Health inspection·June 29, 2023

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and text message review the facility failed to ensure all residents were free from abuse. This affected one resident (#4) of six reviewed for abuse. The facility census was 88. Findings include: Review of Resident #4's medical records revealed an admission date of 06/16/23. Diagnoses included traumatic brain injury, dementia and altered mental status. Review of the care plan dated 06/19/23 revealed Resident #4 had an actual fall on 06/16/23 related to poor balance. Intervention to prevent further falls included to determine factors of the fall. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #4 had intact cognition. Resident #4 required limited assistance with transfers, toileting and personal hygiene. Interview on 06/26/23 at 2:06 P.M. with Activities Aide (AA) #205 revealed on 06/20/23 between 4:00 P.M. and 5:00 P.M. she heard and observed Licensed Practical Nurse (LPN) #217 say to Resident #4 If you make my life hard, I'll make yours harder. AA #205 stated as LPN #217 was making the comment her face was extremely close to Resident #4's face and LPN #217 slapped the back of one of her hands into the palm of the other hand. AA #205 stated the comment was made because Resident #4 wanted to go to the dining room for dinner and LPN #217 did not want Resident #4 to go to the dinning room for dinner; LPN #217 was worried if Resident #4 went to the dining he might fall. AA #205 stated the comment was overheard by State Tested Nursing Assistant (STNA) #213. AA #205 stated she immediately sent a text message to her supervisor, Activities Director (AD) #206, to report what she had witnessed. AA #205 stated AD #206 advised AA #205 to report the incident immediately to the Director of Nursing (DON) and the Administrator. Interview on 06/27/23 at 8:03 A.M. with STNA #213 revealed on 06/20/23 between 4:00 P.M. and 5:00 P.M. he was walking down the hallway and overheard LPN #217 screaming at Resident #4. STNA #213 said he overheard LPN #217 say If you make my life hard, I'll make yours harder. STNA #213 stated he immediately reported the incident to the DON. Interview on 06/27/23 at 10:11 A.M. with Resident #4 revealed he could not recall the incident on 06/20/23. On 06/27/23 at 11:30 A.M. review of text messages with AA #205 revealed a text message sent to AD #206 at 4:20 P.M. that stated AA #205 witnessed LPN #217 screaming at Resident #4. A text message sent at 4:21 P.M. from AA #205 to AD #206 stated LPN #217 told Resident #4 You make my life hard, I'll make your life harder. Page 1 of 8 366491 366491 06/29/2023 Strongsville Healthcare and Rehabilitation 18936 Pearl Road Strongsville, OH 44136

F 0600 This deficiency represents non-compliance investigated under Complaint Number OH00143448. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 366491 Page 2 of 8 366491 06/29/2023 Strongsville Healthcare and Rehabilitation 18936 Pearl Road Strongsville, OH 44136

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, text message review, and facility policy and procedure review the facility failed to ensure an incident of potential abuse was reported to the State agency as required. This affected one resident (#4) of six residents reviewed for abuse. The facility census was 88. Findings include: Review of Resident #4's medical record revealed an admission date of 06/16/23. Diagnoses included traumatic brain injury, dementia and altered mental status. Review of the care plan dated 06/19/23 revealed Resident #4 had an actual fall on 06/16/23 related to poor balance. Intervention included determine factors of the fall. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #4 had intact cognition. Resident #4 required limited assistance with transfers, toileting and personal hygiene. Interview on 06/26/23 at 2:06 P.M. with Activities Aide (AA) #205 revealed on 06/20/23 between 4:00 P.M. and 5:00 P.M. she heard and observed Licensed Practical Nurse (LPN) #217 say to Resident #4 If you make my life hard, I'll make yours harder. AA #205 stated as LPN #217 was making the comment her face was extremely close to Resident #4's face and LPN #217 slapped the back of one hand into the palm of her other hand. AA #205 stated the comment was made because LPN #217 was upset Resident #4 wanted to go to the dinning room for dinner and was worried Resident #4 could fall because he was a fall risk and had a recent fall. AA #205 stated the comment was overheard by State Tested Nursing Assistant (STNA) #213. AA #205 stated she immediately sent a text message to her supervisor, Activities Director (AD) #206, to report what she had witnessed. AA #205 stated AD #206 advised AA #205 to report the incident immediately to the Director of Nursing (DON) and the Administrator. AA #205 stated she reported the incident to the unit manager as well as the Administrator. AA #205 further stated the Administrator took pictures of the text messages she had sent to AD #206. Interview on 06/26/23 at 2:32 P.M. with AD #206 revealed on 06/20/23 at approximately 4:30 P.M. she received text messages from AA #205 regarding an incident that occurred between LPN #217 and Resident #4. AD #206 stated AA #205 immediately reported the incident to the DON and Administrator because AD #206 was not present in the building when the incident occurred. Interview on 06/27/23 at 8:03 A.M. with STNA #213 revealed on 06/20/23 between 4:00 P.M. and 5:00 P.M. he was walking down the hallway and he had overheard LPN #217 screaming at Resident #4 and had overheard LPN #217 say If you make my life hard, I'll make yours harder. STNA #213 stated he had immediately reported the incident to the DON. Interview on 06/27/23 at 10:11 A.M. with Resident #4 revealed he could not recall the incident on 06/20/23. Review of the facility's Self Reported Incidents (SRI) revealed no SRI's were reported to the State agency. Interview on 06/27/23 at 10:41 A.M. with the Administrator and Assistant Director of Nursing (ADON) revealed they had been made aware by AA #205 of an inappropriate interaction that occurred on 06/20/23 at approximately 4:00 P.M.- 5:00 P.M. between LPN #217 and Resident #4. The Administrator said 366491 Page 3 of 8 366491 06/29/2023 Strongsville Healthcare and Rehabilitation 18936 Pearl Road Strongsville, OH 44136

