**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review including review of facility payroll records and facility billing/financial information, review of the facility assessment, review of the employee handbook, review of the facility Resident [NAME] of Rights, review of the facility Abuse/Neglect policy and procedure and interviews, the facility neglected to meet financial obligations for the delivery of care and maintenance and to operate in a manner to ensure all bills were being paid timely to prevent the potential interruption in services and to meet the total care needs of all residents admitted to and/or retained in the facility and failed to have adequate and effective systems in place to ensure staff were compensated via payroll benefits based on their hired agreement and payroll schedule. This resulted in Immediate Jeopardy beginning on 06/07/24 when the identified lack of financial solvency placed all facility residents at risk for serious harm, injury, hospital, displacement due to potential interruption in staffing regarding non-payment of payroll benefits and continued due to non-payment of essential bills including payment to the facility contracted therapy supplier. This affected eight residents, Resident #7, #23, #26, #28, #34, #36, #40 and #41 who were currently receiving therapy (physical, occupational and/or speech therapy) services and had the potential to affect all 42 residents residing in the facility. On 06/13/24 at 5:03 P.M. the Administrator and the Director of Nursing (DON) were notified Immediate Jeopardy began on 06/07/24 when an onsite investigation determined the facility neglected to meet all financial obligations for the delivery of care and maintenance of the facility by not paying staff in a timely manner. This included but was not limited to insufficient funds to make payroll on 06/07/24, non-payment for therapy services (physical, occupational, and speech therapies) resulting in the therapy provider notifying the facility that services would be terminated by the end of the week, if a payment was not received and non-payment to a facility supply company. The Immediate Jeopardy was removed on 06/20/24 when the facility implemented the following corrective actions: • On 06/07/24 at 6:00 A.M. the Administrator identified her paycheck was not available in her checking account. At 8:00 A.M. staff began to identify their pay was unavailable. 39 staff members did not receive their paychecks as scheduled for the 06/07/24 pay day. The Administrator identified herself, the Director of Nursing (DON), Administrative Assistant #20, Registered Nurse (RN) #61, #65, and #82), Licensed Practical Nurse (LPN) (#4, #23, #25, #33, #34, #57, #71, #76), Activity Director #6, Activity Staff #37, Marketing Director #3, Dietary Manager #9, Dietary Staff (#28, #29, #31, #32, #38, #46, #53, #46, #53, and #56), Housekeeping Staff (#5, #26, #30, #51, #58, #73, and #75), Hospitality Aide #36, Business Office Manager #8, Beautician #22, and Maintenance Director #2 who were not paid. • On 06/10/24 by 11:27 A.M., via in person interviews and phone communication with the employees, the Administrator verified payroll had been met as of this date at 100% for the 38 employees affected. • Beginning 06/13/24 at 7:00 P.M. and concluding on 06/14/24, all 68 staff received education via in-person, telephone and hand-outs from the Administrator regarding the facility abuse/neglect policy. • Beginning on 06/13/24 at 7:00PM and ending on 06/17/24 at 10:00 A.M. all 42 residents and/or resident representatives were interviewed by the interdisciplinary team (the Administrator, DON, SSD, BOM, Unit Manager) to ensure care needs were being met. A roster spreadsheet was developed by the Administrator to track completion of the interview questions. The interview questions included: Do you feel that your needs are being met? Do you have any concerns? • Beginning on 06/13/24 to ensure medical supplies, food, medications and staff continue to be provided, the Administrator/designee would complete daily audits. The Interdisciplinary Team (IDT) would ask staff if they have any concerns regarding not having necessary supplies or staffing levels to meet the needs of the residents. If concerns are identified, the management company will be notified immediately, via email and/or phone call. The audits will continue daily for 12 weeks and will be documented on a spreadsheet. • The facility implemented a plan for R&R Management (court appointed receivership beginning 05/30/24) to fund payroll at the beginning of payroll week to ensure adequate time to correct any errors with payroll prior to pay day. Payroll ACHs would be deposited on 06/20/24 (Thursday), the day prior to payroll. An audit will be completed on 06/21/24 (Friday) of payroll by Administrator/designee to ensure that all funds have been received. Audits will be completed via spreadsheet with each employee asked if they have received their pay. If there is a delay in payment, wire transfers will be completed on 06/21/24 (Friday). Payroll will be funded early moving forward to ensure no issues arise on payday. • On 06/17/24, letters to notify vendors of new receiver were sent via US mail. Vendors that were notified included food service, oxygen supply company, therapy company, pharmacy, electric, medical supplies, trash, water, payroll, dietician, and the medical director. New contracts would be obtained by the administrator in collaboration with the new management company. • A Broad River payment plan was initiated on 06/18/24 at 2:45 P.M. that included 25% of outstanding balances to be paid each month beginning on 07/01/24. Additionally, the rehabilitation company would be kept current with 45-day terms. A representative from Broad River Therapy confirmed via email on 06/18/24 at 5:38 P.M. that there would be no interruption of services to therapy (based on the payment plan initiated). • On 06/18/24 at 9:30 A.M., the Administrator verified staffing contracts via email with Interim Staffing at 9:35 A.M.; Premier Staffing at 9:35 A.M.; and with a third staffing representative at 9:57 A.M. Interview revealed two to three days' notice was best to fill shifts, but incentives would be offered to employees who pick up immediate/same day shifts. • Managers were educated on shift pickup should the need arise via in-service. The Administrator provided education via handout on 06/13/24 to Activity Director, SSD, BOM, ADON, DON, Dietary Director, Two Unit Managers, Maintenance Director, and Housekeeping Supervisor. • The facility implemented a plan for ancillary staffing (housekeeping, dietary, maintenance) should the need arise: The Administrator would delegate managers to shifts that were unfilled through shift pick up; State Tested Nursing Assistant staff would be pulled into the ancillary shifts and their shifts would be back filled with agency staff. Staff would also be shared through the staff sharing agreement between other facilities managed by the company. The staffing agreement was established to provide supplemental staffing support to multiple nursing homes within the organization. Staff would be assigned to different facilities based on staffing needs, acuity levels, and skill sets. Shifts and assignments would be based on availability, skill level, and facility needs. • The facility implemented a plan for the Administrator, in collaboration with the new management company, R&R Management, to complete audits of financial obligations weekly to validate obligations continue to be met to ensure the delivery of care continues as required. Special focus would be placed on essential resident care services to ensure vendors were up to date and there was no interruption in services. Essential resident care services include food service, oxygen provider, therapy provider, pharmacy, electric, medical supplies, trash, water, payroll, dietician, and