Stanton Nursing And Rehabilitation Center

F-F600.).

Further review of the facility investigation revealed the initial allegation of abuse was not received by the Administrator until 02/10/2025 at 10:00 AM, three days after the incident occurred. In addition, once the Administrator was notified of the allegation, the facility failed to immediately notify the SSA, as the Office of Inspector General was not notified until 02/10/2025 at 2:57 PM.

During an interview with CNA5 on 04/22/2025 at 2:31PM, she said that after the incident on 02/07/2025, she texted Unit Manager (UM)1 about the incident. CNA5 stated she no longer had the texts, and did not remember specifically what she texted to UM1. However, she indicated that the report to the UM was more about the resident throwing water on CNA4, rather than the suspected abuse in which the CNA pulled the resident's lip with the backscratcher and yelled at him.

During an interview with LPN3 on 04/23/2025 at 3:38PM, she confirmed that CNA5 texted UM1 what happened, and UM1 said OK, figure out what's going on in the morning.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 3 of 4 185352 Department of Health & Human Services Printed: 08/28/2025 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 185352 B. Wing 04/25/2025

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

Stanton Nursing and Rehabilitation Center 31 Derickson Lane Stanton, KY 40380

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 0609 During an interview with UM1 on 04/24/2025 at 10:41AM, UM1 stated CNA5 texted her in the middle of the night, and she did not see the text until she woke up the next morning. Further interview with UM1 revealed Level of Harm - Minimal harm or that she sent a message to the former DON, and he said the resident was just mad, that's not anything. potential for actual harm Continued interview with UM1 revealed she expected her staff to call her and keep calling until she was awake. Residents Affected - Few

During an interview with the former Administrator on 04/24/2025 at 9:33AM, he confirmed that he did not receive the report until a couple days after the incident. The former Administrator stated, It was just one aide aggravating a resident. The former Administrator stated that once he was aware of the allegation, he had two hours to report it to OIG, However, the SSA was not notified of the abuse allegation until almost five hours

after the Administrator was made aware of it. The Administrator confirmed that the facility had not reported

the abuse allegation to APS, saying that he was under the impression OIG informed APS. Continued

interview with the Administrator revealed staff were supposed to notify the Administrator or the Director of Nursing (DON) immediately, and that was specified in the abuse policy of the facility.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 4 of 4 185352

F-F609.)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 2 of 4 185352 Department of Health & Human Services Printed: 08/28/2025 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 185352 B. Wing 04/25/2025

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

Stanton Nursing and Rehabilitation Center 31 Derickson Lane Stanton, KY 40380

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 0609 Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Level of Harm - Minimal harm or potential for actual harm 51174

Residents Affected - Few Based on interview, record review, and review of the facility's policy, it was determined the facility failed to ensure an alleged violation involving abuse was reported immediately, but not later than two hours, for one (Resident (R)1) of four residents reviewed for abuse, out of a total sample of 22 residents. Staff failed to immediately report an allegation of abuse to the Administrator, as well as the State Survey Agency (SSA) and Adult Protective Services (APS).

The findings include:

Review of the facility's policy titled Abuse Prohibition Standard of Practice, revision date 07/2022, revealed alleged violation(s) will be reported to the Administrator and/or designee immediately. Further review revealed alleged violations were to be reported to the SSA and APS. However, the policy did not include the time frames specified in the regulation.

Review of a facility investigation dated 02/10/2025 at 10:00 AM, and which was completed by the former Director of Nursing (DON), revealed that on the evening of 02/07/2025, Resident R1 was asleep in his bed when he was abruptly awakened by two Certified Nursing Assistants ((CNA) 4 and CNA5), who were standing over his bed, talking loudly and attempting to wake him. Per the investigation, CNA4 took Resident R6's bamboo back scratcher from his over-bed table and lightly touched his lip and may have also brushed Resident R6's stomach with

the back scratcher. Resident R6 was startled, and when he felt the backscratcher on his lip, and he threw a half-filled cup of water on CNA4.

Continued review of the investigation revealed CNA4 then left Resident R6's room and brought CNA5 into the room to scold the resident for the water he threw on CNA4. CNA4 told Resident R6 she was going to report him for his actions.

The facility's investigation concluded, that based on information provided by Resident R6 regarding CNA4, abuse was substantiated. (Refer to