Health inspection·February 6, 2024

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few of pain to left arm. The nurse practitioner was aware. New order was obtained for Stat x-ray of left arm. Police were notified. Review of the ADL care plan updated 01/24/24 revealed Resident #41 could require assistance with ADLs, had a history of showing inappropriate sexual behaviors toward staff while being showered, Resident #41 would scratch, hit and pull hair of staff members and would make allegations of abuse. There were not any care planned inventions on how staff should respond when Resident #41 displayed sexual and/or physical behaviors. Review of the Self-Reported Incident dated 01/24/24 revealed Resident #41 alleged physical abuse involving STNA #1. At approximately 11:30 A.M. on 01/24/24, two nurse aides were giving personal care in room of Resident #41. At approximately 11:40 A.M., the Administrator was notified Resident #41 became aggressive with the staff members as they were providing personal care. Resident #41 grabbed the arm of one of the aides (STNA #1) then grabbed her by the neck and back of her head pulling out some of her hair. The other aide (STNA #2) came to assist, and Resident #41 then smacked at her face, causing a red mark before all parties could be separated. At approximately 12:15 P.M., the resident alleged that aides were rough during care. The administrator was informed by police that Resident #41 had made an allegation of abuse. When the police spoke with Resident #41 he shared that staff was allegedly rough with him. Resident #41 alleged aides pulled on his right arm, then began hitting him in the center of his back. Review of the witness statement dated 01/24/24 authored by STNA #1 revealed, at 11:30 A.M., [STNA #2] and I went into [Resident #41's room] to provide morning/perineal care. We got bed partially stripped and were in the process of rolling him to the left towards me. I grabbed his right hand and wrist as [STNA #2] was pushing his shoulder and hip. [Resident #41] started yelling, don't grab my arm, [expletive]. I explained I was just trying to roll him. He grabbed my neck and hair pulling me towards him. [STNA #2] yelled at him to stop and let me go. She then pulled his hand out of my hair. He hit her [STNA #2] in the face. We got bed together and got him redressed and [STNA #2] said she was okay with him and for me to leave and get assessed by nursing and management. He left welts on my neck and pulled my hair out. Review of the Police Incident Report dated 01/24/24 revealed on Wednesday, 01/24/24 at 11:46 A.M., Police Officer (PO) #7 was dispatched to [the facility] for a report of an assault; dispatch said that a patient assaulted two nurse assistants. Review of the police report witness statement date 01/24/24 timed 11:45 A.M. authored by STNA #1 revealed, [Resident #41] scratched my neck and grabbed my hair pulling some out during morning/perineal care. [STNA #2] tried to get him to let go, getting hit in the face/neck in the process. Review of the police report witness statement dated 01/24/24 timed 11:45 A.M. authored by STNA #2 revealed, I witnessed [Resident #41] grab the other aide by the back of the head pulling her hair out and proceeded to scratch her. We were assisting him with morning/perineal care when incident happened. I assisted in getting the resident off the other aide then finished with care. We then proceeded to notify the nurse and the higher ups. Review of the witness statement dated 01/24/24 authored by STNA #2 revealed, I, [STNA #2] and other aide went in to change [Resident #41]. We did perineal care and changed resident's sheets. Resident proceeded to attack other aide by pulling her hair and scratching/grabbing her. I proceeded to get resident off the other aide. I then finished making resident's bed. Afterwards the other aide and I (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366497 If continuation sheet Page 2 of 5 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 366497 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Tamarack Ridge Health and Rehabilitation 5113 State Route 43 Kent, OH 44240 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)

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few went to the nurse to let her know. We then proceeded to go to the higher ups. After talking to the higher ups, I went with another worker to clean up the room. Resident then proceeded to say that his left arm is broke. I witnessed the nurse examine the arm with no pain/redness/bruising/swelling to the affected area. Review of the health status note dated 01/25/24 revealed two view x-ray completed of left arm/wrist, results were negative. Review of the health status note dated 02/05/24 timed 4:02 P.M. revealed Resident #41 was alert and oriented to person. Observation on 02/05/24 at 7:45 A.M. revealed Resident was lying in bed watching television. Interview at the time of the observation revealed Resident #41 was agreeable to talk later about the incident that occurred with the two STNAs. Resident #41 did not know what month or year he was admitted ; he said he had been at the facility for eight months. Interview on 02/05/24 at 8:15 A.M. and 12:00 P.M. with STNA #2 revealed STNA #2 had only worked with Resident #41 a few times prior to 01/24/24 and didn't think STNA #1 had worked with Resident #41 previously. Resident #41's call light was on, so STNA #1 and STNA #2 entered the room together to change his bed linens and give him a bed bath. STNA #1 rolled the resident toward STNA #1 on his right side, toward the door (STNA #2 was aware the resident's left arm was affected from his stroke) and STNA #1 grabbed his left arm (did not pull or yank) to assist him with rolling while STNA #2 applied new linens to the bed. Resident #41 then stated, you stupid [expletive] to STNA #1. As the resident was rolling onto his back, Resident #41 grabbed STNA #1 by the back of head and her hair with his right hand. STNA #2 got his hand free from the STNA's hair and Resident #41 scratched STNA #2's face by accident. STNA #2 called SOS over the Walkie Talkie. STNA #2 finished making his bed, covered him with a sheet and left the room. Interview on 02/05/24 at 9:02 A.M. with Resident #41's family member revealed on 01/24/24, two aides entered his room to change his linens. Resident #41's arm was hurt by the STNA during the incident because the aide was hurrying him and rough with him while changing the linens. The aide ignored him when he told her to stop so he hit the aide since Resident #41 was unable to get away from the STNA because he was paralyzed. Observation on 02/05/24 at 9:38 A.M. revealed Resident #4 was lying in bed holding a remote, watching television. A follow-up interview, during the observation, with Resident #41 revealed when asked if it was a good time to discuss the incident with the STNAs, Resident #41 responded, I can't talk about that. Interview on 02/05/24 at 9:53 A.M. with Registered Nurse (RN) #5 revealed she was familiar with Resident #41 and stated that Resident #41 got frustrated quickly. Resident #41 had a stroke and RN #5 believed his behaviors were a result of the stroke and history of drug use. Resident #41's left arm was affected from his stroke, and he had complained of achy pain in the left arm before. Resident #41 was ordered Tylenol 1000 milligrams three times a day for pain and Lyrica three times a day. Interview on 02/05/24 at 10:17 A.M., 11:01 A.M. and 11:37 A.M. with STNA #1 via telephone revealed STNA #1 and STNA #2 went into Resident #41's room to do ADL care prior to lunch. The STNAs explained to Resident #41 what they were going to do. The STNAs were in the process of rolling him and the resident's left arm was flopping around so STNA #1 placed his left hand in her palm to keep his arm (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366497 If continuation sheet Page 3 of 5 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 366497 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Tamarack Ridge Health and Rehabilitation 5113 State Route 43 Kent, OH 44240 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)

