**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, Self-Reported Incident (SRI) review, witness statement review, policy review and interview, the facility failed to ensure Resident #64 and Resident #93 were free from incidents of physical abuse by Resident #50. This affected two residents (Resident #64 and #93) of six residents reviewed for abuse. Actual harm occurred on 09/24/24 when Resident #93 was physically abused/assaulted by Resident #50 resulting in an injury. At the time of the incident, Resident #50 punched, with a closed fist, Resident #93, unprovoked, resulting in Resident #93 experiencing pain rated a seven out of 10 (on a pain scale with 10 being the most severe pain), headache, distress with crying resulting in a transfer to the hospital emergency department where the resident was admitted to a trauma center for further evaluation and treatment and diagnosed with a nondisplaced right occipital bone fracture. As of 10/01/24 Resident #93 had not returned to the facility. Prior to this incident of physical abuse, Resident #50 was noted to have a history of abuse towards other residents. Findings include: 1. Review of the closed medical record for Resident #93 revealed the resident was admitted to the facility on [DATE] from the hospital and discharged to the hospital on [DATE]. The resident had diagnoses including epilepsy, major depressive disorder, symptoms and signs involving cognitive functions and awareness, suicidal ideation and personal history of transient ischemic attack. Review of a Brief Interview for Mental Status (BIMS) evaluation assessment revealed Resident #93 was cognitively intact. Review of a Social Service History and assessment dated [DATE] revealed Resident #93 used a walker or cane, and rehabilitation was needed to move on to a more normal life. Review of the admission assessment dated [DATE] revealed Resident #93 was alert to person, place, time and situation and was independent with bed mobility, transferring and eating and did not have any pain. Record review revealed Resident #93 and Resident #50 were roommates from 09/17/24 to 09/24/24. Resident #93's daughter was identified to be his Power of Attorney (POA). Review of the medical record for Resident #50 revealed an admission date of 09/23/23 with diagnoses of schizophrenia, dementia with psychotic disturbance, schizoaffective disorder, mood disorder, obsessive compulsive disorder, psychosis, alcohol dependence with alcohol-induced persisting dementia, generalized anxiety disorder and bilateral macular degeneration. Review of the Minimum Data Set (MDS) 3.0 quarterly assessment dated [DATE] revealed Resident #50 was cognitively intact, had hallucinations and delusions, had other behavioral symptoms and wandering behaviors that occurred one to three days during the assessment, and was independent with transferring and walking 150 feet. Resident #50 had legally appointed guardian. Review of a general note dated 09/24/24 timed 7:08 P.M. authored by Registered Nurse (RN) #7 revealed Resident #93 was hit by another resident (Resident #50) on the side of his head while sitting in the hallway in his wheelchair. The residents were separated from each other. Resident #93 was assessed with no apparent injuries noted. The doctor ordered Resident #93 to be sent to hospital for evaluation. Review of a facility SRI dated 09/24/24 revealed at approximately 7:20 P.M., it was reported to the Administrator that Residents #50 and #93 were involved in altercation. Resident #93 was observed sitting in his wheelchair in the hallway, and without provocation, Resident #50 smacked him on the side of his face/ear. Review of the hospital emergency department nursing note dated 09/24/24 timed 8:10 P.M. revealed Resident #93 was brought in by emergency medical services from nursing home for an altercation with his roommate. Resident #93 stated his roommate hit him in the back of his head with his fist for no reason. Resident #93 reported a seven out of 10 headache. It was noted Resident #93 took baby aspirin and was alert and oriented times four spheres (person, place, time and situation). Review of the hospital emergency department physician assistant note dated 09/24/24 timed 8:10 P.M. revealed Resident #93 presented to the emergency department after an assault. Resident #93 was punched once in the back of the head by his roommate at the nursing home around 7:00 P.M. Resident #93 did not fall to the floor. Resident #93 reported a headache now localized to the site of the punch located at the left-side of the head to neck. Resident #93 had some sensations of feeling the room was spinning which he did feel before the punch but the sensation was now consistent. Tenderness was noted over area depicted in photo [left side to middle of neck underneath the skull]. Resident #93 had full range of motion in his neck, some tenderness associated with looking to the right. Resident #93 had pain with movement and muscular tenderness