Health inspection·May 21, 2025

F 0567 Honor the resident's right to manage his or her financial affairs. Level of Harm - Minimal harm or potential for actual harm Based on staff interview, records review and resident family interview, the facility failed to have written authorization to handle resident funds. This affected one (Resident #22) of five residents reviewed for funds. The facility census was 39. Residents Affected - Few Findings include: Record review of Resident #22 revealed an admission date of 06/22/24 with pertinent diagnoses of: metabolic encephalopathy, major depressive disorder, cognitive communication deficit, vascular dementia, and hypertension. Review of the 02/18/25 quarterly Minimum Data Set (MDS) assessment revealed the resident was moderately cognitively impaired. Review of the resident fund management service document dated 03/10/25 revealed Resident #22's power of attorney gave verbal consent for the facility to handle Resident #22 funds. Interview with Admissions #103 on 05/21/25 at 11:56 A.M. revealed she handles resident funds and she stated she did not have written authorization to handle Resident #22 funds only a verbal consent. Interview with Resident #22 power of attorney on 05/21/25 at 1:47 P.M. revealed she does not recall ever giving consent written or verbally for the facility to handle Resident #22 funds. Page 1 of 11 366496 366496 05/21/2025 Allbridge Rehabilitation and Nursing Center 5500 East Broad Street Columbus, OH 43213

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 medical record review, review of the self reported incident, staff interview and review of the facility policy and procedure, the facility failed to report the alleged verbal abuse in a timely manner. This affected one (Resident #20) of one reviewed for self reported incidents. The census was 39. Findings include: Review of Resident #20's medical record revealed she was admitted to the facility on [DATE]. Diagnoses included encephalopathy, diabetes, Chronic kidney disease, alcohol abuse, restlessness and agitation, depression and mixed anxiety, delirium and psychotic disorder with hallucinations. Review of the quarterly minimum data set (MDS) assessment dated [DATE] revealed her cognition was moderately impaired. Review of the Self Reported Incident (SRI) dated 05/10/25 revealed on 05/07/25 at approximately 8:50 A.M. a day shift staff member approached the administrator and reported the resident had informed her a night shift aide had called her a Bitch. Both the staff member and resident were interviewed. According to the resident she stated Someone came into my room, and I said get out of here and she said We want to talk and I said what's there to talk about and she called me a bitch. She did not identify Certified Nurses Aide (CNA) #190 by name , but described her by height. No specific time of the alleged incident was noted. According to CNA #190, she checked on the resident several times during the night and each time she was sleeping. CNA #190 stated that between 6:30 A.M. and 6:45 A.M. she entered the residents room to pass ice, and at that time, she was still asleep. She reported she did not speak to the resident. Other residents were interviewed, and all denied any verbal abuse occurring in the facility. Staff members who worked during the shift were interviewed and all denied witnessing any interaction between the resident and staff. Upon discovery of the allegation, CNA #190 was immediately suspended pending investigation. 05/21/25 9:47 A.M. Interview with the Administrator revealed there was a delay in submitting the SRI due to an oversite. Review of the facility Abuse, Neglect, Exploitation and Misappropriation of resident Property policy and procedure last revision date 10/27/17 revealed the facility will submit and online Self-Reported-Incident form in accordance with the Ohio Department of Health (ODH) then current instructions. 366496 Page 2 of 11 366496 05/21/2025 Allbridge Rehabilitation and Nursing Center 5500 East Broad Street Columbus, OH 43213