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few AA #205 reported LPN #217's tone of voice was inappropriate but they were not aware of the actual comment made or the slap of the hands. The Administrator and ADON had spoken with LPN #217 who had denied an inappropriate interaction had occurred. The Administrator stated she had spoken with Resident #4 who had no concerns related to the interaction. On 06/27/23 at 11:30 A.M. review of text messages with AA #205 revealed a text message sent to AD #206 at 4:20 P.M. that indicated AA #205 witnessed LPN #217 screaming at Resident #4. A text message sent at 4:21 P.M. from AA #205 to AD #206 indicated LPN #217 told Resident #4 You make my life hard, I'll make your life harder. A text message sent at 4:22 P.M. from AD #206 to AA #205 provided direction to inform the Administrator immediately. A text message sent at 4:49 P.M. from AA #205 to AD #206 indicated the Administrator had taken pictures of the text messages that had been sent and AA #205 indicated I'm not sure what they're planning to do or if they do anything. Review of facility policy and procedure titled Abuse Prohibition revised 10/22 revealed all alleged violations involving abuse were to be reported immediately, but no later than two hours after the allegation was made to the State Agency. This deficiency represents non-compliance investigated under Complaint Number OH00143448. 366491 Page 4 of 8 366491 06/29/2023 Strongsville Healthcare and Rehabilitation 18936 Pearl Road Strongsville, OH 44136

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, text message review and facility policy and procedure review, the facility failed to ensure all incidents of potential abuse were thoroughly investigated. This affected one resident (#4) of six reviewed for abuse. The facility census was 88. Residents Affected - Few Findings include: Review of Resident #4's medical record revealed an admission date of 06/16/23. Diagnoses included traumatic brain injury, dementia and altered mental status. Review of the care plan dated 06/19/23 revealed Resident #4 had an actual fall on 06/16/23 related to poor balance. Intervention included determine factors of the fall. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #4 had intact cognition. Resident #4 required limited assistance with transfers, toileting and personal hygiene. Interview on 06/26/23 at 2:06 P.M. with Activities Aide (AA) #205 revealed on 06/20/23 between 4:00 P.M. and 5:00 P.M. she heard and observed Licensed Practical Nurse (LPN) #217 say to Resident #4 If you make my life hard, I'll make yours harder. AA #205 stated as LPN #217 was making the comment her face was extremely close to Resident #4's face and LPN #217 slapped the back of one hand into the palm of her other hand. AA #205 stated the comment was made because LPN #217 was upset Resident #4 wanted to go to the dinning room for dinner and was worried Resident #4 could fall because he was a fall risk and had a recent fall. AA #205 stated the comment was overheard by State Tested Nursing Assistant (STNA) #213. AA #205 stated she immediately sent a text message to her supervisor, Activities Director (AD) #206, to report what she had witnessed. AA #205 stated AD #206 advised AA #205 to report the incident immediately to the Director of Nursing (DON) and the Administrator. AA #205 stated she reported the incident to the unit manager as well as the Administrator. AA #205 further stated the Administrator took pictures of the text messages she had sent to AD #206. Interview on 06/26/23 at 2:32 P.M. with AD #206 revealed on 06/20/23 at approximately 4:30 P.M. she received text messages from AA #205 regarding an incident that occurred between LPN #217 and Resident #4. AD #206 stated AA #205 immediately reported the incident to the DON and Administrator because AD #206 was not present in the building when the incident occurred. Interview on 06/27/23 at 8:03 A.M. with STNA #213 revealed on 06/20/23 between 4:00 P.M. and 5:00 P.M. he was walking down the hallway and he overheard LPN #217 screaming at Resident #4. LPN #217 said If you make my life hard, I'll make yours harder. STNA #213 stated he immediately reported the incident to the DON. Interview on 06/27/23 at 10:11 A.M. with Resident #4 revealed he could not recall the incident on 06/20/23. Interview on 06/27/23 at 10:41 A.M. with the Administrator and Assistant Director of Nursing (ADON) revealed they had been made aware by AA #205 of an inappropriate interaction that had occurred on 06/20/23 at approximately 4:00 P.M.- 5:00 P.M. between LPN #217 and Resident #4. The Administrator said AA #205 reported LPN #217's tone of voice was inappropriate. The Administrator and ADON denied they had been made aware of the comment or the slap of the hands. They spoke with LPN #217 who had denied an inappropriate interaction had occurred. The Administrator stated she spoke with Resident #4 who had no concerns related to the interaction and no further investigation had been done. 366491 Page 5 of 8 366491 06/29/2023 Strongsville Healthcare and Rehabilitation 18936 Pearl Road Strongsville, OH 44136