was present. Review of the weight/vitals tab in the electronic medical record revealed Resident #93 had not had any pain from the time of his admission until staff documented pain on 09/24/24 at 9:35 P.M. as the resident complained of pain rated a seven out of 10. Review of the hospital emergency department physician note dated 09/25/24 timed 12:21 A.M. revealed the physician was notified by radiology of a critical finding of nondisplaced right occipital bone fracture. The note indicated neurosurgery would be consulted. Review of the CT scan of head dated 09/25/24 timed 12:32 A.M. revealed Resident #93 had a questionable nondisplaced fracture of the right occipital bone. Review of the orders-administration note dated 09/25/24 timed 7:42 A.M. revealed Resident #93 was admitted to the trauma center with a diagnosis of a hairline fracture. Review of the repeat CT scan of head dated 09/25/24 timed 8:30 A.M. revealed Resident #93 had a stable nondisplaced right occipital bone fracture. Interview on 09/30/24 at 8:30 A.M. and 10:30 A.M. with Resident #93's daughter/POA revealed on 09/24/24, the nurse called her and had informed her she had observed an incident (resident to resident altercation) and reported that Resident #93 did not provoke Resident #50 in any way. The resident's daughter/POA reported Resident #93 sustained a hairline fracture of the skull as result of the hit from Resident #50. Resident #93 had CT scans of the head prior to being admitted to the facility which did not show a fracture of the skull. When Resident #93's daughter/POA spoke to Resident #93 after the incident, Resident #93 stated, oh my god, I was attacked, my head hurts so bad, my head hurts so bad. Resident #93's daughter/POA confirmed Resident #50 was Resident #93's roommate. Resident #93's daughter/POA also revealed Resident #93 was still at the hospital but was getting ready to discharge to a different long-term acute care hospital for acute rehabilitation. Observation on 09/30/24 at 9:15 A.M. revealed Resident #50 was sitting on the edge of his bed, feeding himself breakfast. Interview, during the observation, with Resident #50 revealed when asked to describe the altercation between himself and Resident #93 last week, Resident #50 responded, that did not happen, nothing happened. Interview on 09/30/24 at 9:20 A.M. with Licensed Practical Nurse (LPN) #4 revealed he received the phone call from the hospital that reported Resident #93 had sustained a hairline fracture of the skull. Interview on 09/30/24 at 11:40 A.M. with RN #7, with the DON present, revealed RN #7 was at the nurses' medication cart, passing medications when Resident #93 self-propelled out of his room and was sitting in his wheelchair in front of the elevator when Resident #50 was walking from the opposite direction then turned around and hit Resident #93 with a closed fist on the left side of Resident #93's head. RN #7 was unable to describe the exact location of the point of contact on Resident #93. RN #7 revealed there had not been any words spoken between the residents at the time of the assault; the assault was unprovoked. Resident #93 reported his head was hurting so the physician ordered to send Resident #93 to the hospital. The RN stated staff had been monitoring Resident #50 every 15 minutes. RN #7 believed she was the only staff member to witness the altercation between Residents #50 and #93. Interview on 10/01/24 at 11:30 A.M. with Physician #14 (who specialized in internal medicine and was Residents #50 and #93's physician) revealed Physician #14 reviewed Resident #93's chart at the hospital and felt Resident #93's occipital bone fracture was still questionable as the resident had prior surgery and the imaging could be unclear. When asked if it was possible that Resident #93 sustained the right occipital bone fracture from Resident #50's hit/punch, Physician #14 stated that it could go either way. Review of a hospital CT scan of the head dated 08/24/24 revealed there was no evidence of Resident #93 having a nondisplaced right occipital bone fracture at the time of this testing. Review of a hospital CT scan of the head dated 09/01/24 revealed there was no evidence of Resident #93 having a nondisplaced right occipital bone fracture at the time of this testing. 