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Review of medical record for Resident #11 revealed an admission date of 01/12/24. Medical diagnoses included cognitive communication deficit, traumatic subdue hemorrhage, hypertension, arteriosclerotic heart disease, unspecified psychosis, alcohol abuse, major depressive disorder, and anxiety disorder. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 03/15/25 revealed the resident had a coded diagnoses of Anxiety, Depression, and Psychotic Disorder. Review of Resident #11 PASARR document dated 01/17/24, indicated no for mental health diagnoses and no diagnosis of substance use related disorder. Interview on 05/20/25 at 09:54 A.M. with Social Service staff #195 confirmed the PASARR documents for Resident #11 need to be updated to accurately reflect his diagnoses. 4. Record review of Resident #26 revealed an admission date of 11/07/23 with pertinent diagnoses of: anoxic brain damage, cerebral atherosclerosis, contracture right and left hand, muscle wasting, HIV, major depressive disorder, chronic embolism and thrombosis, cognitive communication deficit, anxiety disorder, sickle cell disease, insomnia, psychotic disorder with hallucinations, and acute kidney failure. Review of the 11/20/23 pre-admission screening and resident review (PASARR) on 05/19/25 at 9:23 A.M. revealed there was no anxiety or psychotic disorder with hallucinations diagnoses listed on the PASARR screening. Review of the medical record on 05/19/25 revealed Resident #26 had diagnoses of anxiety disorder on 11/07/23, and psychotic disorder with hallucinations dated 07/05/24. Interview with Social Services Designee #195 on 05/20/25 at 10:57 A.M. verified Resident #26 did not a diagnosis of psychotic disorder with hallucinations or anxiety listed on the 11/20/23 PASARR and it had not been updated with the correct diagnoses. Based on staff interview and record review, the facility failed to have accurate diagnoses on the pre-admission screening and resident review (PASARR) when submitted. This affected four of four (Resident #11, #20, #26 and #31) residents reviewed for PASARR. The facility census was 39. Findings include: 1. Review of Resident #20's medical record revealed she was admitted to the facility on [DATE]. Diagnoses included encephalopathy, diabetes, chronic kidney disease, alcohol abuse, dementia, restlessness and agitation, depression and mixed anxiety, delirium and psychotic disorder with hallucinations. Review of the PASARR dated 11/10/24 revealed no dementia or psychiatric diagnoses. On 05/20/25 at 10:00 A.M. interview with Social Service Designee #195 revealed the residents diagnoses were not indicated on PASARR dated 10/11/24. 2. Review of Resident #31's medical record revealed he was admitted to the facility on [DATE]. 366496 Page 3 of 11 366496 05/21/2025 Allbridge Rehabilitation and Nursing Center 5500 East Broad Street Columbus, OH 43213

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Diagnoses included diabetes, chronic obstructive pulmonary, alcohol abuse, pericardial effusion and spinal stenosis. Review of the PASARR dated 10/11/24 revealed alcohol abuse was not indicated on the PASSAR. On 05/20/25 at 10:00 A.M. interview with Social Service Designee #195 revealed the diagnosis was not indicated on PASARR dated 10/11/24. 366496 Page 4 of 11 366496 05/21/2025 Allbridge Rehabilitation and Nursing Center 5500 East Broad Street Columbus, OH 43213

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure the plan of care included services for checking the dialysis port site. This affected one (Resident #9) of one resident reviewed for dialysis. The census was 39. Findings include: Review of Resident #9's medical record revealed she was admitted to the facility 05/18/23. Diagnoses included diabetes, renal dialysis with left AV (abnormal connection between an artery and a vein, often created surgically for dialysis access in patients with kidney disease) fistula, high blood pressure, major depression and morbid obesity. Review of the annual minimum data set (MDS) assessment dated [DATE] revealed her cognition was intact. Further review revealed physicians orders for 01/03/24 to check for bruit (Listen for a sound called a ' bruit ' near the fistula incision site. A ' bruit ' is a whooshing sound. You may need to use a stethoscope to hear the ' bruit ' )/thrill (A thrill or buzz is like a vibration caused by blood flowing through the fistula and can be felt by placing your fingers just above your incision line) every shift and document every shift. Review of the plan of care dated 11/18/24 failed to identify monitoring of the bruit and thrill every shift. On 05/21/25 at 12:11 P.M. interview with Regional Director of Clinical Services #119 verified the plan of care does not identify to check the thrill and bruit. 366496 Page 5 of 11 366496 05/21/2025 Allbridge Rehabilitation and Nursing Center 5500 East Broad Street Columbus, OH 43213