medical director. Concerns identified would be shared with the new management company for resolution. Results of these audits and interventions would be brought to the Quality Assessment Performance Improvement (QAPI) meeting monthly for three months and as needed for review and recommendations. The facility implemented a plan for audits to begin on 06/19/24 via email and phone communication with the new management company. • Residents (#7, #41, #40, #23, #26, #34, #36) were interviewed by SSD #10 on 06/19/24 at 10:00 A.M.; Therapy Director confirmed no interruption of services for Resident #28, who was unable to answer, on 06/19/24 at 10:30 A.M. to ensure continuity of therapy services and no identified interruptions. Although the Immediate Jeopardy was removed on 06/20/24, the facility remains out of compliance at a Severity Level 2 (no actual harm with potential for more than minimal harm that is not Immediate Jeopardy) as the facility is in the process of implementing their corrective action plan and monitoring to ensure on-going compliance. Findings Include: On 06/13/24 at 10:05 A.M. an interview with the Administrator revealed on 06/07/24 there were staff members who did not receive their bi-weekly paychecks (due 06/07/24) via electronic bank deposit. The Administrator revealed the owner of the facility, Owner #1, would be able to provide further information and details and provided the owner's contact information. On 06/13/24 at 11:10 A.M. an interview with the Administrator regarding the facility finances and billing/payment process revealed the facility did not pay any of the vendors directly for services rendered at the facility, and she was unsure if Epic Healthcare Solutions was responsible for all payments. During the investigation and interview with the Administrator, it was determined the facility did not have a comprehensive and effective system in place to monitor the financial solvency of the facility, to ensure bills were being paid timely, vendors were paid the amount due and/or the facility was meeting all financial obligations. The following financial solvency concerns were identified, including but not limited to the following as a result of the complaint investigation: a. On 06/13/24 at 1:05 P.M. an interview with Licensed Practical Nurse (LPN) #34 revealed she was to be paid bi-weekly via electronic bank deposit, and on 06/07/24 she was not paid. LPN #34 revealed she was not paid until three days later, on 06/10/24. On 06/13/24 at 1:09 P.M. an interview with Licensed Practical Nurse (LPN) #4 revealed she was to be paid bi-weekly via electronic bank deposit, and on 06/07/24 she was not paid. LPN #4 revealed she was not paid until three days later, on 06/10/24. On 06/13/24 at 1:30 P.M. an interview with Social Services Director (SSD) #10 revealed she was to be paid bi-weekly via electronic bank deposit, and on 06/07/24 she was not paid. Social Services Director (SSD) #10 revealed she was not paid until three days later, on 06/10/24. On 06/13/24 at 1:36 P.M. an interview with Housekeeping Staff #75 revealed she was to be paid bi-weekly via electronic bank deposit and on 06/07/24, she was not paid. Housekeeping Staff #75 revealed she was not paid until three days later, on 06/10/24. On 06/13/24 at 2:10 P.M. an interview with Administrative Assistant #20 revealed she was to be paid bi-weekly via electronic bank deposit, and on 06/07/24 she was not paid. Administrative Assistant #20 revealed she was not paid until three days later, on 06/10/24. On 06/13/24 at 1:46 P.M. an interview with Laundry Staff #26 revealed she was to be paid bi- weekly via electronic bank deposit, and on 06/07/24 she was not paid. Laundry Staff #26 revealed she was not paid until three days later, on 06/10/24. On 06/13/24 at 1:55 P.M. an interview with Licensed Practical Nurse (LPN) #33 revealed she was to be paid bi-weekly via electronic bank deposit, and on 06/07/24 she was not paid. LPN #33 revealed she was not paid until three days later, on 06/10/24. On 06/13/24 at 2:20 P.M. an interview with Dietary Manager #9 revealed she was to be paid bi- weekly via electronic bank deposit, and on 06/07/24 she was not paid. Dietary Manager #9 revealed she was not paid until three days later, on 06/10/24. On 06/13/24 at 2:28 P.M. an interview with Dietary Staff #38 revealed she was to be paid bi- weekly via electronic bank deposit, and on 06/07/24 she was not paid. Dietary Staff #38 revealed she was not paid until three days later, on 06/10/24. On 06/13/24 at 2:32 P.M. an interview with Dietary Staff #31 revealed she was to be paid bi- weekly via electronic bank deposit, and on 06/07/24 she was not paid. Dietary Staff #31 revealed she was not paid until three days later, on 06/10/24. On 06/17/24 at 3:41 P.M. an interview with Licensed Practical Nurse (LPN) #71 revealed she was to be paid bi-weekly via electronic bank deposit, and on 06/07/24 she was not paid. LPN #71 revealed she was not paid until three days later, on 06/10/24. On 06/13/24 at 4:40 P.M. an interview with Facility Owner #1 revealed last week when he input data and ACH approval into his bank account at the Bank of Oklahoma there were sufficient funds. On Friday, 06/07/24, he was notified by the facility that a couple of staff didn't get paid. Facility Owner #1 stated he contacted his bank and worked with a nice lady throughout the day Friday on the issue of some of the checks not being released. The owner stated that all of the checks were released by 6:00 P.M. on Friday but didn't make it to the employee's bank accounts in time. The owner stated that he personally spoke with some of the staff over the weekend and offered $200.00 bonuses to help compensate for the delay in staff receiving their paychecks. During the interview, the owner further stated he had been making payments to the therapy provider according to a previous plan and indicated he was not aware of any concerns with payments to the therapy provider (Broad River Rehabilitation). On 06/14/24 at 8:20 A.M. the Administrator provided documentation of a court order for receivership for the facility effective 05/30/24. On 06/17/24 at 3:49 P.M. a follow-up interview with the Administrator revealed on 06/07/24 there were 39 staff members who did not receive their paychecks as scheduled. The Administrator identified herself, the Director of Nursing (DON), Administrative Assistant #20, Registered Nurse (RN) #61, #65, and #82), Licensed Practical Nurse (LPN) (#4, #23, #25, #33, #34, #57, #71, #76), Activity Director #6, Activity Staff #37, Marketing Director #3, Dietary Manager #9, Dietary Staff (#28, #29, #31, #32, #38, #46, #53, #46, #53, and #56), Housekeeping Staff (#5, #26, #30, #51, #58, #73, and #75), Hospitality Aide #36, Business Office Manager #8, Beautician #22, and Maintenance Director #2 who were not paid. Interview on 06/20/24 at 3:52 P.M. with Bank of Oklahoma Treasury Client Services Representative #104 revealed due to the facility's credit history all funding must be in the bank account before any funds can be processed for release. Client Services Representative #104 revealed the facility's payroll was not met on 06/07/24 due to insufficient funds per the bank's policy. He stated funds were sent to the Bank of Oklahoma via a check which required a one- day, intraday hold. The check was received on the same day the payroll was submitted on 06/07/24 and the payroll could not be processed as the funds were not available. Review of the undated facility Employee Handbook revealed employees would receive their pay reimbursement for hours worked either through Pay Card or Direct Deposit. During orientation, the human resources representative would assist with signing up for either direct deposit or a Pay Card. b. During the onsite investigation, the facility identified eight residents, Resident #7, #23, #26, #28, #34, #36, #40 and #41 who were currently receiving