2. Review of the closed medical record for Resident #64 revealed an admission date of 10/28/21 with diagnoses of aphasia following cerebral infarction, mild cognitive impairment and unsteadiness on feet. Review of the Minimum Data (MDS) Set 3.0 quarterly assessment dated [DATE] revealed Resident #64 had short and long-term memory problems, was unable to recall the current season and staff names and faces, was moderately impaired with daily decision making and had continuous inattention and disorganized thinking. Resident #64 did not utilize a mobility device and was independent with transferring and walking 150 feet. Resident #64 had a legally appointed guardian. Review of the medical record for Resident #50 revealed an admission date of 09/23/23 with diagnoses of schizophrenia, dementia with psychotic disturbance, schizoaffective disorder, mood disorder, obsessive compulsive disorder, psychosis, alcohol dependence with alcohol-induced persisting dementia, generalized anxiety disorder and bilateral macular degeneration. Review of the Minimum Data Set (MDS) 3.0 quarterly assessment dated [DATE] revealed Resident #50 was cognitively intact, had hallucinations and delusions, had other behavioral symptoms and wandering behaviors that occurred one to three days during the assessment, and was independent with transferring and walking 150 feet. Resident #50 had legally appointed guardian. Review of the general note dated 09/12/24 timed 6:59 P.M. revealed Resident #64 was unable to communicate if he was in pain. Acetaminophen 650 milligrams was given for pain and an ice pack was applied to the right side of his mouth which was swollen. Review of the general note dated 09/12/24 timed 7:54 P.M. revealed around 6:45 P.M., Resident #64 had just finished his dinner, got up and was walking down the hall when another resident [Resident #50] struck him on the right side of his face, knocking him to the floor. Both residents were immediately separated by staff and assessed for injuries. Resident #64 had a swollen lip. A call was placed to the Medical Director with new orders for vital signs for seven days every shift and apply ice pack to right side of face. The other resident [Resident #50] was sent out to hospital for a psychiatric evaluation and a room change would be completed on a different floor. Resident #50 would remain on one-to-one supervision until the ambulance arrived. Review of the Situation Background Assessment Recommendation or Request (SBAR) Summary for Providers assessment dated [DATE] revealed Resident #64's physician ordered a facial x-ray. Review of the general note dated 09/13/24 revealed Physician #14 was in to see Resident #64 with no new orders. Resident #64 had an x-ray of the right side of this face which was negative. Review of the general note dated 09/13/24 timed 2:10 A.M. revealed Resident #64 returned from emergency department. Review of a facility SRI dated 09/12/24 revealed on 09/12/24 at approximately 6:45 P.M., it was reported that Resident #64 and Resident #50 were involved in a physical altercation. Review of the Individual Aggression Program for Resident #50 updated 09/12/24 (within the Self-Report Incident investigation) revealed to determine the reason for aggression, attempt to identify why the resident was showing such behavior as: behaviors related to reality of declining cognitive status and fear of the future and responded impulsively to other residents/staff being in their space by hitting/kicking out without harm intent. Possible situations: separate residents who were having negative interaction, do not take resident behavior personally, offer/assist with food, use of bathroom or other activities of daily living (ADLs) and encourage/assist to change location. The possible situations chosen for Resident #50 were generalized and not individualized to Resident #50. Review of the witness statement dated 09/12/24 (within the SRI investigation) authored by Licensed Practical Nurse (LPN) #12 revealed at approximately 6:30 P.M., LPN #12 was at the nurses' station in front of the medication cart when LPN #12 witnessed Resident #50 in the hallway close to the nurses' station. Resident #64 came walking by from the dining room and as he was walking by, Resident #50 struck him in the face, and he fell on the floor. LPN #13 immediately went to the area and removed Resident #50 from the scene while other staff assisted Resident #64. Interview on 09/30/24 at 10:55 A.M. and 11:20 A.M. with the Administrator and Director of Nursing (DON) revealed after Resident #50 hit Resident #64, Resident #50 was sent to the hospital and returned with no new orders, then Resident #50 was seen by psychiatry services and a medication review was completed by psychiatry service. Resident #50 was also moved to the third floor and had increased supervision. The DON was unable to specify the expectation for increased supervision. Upon review of Resident #50's medical record as it pertained to the incidents of physical abuse involving Resident #93 and Resident #64 it was noted the resident had a physical behaviors care plan dated 09/13/24 which indicated Resident #50 had potential to demonstrate physical behaviors hitting or attacking because he had poor impulse control. The care planned interventions were generalized and were not individualized to Resident #50. Review of Resident #50's physical behaviors care plan dated 09/25/24 revealed Resident #50 had potential to demonstrate physical behaviors of hitting other residents related to dementia. History of harm to others and intrusive wandering/exit seeking. Resident #50 was demonstrating physical behaviors (hitting