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, resident interview, staff interview and test tray, the facility failed to maintain palatable and appetizing food temperatures. This had the potential to affect all but three (Resident #12, #21 and #26) who do not receive a meal tray from the kitchen. The census was 39. Residents Affected - Some Findings include: Review of Resident #7's medical record revealed he was admitted to the facility on [DATE]. Diagnoses included right and left above knee amputation, mild intellectual disability, diabetes, peripheral vascular disease, congestive heart failure, anxiety, chronic kidney disease Stage 3 and hypertensive heart disease. Review of the quarterly minimum data set assessment dated [DATE] revealed his cognition was intact. He required set up or clean up assistance with eating. Interview on 05/18/25 at 11:04 A.M. with Resident #7 revealed the food is hard, burnt and cold most of the time. 2. Record review of Resident #28 revealed an admission date of 09/09/24 with pertinent diagnoses of: chronic obstructive pulmonary disease, pancytopenia, cognitive communication deficit, nicotine dependence, anemia, alcohol abuse, hypertension, major depressive disorder, alcohol dependence with alcohol abuse induced sleep disorder, chronic fatigue, insomnia, myopia, insomnia, right foot burn, hypotension, third degree hemorrhoids, right shoulder injury, cocaine abuse, cannabis abuse, phylogenic arthritis, anxiety disorder. Interview with Resident #28 on 05/18/25 at 2:38 P.M. revealed the food is cold. On 05/21/25 at 8:52 A.M. a test tray was sent to the floor on the cart. At 8:59 A.M. all hall trays were passed. Temperatures were tested for the eggs and were at 100 degrees Fahrenheit , biscuits and sausage gravy was at 100 degrees Fahrenheit, and milk was at 50 degrees Fahrenheit. The food is cold to taste and milk is palatable. This was verified at the time of the observation with Regional Director of Dietary Services #124. 366496 Page 6 of 11 366496 05/21/2025 Allbridge Rehabilitation and Nursing Center 5500 East Broad Street Columbus, OH 43213

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to store, prepare, distribute and serve food under sanitary conditions. This had the potential to affect all but three (Resident #12, #21 and #26) who do not receive a meal tray from the kitchen. The census was 39. Findings include: 1. On 05/19/25 at 11:20 A.M. Observation of [NAME] #134 revealed she washed her hands and put on gloves and took the food out of the steamer and oven. Removed her gloves and put on new gloves without washing her hands. Then she temped the food, placed two pieces of Salisbury steak and gravy in robo [NAME] and pureed, washed it out and placed two serving of carrots and butter and pureed. [NAME] #134 then removed one glove and put on a new glove without washing hands. 11:35 A.M. this was verified during interview with [NAME] #134 during interview. 2. On 05/20/25 at 11:48 A.M. observations revealed Dietary Supervisor #101 washes his hands and puts on gloves and starts to prepare the resident plates, plates were observed stored wet and were being used for the meal. This verified with Regional Director of Dietary Services #124 on 05/20/25 at 11:52 A.M. 3. On 05/21/25 at 8:16 A.M. observed the following in the kitchen: 1. Walls with food splatter 2. Doors with food splatter 3. The steamer and stove with dried food splatter and food particles on top of the steamer. 4. The floor between between the stove and steamer with a dark build up 5. The trash can lid was on the floor. 6. Black build up between the wall and the ice machine. 7. Food splatter on the wall under the hand washing sink by the dishwasher area. On 05/21/25 at 8:25 A.M. this was verified with Regional Director of Dietary Services. 366496 Page 7 of 11 366496 05/21/2025 Allbridge Rehabilitation and Nursing Center 5500 East Broad Street Columbus, OH 43213

F 0851 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. Based on staff interview and document review the facility failed to timely submit at least quarterly the Payroll Based Journal (PBJ) staffing information for quarter one of 2025 to Centers for Medicare and Medicaid Services (CMS). This affected all 39 residents in the building. Findings include: Review of the PBJ Staffing Data Report [NAME] Report 1705 run date 05/08/25 for quarter one of 2025 (10/01/24 to 12/31/24) revealed the facility failed to submit staffing data for the quarter. Interview with Regional Director of Clinical Operations #119 on 05/20/25 at 02:34 P.M. verified corporate did not report their PBJ staffing. The corporate was under the assumption they did not have to report until they had their first star rating after their first annual survey. 366496 Page 8 of 11 366496 05/21/2025 Allbridge Rehabilitation and Nursing Center 5500 East Broad Street Columbus, OH 43213

