raised Resident #72's bed, removed the blanket covering Resident #72 and began removing her gown. Then STNA #243 stated Hey, you got to get up. The response from Resident #72 was not clear in the video. STNA #243 then removed Resident #72's brief and threw it on the floor. STNA #243 did not provide peri care after removing the old brief or prior to placing a new brief on her. STNA #243 did not talk to Resident #72 and proceed to dress Resident #72 while in bed, pulling at Resident #72's shoulder, arms and legs multiple times to reposition her while dressing her. Resident #72 made moaning sounds during the procedure. After placing Resident #72's pants on, STNA #243 placed Resident #72 on her side to pull the back of her pants up. Resident #72 grabbed the side rail with her right arm. STNA #243 then pulled at Resident #72 right arm and right leg until she released the rail placing her back on her back side. After placing Resident #72's shirt on, STNA #243 lowered the bed, positioned Resident #72's legs over the side of the bed. Resident #72 was viewed stating something to STNA #243 that was not audible. STNA #243 grabbed Resident #72's hands, Resident #72 pulled her hands back towards her chest, away from STNA #243. STNA #243 then grabbed Resident #72's shoulders and quickly pulled her to an upright position. (Resident #72 appeared to be flaccid and not actively participating (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: 366419 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 366419 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twinsburg Post Acute 8551 Darrow Road Twinsburg, OH 44087 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)