other residents related to dementia, history of harm to others, poor impulse control). The care planned interventions were generalized and not individualized to Resident #50. Interview on 09/30/24 at 9:00 A.M. with Registered Nurse (RN) #1 revealed Resident #50 repeated what was spoken to him and invaded personal space. RN #1 was not aware of interventions being in place to protect other residents from Resident #50's impulsive behaviors other than every 15-minute checks. Interview on 09/30/24 at 9:12 A.M. and 10:40 A.M. with State Tested Nurse Aide (STNA) #3 revealed Resident #50 had been getting more aggressive. Resident #50 had resided on the third floor, was moved to the second floor then back on the third floor which was his current location. STNA #3 was not aware of any interventions for Resident #50 other than every 15-minute checks. Observation on 09/30/24 at 9:50 A.M. revealed Resident #50 was lying in his bed, asleep. Interview on 09/30/24 at 10:50 A.M. with STNA #5 revealed Resident #50 was on every 15-minute checks. STNA #5 was not aware of any other interventions being in place to protect the safety of other residents. Observation on 09/30/24 at 10:51 A.M. and 12:45 P.M. revealed Resident #50 was lying in his bed, asleep. Observation on 09/30/24 at 12:50 P.M. revealed STNA #9 sitting at the nurses' station with several papers including one paper dated 09/30/24 with Resident's #50 name on it which indicated Resident #50 was on 15-minute checks with increments of 15-minutes from 12:00 A.M. to 11:59 P.M. with staff initials next to each 15-minute increment. There was no documentation of what Resident #50 was doing when the 15-minute checks were completed. Interview, during the observation, with STNA #9 revealed Resident #50 had a recent increase in physical behaviors that were totally unprovoked. On 09/30/24 at 12:52 P.M. the every 15 minute check log for Resident #50 was requested from the the DON. Interview on 09/30/24 at 4:00 P.M. with the Administrator and Regional Director of Clinical Operations (RDCO) #12 confirmed Resident #50 hit Resident #64 and Resident #93 within less than two-week span, unprovoked. Evidence of Resident #50's every 15-minute checks was requested again. Interview on 09/30/24 at 4:20 P.M. with LPN #12 verified she witnessed Resident #64 walking along and Resident #50 hitting Resident #64, unprovoked. LPN #12 was unable to describe if Resident #50 hit Resident #64 with an open hand or closed fist. On 10/01/24 at 9:50 A.M. evidence every 15- minute checks for Resident #50 were completed was requested from Regional Director of Operations (RDO) #13. Review of the facility's Abuse, Mistreatment, Neglect, Exploitation and Misappropriation of Resident Property dated October 2022 revealed if a resident was accused or suspected, the facility would ensure other residents were protected as determined by the circumstances, which could include but were not limited to, increased supervision of the alleged perpetrator and/or other residents, room or staffing changes, and immediate transfer or discharge, if indicated. Whether the incident/allegation was substantiated or unsubstantiated, the Administrator and/or DON or designee would: ensure involved resident's plan of care was reviewed and revised, as appropriate, consistent with the results of the investigation. At the completion of the complaint investigation on 10/01/24, the facility provided no evidence that every 15 minute checks were completed on Resident #50. This deficiency represents non-compliance investigated under Complaint Number OH00158288 and OH00158285.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of a facility self-reported incident, facility policy review and interview the facility failed ensure a smoking privilege was not withheld as a punishment for Resident #71 and failed to ensure the resident was free from an incident of staff to resident abuse. Actual Harm occurred on 02/17/23 when facility staff withheld smoking as a punishment for Resident #71 which then escalated to an altercation between State Tested Nurse Aide (STNA) #563 Resident #71. STNA #563 was observed to pin Resident #71 against the wall causing the resident to be fearful of the aide and upset/crying resulting in psychosocial harm. This affected one resident (#71) of three residents reviewed for abuse. The facility census was 93. Findings include: Review of the medical record for Resident #71 revealed an admission date of 10/28/22 with diagnoses including bipolar disorder, anxiety disorder, chronic obstructive pulmonary disease, and post-traumatic stress disorder. Review of the admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #71 had intact cognition. Resident #71 required extensive one-staff physical assistance for bed mobility; and supervision with set-up help only for transfers, dressing, eating, toileting, and hygiene. Resident #71 was always continent of urine and bowel. Review of the care plan dated 01/18/23 