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 06/27/23 at 11:30 A.M. review of text messages with AA #205 revealed a text message sent to AD #206 at 4:20 P.M. that indicated AA #205 witnessed LPN #217 screaming at Resident #4. A text message sent at 4:21 P.M. from AA #205 to AD #206 indicated LPN #217 told Resident #4 You make my life hard, I'll make your life harder. A text message sent at 4:22 P.M. from AD #206 to AA #205 provided direction to inform the Administrator immediately. A text message sent at 4:49 P.M. from AA #205 to AD #206 indicated the Administrator took pictures of the text messages and I'm not sure what they're planning to do or if they do anything. Review of facility policy and procedure titled Abuse Prohibition revised 10/22 revealed all allegations of abuse were to be reported immediately and thoroughly investigated. This deficiency represents non-compliance investigated under Complaint Number OH00143448. 366491 Page 6 of 8 366491 06/29/2023 Strongsville Healthcare and Rehabilitation 18936 Pearl Road Strongsville, OH 44136

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, review of manufacturer guidelines, and record review, the facility failed to ensure insulin pens were dated after opening. This affected four residents (#6, #65, #82 and #85) of six observed for insulin medications. The facility census was 88. Finding include: Observation of a medication cart on 06/28/23 at 10:30 A.M. with Licensed Practical Nurse (LPN) #219 revealed Resident #6's and #82's Lantus insulin pens were opened and undated, and Resident #85's Toujeo and Aspart insulin pens were opened and undated. Interview with LPN #219 at the time of the observations verified the insulin pens were undated . LPN #219 stated insulin should be dated upon opening. Observation of another medication cart on 06/28/23 at 10:58 A.M. with LPN #218 revealed Resident #12's and #65's Humalog pens were opened and undated. Interview with LPN #218 at the time of the observation verified the insulin pens were undated. LPN #218 stated insulin should be dated upon opening. Interview on 06/28/23 at 1:54 P.M. with the Director of Nursing (DON) confirmed insulin was to be dated upon opening. Review of Lantus manufacturer guidelines dated 2022 revealed Lantus insulin should be discarded after 28 days of opening. Review of Humalog manufacturer guideline dated 04/2020 revealed Humalog insulin should be discarded after 28 of opening. Review of Novolog (Insulin Aspart) manufacturer guideline dated 02/23 revealed Novolog insulin should be discarded after 28 of opening. Review of Resident #6's medical record revealed an admission date of 05/04/23. Diagnoses included diabetes. Review of Resident #6's current physician orders for June 2023 revealed Resident #6 was ordered Lantus (long acting insulin) 24 units at bedtime. Review of Resident #65's medical records revealed an admission date of 03/31/22. Diagnoses included diabetes. Review of Resident #65's current physician orders for June 2023 revealed Resident #65 was ordered Humalog (fast acting insulin) before meals and at bedtime. Review of Resident #82's medical records revealed an admission date of 05/29/23. Diagnoses included diabetes. Review of Resident #82's current physician orders for June 2023 revealed Resident #82 was ordered Lantus 40 units at bedtime. Review of Resident #85's medical records revealed an admission date of 05/04/23. Diagnoses included diabetes. Review of Resident #85's current physician orders for June 2023 revealed Resident #85 was ordered Insulin Aspart (fast acting insulin) with meals. 366491 Page 7 of 8 366491 06/29/2023 Strongsville Healthcare and Rehabilitation 18936 Pearl Road Strongsville, OH 44136

F 0761 This deficiency represents non-compliance investigated under Complaint Number OH00144104. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 366491 Page 8 of 8