therapy (physical, occupational and/or speech therapy) services. Review of the statement issued by Broad River Rehabilitation, dated 01/02/24, revealed an invoice balance of $18,095.42 for service dates of 12/01/23 through 12/31/23. Review of the statement issued by Broad River Rehabilitation, dated 02/02/24, revealed an invoice balance of $17,825.06 for service dates of 01/01/24 through 01/31/24. Review of the statement issued by Broad River Rehabilitation, dated 03/01/24, revealed an invoice balance of $17,586.39 for service dates of 02/01/24 through 02/29/24. Review of the statement issued by Broad River Rehabilitation, dated 04/01/24, revealed an invoice balance of $13,078.95 for service dates of 03/01/24 through 03/31/24. Review of the statement issued by Broad River Rehabilitation, dated 05/01/24, revealed an invoice balance of $6,740.11 for service dates of 04/01/24 through 04/30/24. Review of the statement issued by Broad River Rehabilitation, dated 06/03/24, revealed an invoice balance of $11,529.63 for service dates of 05/01/24 through 05/31/24. On 06/13/24 at 10:24 A.M. an interview with Chief Executive Officer (CEO) #11 (physical, speech, and occupational therapies provider) revealed the facility's outstanding balance was $84,855.56 for services provided from December 2023 through May 2024. CEO #11 further stated a letter was sent out yesterday, on 06/12/24, notifying the facility management that services would stop by the end of the week, Saturday 06/15/24, if a large payment was not received. Chief Financial Officer (CFO) #12 who was present during the interview via conference call stated the therapy company has tried very hard to work with the facility for payments, but it has been unsuccessful. Review of an email communication from Broad River Rehabilitation CEO #11 to Facility Owner #1, dated 06/17/24 at 4:43 P.M., revealed We are not catching up in payment as we agree. I can't continue if I don't receive a large payment this week. The Department of Health is continuing to reach out to ask .I am sorry, but this is not negotiable at this time. Review of an email communication from Facility Owner #1 to Broad River Rehabilitation Chief Executive Officer #11, dated 06/17/24 at revealed, Understood. We are working with [J4] under receivership now and will be working officially now with them hand in hand to keep services going. On 06/17/24 at 10:15 A.M. an interview with Broad River Rehabilitation Staff Accountant #13 verified the facility's outstanding balance was $84,855.56 for therapy services between December 2023 through May 2024. Staff Accountant #13 revealed it was her understanding that a letter was sent to the facility last week notifying them that if a substantial payment was not received, services would be terminated by the end of the week. Staff Accountant #13 stated she was unsure why services continued past the end of last week but assumed it was because a plan was still in progress for ending services. c. On 06/13/24 at 11:06 A.M. an interview with Account Representative #19 from Medline Medical Supplies revealed the facility's current total outstanding balance was $23,298.14 and the facility current past due amount balance was $3,117.38, which was 13 days past due. Account Representative #19 revealed he could not comment on when supplies would cease due to non-payment as it was determined on a case-by-case basis. No additional information was provided by the facility during the investigation to explain why the facility had a past due balance or evidence the facility was in good standing with this vendor/supplier. Review of the undated Ohio and Federal Nursing Home Residents' [NAME] of Rights booklet, provided to the resident upon admission, revealed upon admission and thereafter, the right to adequate and appropriate medical treatment and nursing care and to other ancillary services that comprise necessary and appropriate care consistent with the program for which the resident contracted. Review of the facility assessment dated [DATE] revealed the facility provided all care and services as required in the requirements of participation including, but not limited to assistance with activities of daily living, personal care services, medication administration, pain management, infection prevention and control, nutritional services, skin care, fall and injury prevention, pharmacy, and therapy services. Additionally, the facility provided medical director, attending physicians, physician assistants, nurse practitioners, dentist, podiatrist, ophthalmologist, and psychiatrist services, and pharmacist. Review of the facility policy titled, Abuse Prevention, Identification, Investigation and Reporting Policy, revision date of 08/15/22, revealed neglect was the failure of the facility, its employees or service providers to provide goods and services to a resident that were necessary to avoid physical harm, pain, mental anguish, or emotional distress. This deficiency represents non-compliance investigated under Complaint Number OH00154712.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, including review of the facility payroll records, review of facility billing/financial information, review of email communication, review of the employee handbook, review of the facility Abuse/Neglect policy and procedure and interviews, the facility neglected to meet financial obligations for the delivery of care and maintenance and to operate in a manner to ensure all bills were being paid timely to prevent potential interruption in services and to meet the total care needs of all residents admitted to and/or retained in the facility. The facility also failed to have an effective system in place to ensure staff were compensated via payroll benefits based on their hired agreement and payroll schedule. This resulted in Immediate Jeopardy beginning on 02/16/24 when the lack of financial solvency placed all facility residents at risk for serious harm, injury, hospitalization, displacement due to potential interruption in staffing and/or outside service providers. This had the potential to affect all 41 residents residing in the facility. On 03/05/24 at 5:28 P.M., the Administrator and Director of Nursing (DON) #800 were notified Immediate Jeopardy began on 02/16/24 when the onsite investigation determined the facility neglected to meet all financial obligations for the delivery of care and maintenance of the facility by not paying staff in a timely manner and having outstanding balances with vendors and providers. This included, but was not limited to, insufficient funds to meet staff payroll on 02/16/24 and 03/01/24, delinquent balances owed to nutrition services which resulted in dietitian services being cut from 03/01/24 through 03/04/24, delinquent balances for the Medical Director and Psychiatrist, and delinquent balances for therapy services. The Immediate Jeopardy remains ongoing, as the facility failed to implement corrective measures to remove the Immediate Jeopardy situation. Findings include: Review of the facility survey history revealed on 12/18/23 a complaint survey was completed which resulted in concerns related to financial solvency. An issue identified at that time was related to employee payroll. An interview on 12/05/23 at 2:25 P.M. an interview with the Administrator revealed there were 14 employees who did not receive paychecks on 10/13/23 as their checks were returned due to insufficient funds. At the time of the survey, the Administrator did not provide any additional information as to why payroll was not met for these employees on this date. This payroll issue was in addition to the identification of other vendors/suppliers with past due balances, non-payment and shut off notices being issued to the facility. Following the 12/18/23 survey, the facility provided evidence of payments being made to various different supplies/vendors removing the