revealed Resident #71 had chronic obstructive pulmonary disease related to smoking. Interventions included to increase supervision while smoking and monitor for signs and symptoms of acute respiratory insufficiency. The care plan also included a focus that Resident #71 had behavior problems related to sexually provocative behaviors. Interventions included to administer medications as ordered and to approach and speak to the resident in a calm manner and divert attention as to remove her from the situation and take to an alternative location. Review of the smoking safety screen dated 01/28/23 revealed Resident #71 was safe to smoke with supervision. Review of the elopement evaluation completed 02/07/23 revealed Resident #71 was not at risk for elopement. Review of a facility SRI, tracking number 232237 initiated 02/18/23 revealed Resident #71 alleged on 02/17/2023 around 7:45 P.M. (during resident smoke time) she entered the sitting area leading to the outside area. The resident indicated she was stopped by STNA #563 and advised she needed to wait due to requiring increased supervision while smoking. While the resident attempted to proceed to go outside, STNA #563 attempted to redirect the resident and stood in front of the door with her back facing the resident. Resident #71 placed her arm around STNA #563's neck trying to pull her to the ground. Resident #71 then grabbed STNA #563's face causing her to have scratch that bled. STNA #563 turned her body around to face Resident #71, while still in a hold, and pushed the resident back breaking loose from the resident's grip. STNA #601 intervened. The receptionist, who heard the commotion came to assist and escorted Resident #71 back to her unit. At approximately 10:00 P.M., East Cleveland Police came to the facility to report Resident #71 had contacted them to make a report; however, upon attempts to interview the resident, she declined to say anything regarding the incident. On 02/18/2023 STNA #601 contacted ADON #610 to report that at the time of the incident she witnessed STNA #563 punch Resident #71 in the face after pushing the resident off her. STNA #563 was immediately suspended pending investigation but had not worked since the time of the incident. Resident #71 was assessed with no visible signs of being punched in the face. Upon further investigation, it's noted that other witnesses who were there at the time of this incident did not see STNA #563 punch Resident #71 in the face. Interview with Resident #71 revealed she denied being punch in the face. Review of the nursing progress note dated 02/22/23 revealed Resident #71 had a skin assessment performed with no skin impairments noted. Interview on 02/22/23 at 2:31 P.M. with Resident #12 revealed she witnessed the commotion of a fight with a staff member and a resident on 02/17/23 during the evening smoke break. Resident #12 reported when she heard their voices raise, she went and stood in a opposite corner on the smoking patio because she was scared and did not remember a lot of details. Interview on 02/22/23 at 3:47 P.M. with Resident #71 revealed the night of 02/17/23 at the 7:00 smoke break, she was told by an aide that she was not allowed to go outside to smoke. She reported the staff were mad at her because around 2:30 P.M. she attempted to assist a wheelchair resident outside causing the alarm to go off. She reported after the incident staff told her she could not have her evening smoke break, another aide stood in the doorway blocking her from exiting to the smoking patio. She reported that aide broke her cigarette in half and turned around facing outside blocking the doorway. Resident #71 reported she then attempted to physically get around the aide by grabbing onto her back and attempting to slip underneath her arm to get outside. The aide then turned around and pinned her up against the wall restraining her with her right hand on the right side of her chest and neck. She confirmed many staff members then came to the area and she was taken back to her room. She reported she denied seeking any medical treatment and did not file a police report because she did not want to be an enemy to anyone. Resident #71 stated she used to work in a nursing home and would never treat her residents that way and reported she just went to her room to cry. Resident #71 became tearful during the interview. Telephone interview on 2/23/23 at 11:21 A.M. with STNA #563 revealed Resident #71 was at the door around smoke break time on 02/17/23 around 7:35 P.M. Resident #71 was told by a co-worker that she could not go out and smoke because she was caught attempting to elope with a wheelchair resident earlier in the day setting the alarms off. STNA #601 informed Resident #71 that she did not follow the rules; therefore, she could not smoke. STNA #563 stated she asked Resident #71 to give her the cigarette she was holding, and Resident #71 gave it to her. She was then standing in the doorway to the