Paoli Health And Living Community

F-F740.

During an interview on 4/9/25 at 12:34 P.M., CNA 26 indicated staff did do in services but she did not remember talking about Schizophrenia, TBIs, or PTSD specifically. The in services talked about dementia, what to do when a resident refused care, and how to redirect residents. She was unaware of a resident having behaviors and PTSD, what his triggers were, and what to do about them.

During an interview on 4/10/25 at 11:13 A.M., Regional Clinical Support 2 indicated the corporation had in services the employees have to do on their electronic training program, but in person in services were decided by the facility depending on what their resident's needs were and depending on what it dealt with, it usually wasn't for all employees.

During an interview on 4/10/25 at 11:33 A.M., the ADON indicated they don't give in services based on specific mental health diagnoses, such as schizophrenia, PTSD, or TBI, but they will in the future.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 21 of 22 155333 Department of Health & Human Services Printed: 08/29/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 155333 B. Wing 04/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Paoli Health and Living Community 559 W Longest St Paoli, IN 47454

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0949 On 4/10/25 at 3:00 P.M., a current Behavioral Health Management Program Policy, dated January 2024, was provided by Regional Clinical Support 2 and indicated [company name] communities provide services to our Level of Harm - Minimal harm or residents with specific diseases and disorders. Some of our residents have medical disabilities that can lead potential for actual harm to disruptive behaviors and these behaviors have the potential to create a negative effect on the resident, other residents, visitors, and staff. It is [company name]'s policy that each community will have a behavior Residents Affected - Few program that: identifies, monitors, manages, and disseminates (whenever possible) all behavior events . each individual resident will receive services according to their needs . Residents who demonstrate any of

the following characteristics should be involved in the behavior program . any resident demonstrating new or worsening behaviors . unresolved repetitive behaviors . currently has a doctor's order to use antipsychotic, antidepressant . Each [company name] facility will use the following documents to track behaviors and document ongoing services/interventions . The nurse or social services will complete a behavioral event in

the electronic medical record for each new or worsening behavior the resident demonstrates .CNAs are able to document . during the clinical meeting, when the IDT [Interdisciplinary team] is present, each behavior will be discussed . IDT will write a note . It is [company name] policy to ensure etiology of a resident's behavior is thoroughly investigated, documented, and care planned .

On 4/11/25 at 9:00 A.M., a current In service Education Meeting excerpt from the Employee Handbook was provided by the administrator and indicated Regular training and education for associates is provided to promote an informed and competent staff and to maintain a high quality of resident service and care . This training is provided in compliance with all relevant State and Federal regulations .

3.1-37(a)

3.1-43(a)(1)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 22 of 22 155333