likelihood of situations of neglect and the resolution of shut off notices for the facility. However, at the time of this complaint survey, the facility failed to ensure their governing body was effective in establishing and implementing policies regarding the management and operation of the facility and the Quality Assurance Performance Improvement Program provided continual monitoring, which included ongoing compliance with all financial obligations for the delivery of care regarding payroll, therapy services and electricity. On 03/04/24 at 9:10 A.M. an interview with State Tested Nursing Assistant (STNA) # 227 revealed on 02/16/24 her payroll check did not clear the bank. She stated she did not receive her money until 02/26/24 because her bank placed a hold on her pay check. She stated this was not the first time her paycheck had not cleared the bank and she was charged penalties and late fees. On 03/04/24 at 9:15 A.M. an interview with STNA #100 revealed her paycheck on 02/16/24 did not clear the bank. She stated she was assessed fees and she did not get paid until 02/29/24 (13 days after her paycheck was issued). On 03/04/24 at 9:20 A.M. an interview with Laundry #110 revealed she had been employed at the facility for two years. She stated she has had her paycheck returned for insufficient funds four times since October 2023 with the most recent being 02/16/24 but she was waiting to see if her check from 03/01/24 cleared the bank. She stated her bank had placed a 10-day hold on the 03/01/24 pay check. On 03/04/24 at 9:40 A.M. an interview with Dietary Manager #122 revealed her check from 02/16/24 had not cleared the bank. She stated she had not received her payment until the following Wednesday (02/21/24). She stated she had not been reimbursed for wire fees and overdraft fees. She stated she was told it would be on this check but she did not believe it should be on a check with taxes taken out because she was losing money. She believed it should be cash. On 03/04/24 at 9:45 A.M. an interview with [NAME] #124 revealed her payroll check bounced the last two pay periods and she has not been paid the fees associated with the check bouncing. She stated she did not know about this week's check (for payroll on 03/01/24) as of this time. On 03/04/24 at 9:50 A.M. an interview with the Director of Nursing revealed employee payroll checks were not clearing the bank. She stated her paycheck did not clear the last two paydays. She stated she was not leaving (employment) but stated she was only staying because the previous Administrator had quit and she would not do that to the residents. On 03/04/24 at 9:57 A.M. an interview with CFO #600 revealed his corporation had more issues with banking since the previous two surveys in December 2023 and January 2024. He stated on 02/16/24 there was an error with their Positive Pay system (an automated cash-management service used by financial institutions where checks issued by companies are matched with those presented for payment). CFO #600 stated they placed the check numbers into the system and uploaded it from the Human Resource file to the bank and those were paid by the bank. He stated they covered the wire fees and bounced check fees as soon as the employee updated them on the amounts. An additional interview on 03/04/24 at 10:35 A.M. with CFO# 600 revealed, Chief Executive Officer (CEO) #601, Director of Finances (DOF) #603 and CFO #600 revealed they handled all the financial responsibilities for this facility and two sister facilities, Astoria Place of Cambridge, and Oakhill Manor. He confirmed he was aware the payroll checks from 03/01/24 were returning for insufficient funds for all three facilities. He stated they (Epic Corporation) used the same bank for all the payroll and wired transfers. He stated each facility had its own accounts to pay for payroll and to pay their suppliers. He stated on 02/16/24 there was a Positive Pay file error (they place a restricted range of check numbers in the account for the checks to be cashed to match the HR files and only those check would clear). He stated there was a mix-up with the numbers so all the checks were rejected. He confirmed he had no evidence from the bank that this was a banking error. In addition to the staff payroll issues, he stated the corporation had placed Physician #130 on a payment plan to get him caught up with monies due and had just sent Physician #130 a check for $6000.00 on this date. He stated he would stay in communication with the other providers the facility used and would never let the bills get to the point of a provider termination of service. He stated he was working with all the staff at the facility to get them paid. He was unable to answer the question as to why payment plans that either himself, Chief Executive Officer (CEO) #601 or Director of Finance #603 initiated, were not followed through with and why payments were missed. On 03/04/24 at 10:40 A.M. an interview with the Administrator revealed she had just started in the position of Administrator two weeks ago but she was previously the assistant administrator. She stated the corporate office had not given her a reason as to why the staff pay checks were returned for insufficient funds. She stated she does not know if any of the suppliers were being paid, however no suppliers had reached out to her directly in the last two weeks stating they had not been paid. Staff were to come to her about their paychecks and she was letting the corporate office know their checks did not clear the bank. She stated she was told their money would be wired within 24 hours. On 03/04/24 at 2:45 P.M. an interview with Business Office Manager (BOM) #120 revealed most of the bills were paid through the corporate office. She stated the secretary received the statements then she would give them to her, she would go through them, sort them out, and she would give the ones that needed to be paid to the Administrator and she wound send them to the corporate office to be paid. She stated Physician #130 and #131 had come to her asking about payment and she had to reached out the corporate office; however, they said they would take care of it but it never got done. She stated she also was responsible for completing employee payroll. She stated on 02/16/24 the facility had 43 staff members ( STNA #100, #103, #105, #106, #107, #116, #210, #211, #212, #215, #216, #220, #224, #225, #227, #229, #231, #232, #235, #236, LPN #109, #213, #214, #223, #226, #237, Dietary #122, #123, #124, #222, #228, #230, #233, #234, BOM #120, Social Service #217, Housekeeping #118, #119, #126, Marketing #121, Hospitality Aide #219, Maintenance #113 and #218) whose checked did not clear the bank. She stated they had all since been paid but there was a delay in payment. She stated the staff were told to bring her the documentation for the fees they received and they would also be paid. An email from the Administrator dated 03/07/24 at 3:08 P.M. revealed the facility had 23 staff (STNA #101, #102, #212, #224 #242, LPN #125, #223, #237, #240, Dietary #123, #228 , #233, Housekeeping #118, #126, #243, Maintenance #113, #121, Activity #112, #241, Administrator #500, #501, Receptionist #117 and Social Service #217) whose checks where returned for insufficient funds from the 03/01/24 payday. In addition to the facility's failure to ensure payroll obligations were met and continued to be met to ensure the ongoing effective day to day operation of the facility the following vendors/suppliers were reviewed as part of the State agency investigation with concerns identified: a. On 03/04/24 at 10:50 A.M. an interview with Pest Control Service #133 revealed the facility was behind from October 2023 through the present day in the amount of $810.00. She stated since the new company had taken over, they had not paid any invoices for service at all. b. Review of the invoices from