smoking patio facing the outside when Resident #71 jumped on her back attempting to take her to the ground. STNA #563 reported Resident #71 got her almost on her knees when she regained her footing and stood up and turned around now face to face with Resident #71 when she pushed her with her right hand on Resident #71's chest and neck pinning her up against the wall by the vending machines to restrain her. She reported two other aides attempted to separate them when Resident #71 scratched her face drawing blood. Telephone interview on 02/23/23 at 11:27 A.M. with STNA #601 revealed when she was coming to work on 02/17/23 she saw Resident #71 pushing a wheelchair resident outside the front doors setting off the alarms. She reported because Resident #71 was attempting to elope she was denied her smoking privileges for that evening, and Resident #71 was instructed not to go to the first floor without supervision. While she was taking residents to the 7:00 P.M. smoke break she found Resident #71 on the first floor unsupervised. STNA #601 said she told Resident #71 to return to her room because she could not go out for smoke break because she was caught taking a resident outside earlier setting off the alarms and was asked to not come on the floor unsupervised. She reported STNA #563 was standing at the doorway and took Resident #71's cigarette and broke it in half and then turned to look outside while taunting Resident #71 saying you can't smoke. Resident #71 then charged behind STNA #563 and attempted to take her down. STNA #563 regained her footing turned around, so she was face to face with Resident #71 and pushed her back into the building pinning her against the wall with her right-hand holding Resident #71 against the wall by her right neck and chest area. STNAs #600 and #601 attempted to break them up when Resident #71 slipped her arms underneath STNAs #600 and #601 scratching STNA #563 in the face causing her to bleed and let go of her grip on Resident #71. STNA #601 reported after Resident #71 scratched STNA #563 in the face, STNA #563 punched Resident #71 in the head. (Resident #71 denied being punched in the head by STNA #563). Telephone interview on 02/23/23 at 11:43 A.M. with STNA #600 revealed she was in the smoking patio door area on 02/17/23 around 7:00 P.M. using the vending machines. She reported she heard STNA #601 tell Resident #71 she could not go smoke. STNA #563 then began blocking the door and informing Resident #71 she could not go smoke when Resident #71 charged her back attempting to remove her from the doorway. STNA #563 then regained her footing turned around and pushed Resident #71 back into the building pinning Resident #71 against the wall with her right hand holding her by her right neck and chest area. STNA #600 reported her, and STNA #601 attempted to separate them when Resident #71 reached underneath their hands and scratched STNA #563 in the face causing her to bleed. STNA #600 reported sometimes STNA #563 could get very heated, and she was pleading with her to let Resident #71 go when she had her pinned to the wall and the only thing that made her let Resident #71 go was when Resident #71 scratched her in the face. Interview on 02/23/23 at 1:30 P.M. with the Interim Administrator reported her staff should never tell a resident they cannot smoke as a form of punishment. Following the incident on 02/17/23, the Administrator reported Resident #71 was examined, had no physical injuries, reported no physical harm and denied filing a police report or seeking emergency medical attention. Interview on 02/23/23 at 2:00 P.M. with the Interim Administrator, the Director of Nursing (DON), and Resident #71 revealed Resident #71 confirmed STNA #563 did pin her up against the wall with her right-hand holding her by her right neck and chest area. She confirmed she had no physical markings, but reported she was afraid to say anything because she does not want enemies in the facility. Resident #71 repeated she used to work in a nursing home and would never treat her residents that way. During the interview, Resident #71 denied being punched in the head by STNA #563. Review of the facility policy Abuse, Mistreatment, Neglect, Exploitation, and Misappropriation of Resident Property, dated October 2022, revealed residents have the right to be free from abuse, neglect, exploitation, and misappropriation of resident property. This includes but is not limited to, freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint that is not required to treat the resident's medical condition. Abuse is defined as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. Abuse also includes the deprivation by an individual, including a caretaker of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. This deficiency represents noncompliance investigated under Master Complaint Number OH00140497. This deficiency is an example of continued noncompliance from the survey completed on 01/31/23.