**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of the Self-Reported Incident (SRI) and interviews, the facility did not ensure all residents were protected from misappropriation of resident funds by staff. This affected one resident of four residents reviewed for resident rights. The facility census was 74. Findings included: Record review for Resident #535 revealed an admission date of 05/22/23 with diagnoses including anxiety disorder, hypertension, constipation, anorexia, major depressive disorder. Record review of the facility Minimum Data Set ( MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status ( BIMS) score of 11 indicating moderate cognitive impairment. Record review of the SRI dated 10/03/23 and the facility investigation revealed agency State Tested Nurse Assistant (STNA) # 176 took a check from Resident #535 and wrote it out for $4000. On 10/03/23 the family of Resident #535 alerted the facility that a check allegedly signed by Resident #535 had been electronically presented for payment to the bank. The check for $4,000 dollars was made out to STNA #176. STNA #176 was employed as an agency state tested nurse aid and had worked on Resident #535's unit on 09/30/23. The allegation of misappropriation was substantiated by the facility. Review of the investigation report from the Abuse, Neglect and Misappropriation investigator from the Ohio Deptartment of Health revealed the staff person (STNA #176) admitted to taking the check and writing it out for $40000 so she could by a car and pay for her outstanding warrants of approximately $1,000. Interview with the Executive Director (ED) #177 on 12/21/23 at 1:45 PM verified the agency STNA #176 did take a check from Resident #535 and attempt to cash it at the bank for $4000.00. ED #177 stated the money was reimbursed to the resident. This deficieny resulted from incidental findings during the investigation of Complaint Number OH00149086.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of the Self-Reported Incident (SRI) and interviews, the facility did not ensure all residents were protected from misappropriation of resident funds by staff. This affected one resident of four residents reviewed for resident rights. The facility census was 74. Findings included: Record review for Resident #535 revealed an admission date of 05/22/23 with diagnoses including anxiety disorder, hypertension, constipation, anorexia, major depressive disorder. Record review of the facility Minimum Data Set ( MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status ( BIMS) score of 11 indicating moderate cognitive impairment. Record review of the SRI dated 10/03/23 and the facility investigation revealed agency State Tested Nurse Assistant (STNA) # 176 took a check from Resident #535 and wrote it out for $4000. On 10/03/23 the family of Resident #535 alerted the facility that a check allegedly signed by Resident #535 had been electronically presented for payment to the bank. The check for $4,000 dollars was made out to STNA #176. STNA #176 was employed as an agency state tested nurse aid and had worked on Resident #535's unit on 09/30/23. The allegation of misappropriation was substantiated by the facility. Review of the investigation report from the Abuse, Neglect and Misappropriation investigator from the Ohio Deptartment of Health revealed the staff person (STNA #176) admitted to taking the check and writing it out for $40000 so she could by a car and pay for her outstanding warrants of approximately $1,000. Interview with the Executive Director (ED) #177 on 12/21/23 at 1:45 PM verified the agency STNA #176 did take a check from Resident #535 and attempt to cash it at the bank for $4000.00. ED #177 stated the money was reimbursed to the resident. This deficieny resulted from incidental findings during the investigation of Complaint Number OH00149086.

Based on observation, record review and interview the facility failed to ensure a variety of foods were offered for Resident #51 and Resident #85 and failed to ensure Resident #2, Resident #65 and Resident #80, who were ordered a pureed diet received the proper serving size of soup. This affected two residents (#51 and #85) of four residents reviewed for food concerns based on the menu and three residents (#2, #65 and #80) of three residents reviewed for pureed diets. Findings include: On 03/10/20 observation of both the lunch and dinner meals revealed beef and barley soup was served for both meals. Interview with Dietary Managers #201 and #202 on 03/10/20 at 5:45 P.M. regarding observations of beef barley soup having been served on 03/10/20 for both lunch and dinner meals, and concerns residents (#51 and #85) had stated in regard to the lack of variety of meals served were discussed. Dietary Manager #201 stated, The same meals are not served back to back and denied beef and barley soup had been served at lunch and dinner on 03/10/20. Review of the menu spreadsheet on 03/10/20 with Dietary Managers #201 and #202 at 5:47 P.M. confirmed the menu had beef and barley soup listed for both meals. Dietary Manager #201 stated this was a typo. Observation of Dietary Aide #205 serving lunch on 03/10/20 at 11:37 A.M. revealed the beef and barley soup was served to residents on the second floor with a six ounce ladle, and a three ounce serving was served to residents on the second floor prescribed pureed diets. Interview with Dietary Aide #205 at 11:47 A.M. confirmed the size of the soup ladle was six ounces and the size of the spoon used for the pureed portions of soup was three ounces. Interview with Dietary Aide #200 on 03/10/20 at 11:49 A.M. revealed the Dietary Aides serve the foods to residents without referring to the dietary cards and go by memory. Interview on 03/10/20 with Dietary Manager #201 confirmed residents on the second floor who received pureed diets, (Resident #2, Resident #65 and Resident #80), should have received six ounce servings of soup for lunch and that staff should have known not to serve only three ounces, as they all had been trained. Review of the facility record, Diet Type Report dated 03/09/20, revealed there were 44 of 45 residents on the second floor who had meals served by the facility and three of the 45 residents, (Resident #2, Resident #65 and Resident #80) were prescribed pureed diets. Record review of the facility documents titled, Diet Spreadsheets Fall and Winter, revealed the portion size for residents prescribed either a regular or pureed diet was a six ounce ladle of soup.

Based on observation, record review and interview the facility failed to ensure a sanitary food preparation area was maintained during tray/serving line of meals to prevent potential contamination and/or food borne illness. This had the potential to affect 44 residents (#1, #2, #4, #5, #7, #9, #12, #13, #14, #18, #20, #22, #24, #27, #28, #29, #31, #35, #37, #48, #49, #51, #52, #58, #61, #64, #65, #66, #68, #73, #74, #77, #79, #80, #81, #84, #88, #90, #91, #93, #293, #294, #295 and #296) of 45 residents who take foods by mouth, reside on the second floor and receive their meals from the pantry. Findings include: Interview with Dietary Manager #201 on 03/09/20 at 10:00 A.M. revealed all dietary staff had been trained in safe food serving. Observation of the second floor food tray/serving line 03/10/20 at 11:28 A.M. revealed Dietary Aide #200 was observed to put a used paper towel, alcohol wipe and wrapper onto the serving area and those items fell upon the heavily traveled pantry floor. Dietary Aide #200 picked the items up off of the floor with bare hands and placed them back onto the serving area in front of the hot foods before the items were discarded in the trash. The food prep/serving area was not cleaned afterward. Dietary Aide #206 set the soup ladle onto the uncleaned serving area, placed the soup ladle into the soup and then served the residents. The facility identified 44 residents, Resident #1, #2, #4, #5, #7, #9, #12, #13, #14, #18, #20, #22, #24, #27, #28, #29, #31, #35, #37, #48, #49, #51, #52, #58, #61, #64, #65, #66, #68, #73, #74, #77, #79, #80, #81, #84, #88, #90, #91, #93, #293, #294, #295 and #296 who take foods by mouth, reside on the second floor and receive their meals from the pantry. Review of the policy titled Dietary Infection Control, dated 03/11/20; Food Handling, dated 03/11/20, revealed it was the policy of the facility that all local, state and federal standards and regulations were followed in order to assure a safe and sanitary dietary department. The Infection Control policy indicated, all employees would be in good health, would have clean personal habits and would handle all foods safely. The food handling policy revealed all food items were prepared to conserve maximum nutritive value, develop and enhance flavor and to be free of injurious organisms and substances.