Anova Psychiatric Services and Physician #130 revealed the facility was billed $500.00 on each month for 04/25/23, 05/25/23, 06/24/23, 07/25/23, 09/25/23 and 10/25/23 for a total of $3000.00. The Administrator did not have the most current invoices. On 03/04/24 at 10:54 A.M. an interview with Physician #130 (Anova Psychiatric Services) revealed he has not been paid for almost a year. He stated he received a paper check in November 2023; however, it was returned for insufficient funds. He stated he had called the corporate office in Florida but just gets the run-a-around. He stated although he had no plans to discontinue service as of this date, he hoped the company resolved the issue soon. Review of the check written on 03/04/24 revealed the facility sent a check to Physician #130 for $3000.00 to pay invoices from 04/25/23 through 10/25/23. c. On 03/04/24 at 11:05 A.M. an interview with Sanitation #213 revealed the facility was 30 days past due with their account. d. On 03/04/24 at 11:50 A.M. an interview with City Water Company Office Manager #134 from Barnesville water revealed the facility had a past due amount of $3345.82 with a current bill of $6420.97 which included the past due and current bill. e. On 03/04/24 at 11:57 A.M. an interview with Broad River Therapy Office Manager #128 revealed they had not received payment from the facility since September 2023; however, CFO #600 reported the facility would be sending out checks this week. Review of the email from Broad River Therapy Services dated 03/06/24 at 8:48 A.M. revealed the facility had a past due amount of $103,531.89. They had a statement from 11/02/23 with a due date of 12/02/23 which was 94 days past due for $27,252.19, a statement for 12/01/23 with a due date of 12/31/23 which was 65 days past due for $28291.58, a statement for 01/02/24 with a due dated of 02/01/24 which was 33 days past due for $22,527.73 and a statement for 02/02/24 with a due date of 03/03/24 which was two days past due for $25,461.39. f. The facility utilized a contracted service for the services of a dietitian. Review of the invoice from Nutritech Consulting Services dated 02/01/24 revealed the facility owed $1,645.00 and the due date was 02/10/24. This had been received by the facility and scanned to the corporate office on 02/02/24. Interview on 03/04/24 at 12:39 P.M. with Dietitian #135 revealed she was the owner of the nutrition services company that provided services to the facility. She stated due to previous concerns of not receiving payment, she required the facility to pre-pay for her services. Dietitian #135 stated she had terminated services on 03/01/24 as the facility was 23 days behind on their pre-pay plan. She stated CFO #600 called on 03/04/24 and paid the February 2024 balance of $1,645.00 so services would resume. The facility had until 03/10/24 to pre-pay for the March 2024 services. A follow-up interview on 03/11/24 with Dietitian #135 revealed if the facility did not make additional payment in full on this date, she would have to terminate services. g. Review of the invoices from the Medical Director (Physician #131) revealed the facility was billed $2000.00 on 12/11/23, 01/10/24, 02/01/24 and 02/28/24 for a total of $8000.00 owed. On 03/04/24 at 2:04 P.M. an interview with Medical Director Office Manager #132 revealed the facility was charged $2000.00 a month for Medical Director services and had not paid in four months. She stated they have an outstanding bill of $8000.00 as of 03/04/24. Review of the Nursing Facility admission Agreement, provided to all residents, revealed the facility was responsible for basic services including room and board, routine nursing care and supplies for residents and such other personal services as may be necessary for the resident's health, well-being, and grooming. The facility would also provide meals, linens, housekeeping, social services and activities and other regular services required by law. Review of the Employee Handbook effective 2020 revealed employees would receive their pay reimbursement for hours worked either through Pay Card or Direct Deposition. During orientation, the human resources representative will assist with signing up for either direct deposit or a Pay Card. Review of the facility policy titled, Abuse Prevention, Identification and Reporting, revised 08/15/22, revealed the facility defined resident abuse to include neglect which was the failure of the facility, its employees or service providers, to provide goods and services to a resident which were necessary to avoid physical harm, pain, mental anguish, or emotional distress. Review of the facility assessment dated [DATE] revealed the facility provided all care and services as required in the requirements of participation including, but not limited to assistance with activities of daily living, personal care services, medication administration, pain management, infection prevention and control, nutritional services, skin care, fall and injury prevention, pharmacy, and therapy services. Additionally, the facility provided medical director, attending physicians, physician assistants, nurse practitioners, dentist, podiatrist, ophthalmologist, and psychiatrist services, and pharmacist. This deficiency represents non-compliance investigated under Complaint Number OH00151616.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review including review of facility payroll records, review of facility billing/financial information, review of the [NAME] County Treasurer report, review of the facility assessment, review of the employee handbook, review of the facility admission agreement, review of the facility Abuse/Neglect policy and procedure and interviews, the facility neglected to meet financial obligations for the delivery of care and maintenance and to operate in a manner to ensure all bills were being paid timely to prevent potential interruption in services and to meet the total care needs of all residents admitted to and/or retained in the facility and failed to have adequate and effective systems in place to ensure staff were compensated via payroll benefits based on their hired agreement and payroll schedule. This resulted in Immediate Jeopardy beginning on 10/13/23 when the identified lack of financial solvency placed all facility residents at risk for serious harm, injury, hospital, displacement due to potential interruption in staffing regarding non-payment of payroll benefits and continued due to non-payment of essential bills. This had the potential to affect all 42 residents residing in the facility. On 12/12/23 at 9:01 A.M. the Administrator and the Director of Nursing (DON) were notified Immediate Jeopardy began on 10/13/23 when an onsite investigation determined the facility neglected to meet all financial obligations for the delivery of care and maintenance of the facility by not paying vendors and staff in a timely manner. This included insufficient funds to make payroll on 10/13/23, a city water disconnect notice due to non-payment and/or returned checks due to insufficient funds, an electric company disconnect notice due to non-payment and/or returned checks due to insufficient funds, non-payment for therapy services resulting in a change of providers and non-payment for the current therapy services, delinquent property taxes since 02/2021, telephone company disconnect notice due to non-payment and/or returned checks due to insufficient funds, and the inability to meet the total care needs of the residents admitted to and/or retained in the facility. The Immediate Jeopardy was removed on 12/14/23 when the facility implemented the following corrective actions: • On 11/28/23 at 10:30 A.M. the Assistant Administrator and the DON verified the residents had the needed supplies (food, oxygen, medication, medical supplies) to meet the needs of the residents. • Beginning on 11/28/23 and concluding on 