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stable. Resident #41 yelled, you're breaking my arm, [expletive] so she told the resident to rest his hand on handrail. As he was rolling onto his back, Resident #41 reached up, grabbed the back of her head/hair, and pulled her head down towards his groin. STNA #2 was able to untangle STNA #1's hair and the resident hit STNA #2 in the face while she was trying to untangle the hair. STNA #1 asked the resident, can we just get finished so you can eat lunch? STNA #1 proceeded to wash his armpits, put a gown on him then exited the room. During the care, Resident #1 kept asking for STNA's #1's name, grabbed her name badge string and pulled it and was trying to throw his legs over the edge of the bed. STNA #1 did not leave the room after Resident #41 grabbed her by the back of the head and pulled her hair because STNA #1 and STNA #2 were in the room together, STNA #1 did not want to leave STNA #2 alone with the resident, and STNA #1 was focused on getting care taken care of then they would leave the room together. STNA #1 did not use her Walkie Talkie to call for assistance because her hands were full with Resident #41. STNA #1 also reported that Resident #41 had a history of cussing at STNA #1 and calling STNA #1 derogatory names and when this happened STNA #1 would notify the nurse. Interview on 02/05/24 at 10:30 A.M. with PO #7 revealed the case involving Resident #41, STNA #1 and STNA #2 had been turned over the County prosecuting attorney to review to determine if any charges would be brought forth to any of the parties. PO #7 revealed none of the three people involved (Resident #41, STNA #1, and STNA #2) had any evidence of assault on their body when he arrived on the scene. Resident #41 was unable to give a written statement, so a verbal statement was recorded by the body camera worn by PO #7. Resident #41 reported that one aide pulled his left arm and the other aide was pushing on his back and it felt like he was being punched. Observation on 02/05/24 at 2:15 P.M. revealed Resident #41 was lying in bed watching television. Interview, during the observation, with Resident #41 revealed he spoke to his mother and his mother told him that he was allowed to speak to the surveyor. Resident #41 stated that STNA #1 seemed mad at him and he had never met her before so he wasn't sure she was actually an STNA. STNA #1 grabbed his left forearm (the resident pointed to the arm between his wrist and elbow) and reached across him and put her whole-body weight on his arm; his arm was in pain. STNA #1 told him he wasn't moving fast enough and started punching him in the back, telling him to move faster. Resident #41 stated the other aide didn't do anything to help him. The resident stated his arm was in pain for three days after the incident. He stated the pain in his arm was usually a four out of 10 on the pain scale and after the incident with the STNAs, he rated his arm pain as a five out of 10. Interview on 02/05/24 at 2:30 P.M. with the Administrator and Director of Nursing verified STNA #1 should not have continued to provide care to Resident #41 after being grabbed and hair pulled and should have immediately exited Resident #41's room. Review of the facility's Abuse, Neglect, Exploitation and Misappropriation of Resident Property dated 11/21/16 revealed the facility would educate it's staff and volunteers upon hire and annually thereafter regarding the facility's policy concerning Abuse, Neglect, Exploitation of residents, and Misappropriation of Resident Property, and how to handle resident-to-resident Abuse and Injuries of Unknown Source. These training sessions were to include, but not necessarily be limited to appropriate interventions to deal with aggressive behaviors and/or extraordinary reactions to residents to ordinary stimuli, such as the attempt to provide care (i.e. Catastrophic Reactions). Review of the undated facility's Behavioral Reference Toolbox for Behavior Reference Strategies for Some Common Behavioral Symptoms in Nursing Home Residents revealed fighting was a severe behavioral symptom because of the potential harm to others. Residents with cognitive loss did not have the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366497 If continuation sheet Page 4 of 5 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 366497 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Tamarack Ridge Health and Rehabilitation 5113 State Route 43 Kent, OH 44240 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)

F 0607 Level of Harm - Minimal harm or potential for actual harm skills to end conflict better ways. Separation was the first concern. When personal space was a concern of the resident, stay back a few feet from the person. Give the resident time and space to calm themselves. Verbal aggression: if the verbal aggression is directed to you and the resident is safe, you can leave. Explain your actions and that you will return later. When you return, take something in to use as a distraction. Residents Affected - Few This deficiency represents non-compliance investigated under Complaint Number OH00150725. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366497 If continuation sheet Page 5 of 5