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on interview, review of personnel files, review of the tuberculosis (TB) risk assessment, and review of facility policies the facility failed to fully complete the TB risk assessment and failed to test staff according to their TB risk assessment. This had the potential to affect 39 of 39 residents residing in the facility. Residents Affected - Many Findings include: Review of the facility's TB risk assessment worksheet, dated 04/01/25 revealed under risk classification the facility put 'not applicable' next to how many inpatient beds are in your inpatient setting? They did not indicate how many patients with TB they had encountered in the last year and did not indicate their risk level. The facility indicated healthcare workers would be tested for TB upon hire and annually. Review of the personnel file for Licensed Practical Nurse (LPN) #107 revealed a hire date of 03/02/24, she did not have an annual TB test. Review of the personnel file for State Tested Nursing Assistant (STNA) #126 revealed a hire date of 11/02/23, she did not have an annual TB test. Review of the personnel file for STNA #138 revealed a hire date of 03/03/25. STNA #138's initial TB test was not begun until 05/19/25 when the test was initiated, the results had not yet been read. Interview on 05/21/25 at 2:50 P.M. with the Administrator verified STNA #138's initial Mantoux test was not completed timely Interview on 05/21/25 at 2:58 P.M. with Regional Director of Clinical Operations #119 verified the TB risk assessment was not completed. She reported she thought the inpatient section only had to be completed if you had TB in house. Verified the risk assessment did not indicate what level of risk they were. She additionally verified they had not been doing annual TB tests as the risk assessment indicated. Review of the policy' Tuberculosis Infection Control Program' dated January 2012, revealed screening and surveillance of residents and employees for latent tuberculosis infection and active TB as appropriate for the current TB risk classification. 366496 Page 9 of 11 366496 05/21/2025 Allbridge Rehabilitation and Nursing Center 5500 East Broad Street Columbus, OH 43213

F 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm Based on observation, resident interview, record review, and staff interview, the facility failed to have functioning call lights in two rooms. This affected two (Resident #14 and #21) of six residents reviewed for environment. The facility census was 39. Residents Affected - Few Findings include: 1. Record review of Resident # 14 revealed an admission date of 01/27/25 with pertinent diagnoses of schizophrenia, metabolic encephalopathy, congestive heart failure, and insomnia. Review of the 02/03/25 admission Minimum Data Set (MDS) assessment revealed the resident is cognitively intact. Observation on 05/19/25 at 8:27 A.M. revealed Resident #14 call light was not functioning. There was no light on over the the door or at the nurse station. Interview with Resident #14 on 05/19/25 at 8:27 A.M. revealed the call light has not been functioning for a while now. 2. Record review of Resident #21 revealed an admission date of 05/19/23 with pertinent diagnoses of: hemiplegia and hemiparesis, cerebral infarction, altered mental status, anemia, and epilepsy. Review of the 04/01/25 quarterly Minimum Data Set (MDS) assessment revealed the resident is rarely or never understood. Observation on 05/19/25 at 8:28 A.M. revealed Resident #21 call light was not functioning. There was no light on over the the door or at the nurse station. Interview with Certified Nurse Aide (CNA) #112 on 05/19/25 at 8:30 A.M. verified the call light for Resident #14 and #21 were not functioning. There was no lights on over the the doors or at the nurse station for either residents call light. 366496 Page 10 of 11 366496 05/21/2025 Allbridge Rehabilitation and Nursing Center 5500 East Broad Street Columbus, OH 43213

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to maintain and sanitary and homelike environment. This had the potential to affect the 39 of 39 residents residing in the facility. Findings include: 1. 05/21/25 from 1:46 P.M. to 1:52 P.M. tour of the facility with Regional Director of Dietary Services #124 revealed the following: a. The hallway tile has a dark build up around the wall and the floor. b. room [ROOM NUMBER] has a dark build up around the tile and the wall in the room and bathroom and a rusty colored build up around the commode. Patches of paint missing on the wall in the bathroom. The door into the room, bathroom and door jams with the paint scuffed. c. The hand rail scuffed in the hallway outside of the kitchen entrance. d. The hallway outside of the kitchen entrance with a rust colored build up at the tile and wall. e. A chair by the 100 nurses station with multiple stains on the upholstery. f. The two doors and door jam into the dining room scuffed. g. The carpet in the from area near the entranced stained. h. Four chairs at the end of the 200 hall with the upholstery peeling. This was verified at the time of the observations with the Regional Director of Dietary Services #124. 2. Observation during tour facility outside resident room [ROOM NUMBER] revealed tile cracks had a dark build up of dirt in between each tile outside the door extending into room [ROOM NUMBER]. Dirt build-up on floor noted on both sides of entry way to room [ROOM NUMBER]. Hallway ledge had scuff marks and dirt on the outside. The lower bumper rim of the hallway had brown dirt in cracks connecting to the wall. Wall outside room [ROOM NUMBER] under ledge had a yellow, dried substance that dripped down toward bumper. room [ROOM NUMBER]'s brown painted door had large, white streaks of missing paint. Findings confirmed with Regional Director of Dietary #124 and Director of Nursing. 366496 Page 11 of 11