11/29/23, the Administrator and/or designee re-educated, through in-person and phone communication, all facility staff on the abuse policy. All staff included: five Registered Nurses (RN), 14 Licensed Practical Nurses (LPN), 26 State Tested Nursing Assistants (STNA), four Hospitality Aides, two Maintenance Staff, seven Dietary Aides, one Activity Director, one Activity Aid, six Housekeepers and five Administration employees. This education included the requirement to meet financial obligations for the delivery of care and maintenance and to operate in a manner to ensure all bills were being paid in a timely manner to prevent potential interruption in services and to meet the total care needs of all the residents admitted to and/or retained in the facility. • Beginning on 11/28/23 and concluding on 11/28/23 the DON and the Assistant Director of Nursing (ADON) completed education with all staff on communicating if there are any supply, vendor and/or food supply concerns to immediately notify the DON and the Administrator. All staff included five Registered Nurses (RN), 14 Licensed Practical Nurses (LPN), 26 State Tested Nursing Assistants (STNA), four Hospitality Aides, two Maintenance Staff, seven Dietary Aides, one Activity Director, one Activity Aid, six Housekeepers and five Administration employees. • On 11/28/23 the DON and ADON completed a review of all 43 resident records to verify there was no change of condition related to the facility's lack of payment to vendors. • Beginning on 11/28/23, the Administrator and/or designee monitors and ensures essential resident care services are provided by daily (Business Days) communication in stand-up meeting with facility leadership team by asking if there are any essential vendor concerns. • Beginning on 11/28/23, the Administrator and/or designee will communicate facility needs to the management company (Chief Compliance Officer #602, Chief Executive Officer #601, and/or Chief Financial Officer #600) as they arise via email communication. • On 11/28/2023 at 1:00 P.M. an ad hoc Quality Assurance Performance Improvement (QAPI) meeting was held to review the QAPI Plan to address potential for resident abuse /neglect as it pertains to financial solvency due to issues that arose in the facility. In-person attendance included the Administrator, Assistant Administrator, Director of Nursing, Business Office Manager (BOM) #100, and Dietary Director #105. Medical Director #110, Chief Compliance Officer (CCO) #602 and Chief Financial Officer (CFO) #600 attended via phone. • BOM #100 and Receptionist #200 were re-educated on 11/28/2023 by the Administrator on the Stampli process. BOM #100 and/or designee and Receptionist #200 scan bills into Stampli (online portal for the Management Company's (located in Florida) approval and payment). • On 11/28/23, Corporate Compliance Officer #602 re-educated the Administrator, Assistant Administrator and DON on the abuse policy. This education included the requirement to meet financial obligations for the delivery of care and maintenance and to operate in a manner to ensure all bills were being paid timely to prevent potential interruption in services and to meet the total care needs of all the residents admitted to and/or retained in the facility. • Beginning 11/28/23, Social Services #120 and/or designee will interview four residents weekly for four weeks and then randomly thereafter to ensure their needs are being met. • Beginning 11/28/23, the DON or Designee would interview five clinical employees weekly for four weeks and randomly thereafter to verify that staff have adequate supplies, food and staffing to meet the needs of the residents. • Beginning 11/29/23, the Administrator and/or designee and CFO #600 and/or designee would complete weekly audits for four weeks and then randomly thereafter of financial obligations to essential resident care services (food, pharmacy, oxygen, medical supplies, therapy, staff) by ensuring that invoices were being paid and that no disconnect/cut off/end of service notifications were delivered within the week. • Beginning 11/29/23, weekly conference calls would be held on Wednesdays with the Administrator and/or designee with the management company (Corporate Compliance Officer, CEO, or CFO) to communicate any concerns with essential resident care services weekly for 12 weeks. • Beginning 11/29/23, the Administrator and/or designee would verify with the Management Company (CEO, CFO, and/or Corporate Compliance Officer) that the following vendors bills were made current or placed on a payment plan: a. AEP (Electric) - On 12/11/23 account payments were made in the amounts of $103.82, and $7,876.51 (checks were delivered via FedEx on 12/13/23). b. [NAME] (Trash) - On 11/27/23 payment in the amount of $488.75 was posted to the account. c. Respiratory Care Partners (Oxygen) - On 12/06/23 a delinquent balance of $396.25 was paid. d. City of Barnesville Water - On 12/12/23 delinquent payment was made in the amount of $2,498.27. e. [NAME] County Treasurer (Property Taxes) Parcel 1 - Payment Plan initiated on 11/16/23 with 12 monthly payments of $6,613.50. Payments concluding on 10/16/24. Initial payment made on 11/16/23 via cashier's check in the amount of $13,612.00 (November and December payment for both parcels). f. [NAME] County Treasurer (Property Taxes) Parcel 2 - Payment Plan initiated on 11/16/23 with 12 monthly payments of $192.45. Payments concluding on 10/16/24. Initial payment made on 11/16/23 via cashier's check in the amount of $13,612.00 (November and December payment for both parcels). g. Medline (Medical Supplies) - A payment plan was initiated company wide to include a minimum payment of $15,000 each week via electronic payment. A payment of $7,135.78 was made on 11/20/23 and a payment of $3,340.01 was made on 12/11/23. h. Broad River (Therapy) - A payment plan was initiated on 12/14/23 with an electronic payment of $5,457.23 made. The facility indicated a payment plan contract was implemented to pay the oldest invoices first, starting with the September 2023 invoice (paid on 12/14/23). A conference call would be held on 12/14/23 to discuss the next payments. i. AT&T - A payment of $1,738.93 was made on 12/13/23 via phone debit transaction. j. Ohio Hills Health Services (OHHS) for the Medical Director's services - A payment plan was initiated on 12/07/23 to include paying three invoices in December 2023 and two invoices per month for the first six months in 2024 to bring the account current (the outstanding balance amount was not provided to the surveyor from the account manager at OHHS). • Results of all audits and interventions were reviewed during an Ad Hoc QAPI meeting on 12/12/23 at 9:30 A.M. Attendees included the Administrator, Assistant Administrator, DON, [NAME] Date Set (MDS) Registered Nurse (RN) #8, Social Service Director (SSD) #64, Business Office Manager (BOM) #116, Therapy Director #230, Infection Preventionist (IP) Licensed Practical Nurse (LPN) #112, and Unit Manage LPN #120. The Medical Director was notified via phone. The results of all audits and interventions will be brought to the facility's monthly QAPI meeting for three months and as needed for review and recommendations. Although the Immediate Jeopardy was removed on 12/14/23, the facility remained out of compliance at a Severity Level 2 (no actual harm with potential for more than minimal harm that is not Immediate Jeopardy) as the facility was still in the process of implementing their corrective action and monitoring to ensure compliance. Findings Include: On 12/05/23 at 1:10 P.M. an interview with the Administrator revealed he was the Administrator at this facility as well as a sister facility, Astoria Place of Cambridge. The Administrator stated he was unaware of the extent of the financial issues this facility was experiencing until the complaint survey was in-progress at Astoria Place of Cambridge. The Administrator shared corrective actions from Astoria Place of Cambridge were also implemented at this facility, beginning on 11/28/23. On 12/06/23 at 2:35 P.M. an interview with Business Office Manager (BOM) #46 revealed most facility bills were sent directly from vendors to Epic Healthcare Solutions (the facility management company located in Florida). All bills and invoices received at the facility were scanned and emailed directly to Stampli (company that processes and pays invoices) every Wednesday. There was no evidence these bills were monitored to ensure they were being paid in a timely manner or to ensure payments were made as required to prevent outstanding balances or termination notices for the facility. Payroll information was sent to the corporation on a Monday and paper checks were sent overnight to the facility for payday (every other Friday). On 12/07/23 at 2:40 P.M. an interview with the Administrator regarding the facility finances and billing/payment process revealed BOM #46 would forward invoices and bills received at the facility to Stampli via email. The Administrator revealed the facility did not pay any of the vendors directly for services rendered at the facility, the payments were being made by an accounts payable department based in Florida. There was no evidence the facility had a comprehensive and effective system in place to monitor the financial solvency of the facility, to ensure bills were being paid timely, vendors were paid the amount due and/or the facility was meeting all financial obligations. The following financial solvency concerns were identified (to include but not limited to) the following as a result of the complaint investigation: a. On 12/05/23 at 2:25 P.M. an interview with the Administrator revealed there were 14 employees who did not receive paychecks on 10/13/23 as their checks were returned due to insufficient funds. The Administrator did not provide any additional information as to why payroll was not met for these employees on this date. On 12/05/23 at 1:25 P.M. an interview with Housekeeping Staff #74 revealed they had a paycheck from 10/13/23 returned due to insufficient funds. On 12/05/23 at 1:30 P.M. an interview with Laundry Staff #6 revealed they had a paycheck from 10/13/23 returned due to insufficient funds. On 12/05/23 at 1:35 P.M. an interview with Licensed Practical Nurse (LPN) #128 revealed they had a paycheck from 10/13/23 returned due to insufficient funds. On 12/07/23 at 9:51 A.M. an interview with Housekeeping Staff #80 revealed they had a paycheck from 10/13/23 returned due to insufficient funds. On 12/07/23 at 10:01 A.M. an interview with Activity Staff #56 revealed they had a paycheck from 10/13/23 returned due to insufficient funds. On 12/07/23 at 10:08 A.M. an interview with Dietary Staff #96 revealed they had a paycheck from 10/13/23 returned due to insufficient funds. On 12/07/23 at 2:40 P.M. interview with the Administrator revealed BOM #46 sent payroll information to corporate on a Monday and paper checks were sent overnight to the facility for payday (every other Friday). The Administrator stated paper checks had been used for several months but he was unsure why this was changed from direct deposit. Further interview revealed the Administrator called corporate on 10/13/23 when his check was returned for insufficient funds and again on 10/16/23 when the checks for 13 additional employees were returned on 10/16/23 due to insufficient funds. The Administrator identified himself, the Director of Nursing (DON), the Assistant Administrator, Licensed Practical Nurse (LPN) #210, Activity Director #56, Marketing Director #14, Dietary Director #98, Dietary Staff #88, #90 and #96, Housekeeping Staff #12, #74 and #218, and Maintenance Director #54 who had payroll checks returned due to insufficient funds. The 14 staff (the Administrator, DON, the Assistant Administrator, LPN #210, Activity Director #56, Marketing Director #14, Dietary Director #98, Dietary Staff #88, #90, #96, Housekeeping Staff #12, #74, #218 and Maintenance Director #54) identified were verified with facility payroll records to have payroll checks dispersed and dated 10/13/23. Review of the undated facility Employee Handbook revealed employees would receive their pay reimbursement for hours worked either through Pay Card or Direct Deposit. During orientation, the human resources representative would assist with signing up for either direct deposit or a Pay Card. b. The following vendor/suppliers were reviewed as part of the State agency investigation with financial solvency concerns including but not limited to the following: 1. Review of the statement issued by [NAME] Innovative Management Partners, dated 11/18/23, revealed the facility owed a balance of $133,353.10 with invoices dated back to June 2023. The facility owed the amount of $77,020.88 that was over 90 days past due. This vendor was the facility's previous food supply vendor. On 12/05/23 at 1:50 P.M. an interview with Dietary Director (DD) #98 revealed food service vendors were changed from [NAME] Distributors on 10/28/23 to [NAME] Food Services starting 10/29/23. DD #98 stated the previous food budget was set at $1,700.00 per week, which was a low dollar amount and made it difficult to order needed food items due to the increased food costs. DD #98 revealed she would have to borrow items from her emergency food supply to get through to the next week and then replace items with the next order. On 12/11/23 at 11:30 A.M. an interview with the Administrator revealed the facility's outstanding balance to [NAME] Distributors was $133,353.10 which included labor, food services, and supplies. 2. Review of a bill from Barnesville Water Department, dated 11/21/23, revealed the facility account was delinquent with an amount due of $2,498.27. The bill included, if payment was not received by 12/05/23, service would be terminated without further notice. Review of check #1006, from Bank of Oklahoma, dated 12/01/23 revealed payment of $2,498.27 made to the order of Barnesville Water Department. On 12/11/23 at 9:34 A.M. an interview with Barnesville Water Department Clerk #330 revealed a check payment was received on 12/05/23 for $2,298.27 and the payment was deposited on 12/05/23. However, on 12/08/23 there was a notice the payment had been returned due to an incorrect routing number on the check. Barnesville Water department Clerk #330 confirmed the recent bill dated 11/21/23 was a delinquent notice with possible termination of services if the amount was not paid by 12/05/23. Further interview with the clerk revealed concerns the facility/Epic Healthcare Solutions was always late on their payments for water services. On 12/15/23 at 11:01 A.M. an additional interview with Barnesville Water Department Clerk #330 revealed the delinquent statements are sent out to accounts which have a history of late payments. Epic Healthcare Solutions has a history of having late payments with the water department and would only send payment once the delinquent notice was received for the amount due including a 10% late fee. She also verified it is their practice to issue the shut off notice if payment is not received, and the facility was addressed in the same manner as a residence. 3. Review of an invoice from American Electric Power (AEP) Ohio, dated 11/29/23, revealed the facility had an amount due of $7,876.57, with a disconnection date of 12/08/23, if payment was not received. Review of check #1007 from Bank of Oklahoma, dated 12/01/23, revealed a payment of $7,876.51 paid to the order of AEP Ohio. On 12/12/23 at 10:20 A.M. an interview with AEP Customer Service Representative #365 revealed a check payment was received on 12/06/23 for $7,876.57. However, on 12/11/23 the payment for $7,876.57 was returned with no reason noted. An additional interview on 12/13/23 at 10:35 A.M. with AEP Customer Service Representative #377 revealed the facility had a current outstanding account balance of $10,891.71 due 12/29/23. A past due balance of $7,876.57 was due immediately. Per the representative, there were no pending payments noted to be on the account as of this date (12/13/23). 4. Review of an invoice from American Telephone and Telegraph (AT&T) dated 11/19/23 revealed a current charge of $640.27 with a past due balance of $2,182.82 resulting in total amount of $2,823.09 due in full by 12/19/23. Review of an email communication from Director of Finance #608 to the Administrator, dated 12/08/23, revealed a forwarded email, dated 12/07/23 at 5:01 P.M., from AT&T Business Payment Confirmation, showing a payment confirmation via bank debit for AT&T account. The payment amount and date of payment was not made available. On 12/13/23 at 10:43 A.M. an interview with AT&T Collections Representative #370 revealed a payment of $2,823.09 was received on 12/04/23. On 12/08/23 the same payment was returned due to an incorrect routing number. On 12/04/23 there was a credit placed on the account for $427.65 making the current amount owed $1,738.93 due immediately with the account being in jeopardy of termination. On 12/13/23 at 10:55 A.M. the Administrator and CFO #600 paid the account balance of $1,783.93 via the facility's petty cash credit card with the amount loaded onto the card by CFO #600. 5. Review of an invoice from the [NAME] County Treasurer Office dated 10/14/23 revealed two parcels of property located at the facility's address. The first parcel property tax amount of $79,362.61 with a payment noted on 11/17/23 for $13,227.10 bringing the current balance owed to $66,135.51. The second parcel property tax amount of $2,309.34 with a payment noted on 11/17/23 for $384.90 bringing the current balance owed to $1,924.44. On 12/11/23 at 9:52 A.M. an interview with [NAME] County Treasurer Clerk #373 revealed there was a payment plan contract dated 11/16/23 for monthly payments of $6,613.55 for the first parcel and $192.45 for the second parcel with each payment due on the 16th of each month. [NAME] County Treasurer Clerk #373 verified there were two separate payments on 11/16/23, one for $6,613.55 and the other for $384.90. 6. On 12/07/23 at 2:40 P.M. interview with the Administrator revealed the previous contracted therapy company (Arbor Therapy) terminated services on 09/17/23 (due to payment issues) and a new therapy company (Broad River Therapy) began services on 09/18/23. On 12/11/23 at 9:46 A.M. an interview with a Representative from Broad River Therapy #376 revealed the facility began services on 09/18/23 and the first invoice #106861 was sent on 10/03/23 for $5,457.23 with payment due on 11/02/23. On 11/02/23 a second invoice was sent for $18,688.17 due on 12/02/23. The facility had a current outstanding balance of $18,688.17 due immediately. Broad River Therapy #376 revealed the facility entered a payment plan contract, on 12/14/23 to pay the oldest invoices for the facility starting on 12/14/23 for the September invoice payment of $5,457.23 with a conference call to schedule the next set of payments (the conference call was also scheduled for 12/14/23). On 12/14/23 at 10:39 A.M. an interview with Arbor Rehabilitation and Healthcare Inc. Chief Executive Officer (CEO) #503 revealed therapy services provided by his therapy company in the facility, were ended due to lack of payment. The facility owes $187,594.25 for therapy services accrued from 01/17/22 to 09/17/23. CEO #503 stated the facility would not commit to a payment plan because it was too binding, and they wanted flexibility. CEO #503 stated monthly payments were not being made and a payment had not been made since 03/30/23. Review of an Excel Spreadsheet, created by Arbor Rehabilitation and Healthcare Inc. dated 11/15/23 and provided by CEO #503, verified the facility owed $187,594.23. 7. Review of the invoice for Medline Medical Supplies revealed an outstanding balance for Epic Healthcare Solutions of $41,659.20. The facility provided a payment plan that was corporation wide and not specific to the facility. The weekly agreed upon payments were to be between $15,000.00 to $20,000.00 entity wide. There were payments made on 11/20/23 for $7,135.78 and on 12/11/23 for $3,340.01 which were specifically for the facility. (However, the information regarding how the payments were made was not provided during the survey). Attempts were made to contact Medline regarding payments and outstanding balances. Medline did not return calls or emails. 8. On 12/11/23 at 11:45 A.M. an interview with [NAME] Credit Account Manager #245 revealed the facility had been 90 days delinquent with their invoice payments resulting in a suspension of service for the last week of October (10/29/23 - 11/04/23). The delinquent payment plus late fees totaled $1,552.00 and was paid on 11/06/23 and the facility service was restored. 9. On 12/11/23 at 10:35 A.M. an interview with Ohio Hills Health Services Office Manager #380 revealed Medical Director services had not been paid by the facility since 04/2023. Medical director service charges were $2,000.00 per month. A payment plan, dated and signed 12/14/23, revealed an electronic payment was to be paid by the 15th of each month in the amount of $6,000.00 until the account was paid current. The first payment was to be paid by electronic payment on 12/14/23 for $6,000.00. The current outstanding account balance was $16,000.00. On 12/11/23 at 2:00 P.M. during an interview with the Medical Director (MD) #225, the MD revealed he was aware the facility was not paying for his services as medical director. MD #225 revealed he had also been made aware by the Administrator related to the concerns with payroll not being met on 10/13/23. However, the MD denied knowledge of other unpaid vendors including water and electricity. On 12/12/23 at 10:33 A.M. an interview with Chief Financial Officer (CFO) #600 revealed the facility had attempted to make payments for some outstanding invoices/bills on 12/01/23; however, most were returned. CFO #600 revealed he believed the reason for the most recent vendor payments being returned was due to a new program offered through Bank of Oklahoma which required a routing number to be assigned prior to checks being sent out as payment. When the facility corporation, Epic sent out checks at the beginning of December 2023, the new program had not been implemented completely with the routing numbers which caused the checks to be returned. CFO #600 gave no explanation for the lack of payments to facility vendors resulting in high outstanding balances and shut-off notices to the water and electric and disconnect notices for the facility phone lines that was noted to be occurring prior to 12/01/23. Review of the undated Nursing Facility admission Agreement, provided upon admission to the facility, revealed the facility would provide routine nursing care and supplies, meals, housekeeping, social services, activities, laundry, and medical supplies. Review of the Facility Assessment, dated 09/12/23, revealed the facility's residents were at a clinically complex and special high categories who oftentimes have one or more chronic or comorbid conditions including their acuity. Residents of the facility were at risk for falls, pressure ulcers, infections, incontinence, increased disability, weight loss, depression, and other potential areas of decline. Review of the facility policy titled, Abuse Prevention, Identification, Investigation and Reporting Policy revised 08/15/22 revealed, Neglect was the failure of the facility, its employees or service providers to provide goods and services to a resident that were necessary to avoid physical harm, pain, mental anguish, or emotional distress. This deficiency represents non-compliance investigated under Complaint Number OH00148884.