The Merriman

F 0558

Reasonably accommodate the needs and preferences of each resident.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review, observation, interview, and facility policy review, the facility failed to ensure the call light was within reach for Resident #20. This affected one resident (#20) of three residents reviewed for call light accessibility. The facility identified five residents (#20, #24, #27, #45 and #57) who were unable to self-ambulate. The facility census was 45.Findings include:Review of the medical record for Resident #20 revealed an admission date of 04/19/23. Diagnoses included end stage renal disease, asthma, left leg below the knee amputation, diabetes, respiratory failure, and right leg above the knee amputation.Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE REDACTED] revealed Resident #20 was cognitively intact. He required partial to moderate assistance for hygiene, set up help for eating, supervision for toileting was independent with oral care. Resident #20 used a manual wheelchair for ambulation.Observation and interview with Resident #20 on 11/06/25 at 2:11 P.M. revealed he was in a manual wheelchair in his room towards the foot of his bed. Resident #20 revealed he would like to lie down but could not reach his call light. Resident #20 further revealed he was unable to self-propel his wheelchair.

Observation at the time of the interview revealed the wheels on Resident #20's wheelchair were located at

the bottom of the wheelchair, and Resident #20 could not reach them to propel his wheelchair with his hands. Resident #20 began yelling for staff assistance. Certified Nursing Assistant (CNA) #547 entered the room at approximately 2:13 P.M. to assist Resident #20.Interview on 11/06/25 at 2:15 P.M. revealed CNA #547 confirmed Resident #20 could not propel his wheelchair independently and required staff assistance to move about his room or common areas. She also confirmed his call light was not within reach at the time

he wished to lie down, and the resident's call light should be within reach at all times.Review of the facility policy titled Call Lights, dated April 2025, revealed call lights would remain within reach of residents at all times, and if traditional call lights could not be used, an alternative call light would be provided.This deficiency was an incidental finding identified during the complaint investigation.

Residents Affected - Few

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

FORM CMS-2567 (02/99) Previous Versions Obsolete

Facility ID:

If continuation sheet

Event ID:

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Resident #47 did not respond because she was scared. CNA #565 revealed she pulled her phone out to

the side of her and was going to attempt to record CNA #549, but he did not do anything. CNA #565 revealed she asked CNA #549 what he was going to do, when CNA #549 stated he was going to smack the [expletive] out of Residebt #47 for disrespecting him. CNA #549 stated he did not give a [expletive] that Resident #47 was a resident and she could go and get whoever she wants to get. Resident #47 calmed down, and later when walking pass CNA #549, Resident #47 stated there go that [expletive] and CNA #549 responded by saying what [expletive] and Resident #47 and CNA #549 started arguing. CNA #565 revealed

the unidentified nurse explained to CNA #549 that he could not argue with residents, but CNA #549 stated

he didn't give a [expletive] CNA #565 revealed Resident #47 was upset about her medications because staff kept telling her to wait. CNA #565 revealed she observed Resident #47 getting her MiraLAX, when CNA #549 told the unidentified nurse I wouldn't give her [expletive] if I was you and Resident #47 then proceeded to throw the MiraLAX at the unidentified nurse and walked off. Further review of the SRI tracking number 261418 revealed on 06/09/25, the Administrator and DON contacted Resident #47 in regard to the alleged incident. Resident #47 informed the Administrator and DON that after CNA #549 witnessed her interaction with the unidentified nurse about her medications, CNA #549 became verbally aggressive telling her she can't treat others like that. Resident #47 revealed she called CNA #549 a wanna be [expletive] and CNA #549 stated I don't care about this job. Resident #47 revealed she and CNA #549 continued to exchange words until he told Resident #47 to go back to her room and not come back. Resident #47 then stated she would come back if she needed something.Further review of the SRI revealed on 06/09/25, the Admin[TRUNCATED]

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 0602

Protect each resident from the wrongful use of the resident's belongings or money.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review, review of a self-reported incident (SRI), interview and review of facility policy, the facility failed to ensure Resident #1 was free of misappropriation. This affected one (Resident #1) of five residents reviewed for misappropriation. The facility census was 45.Findings include:Review of the medical record for Resident #1 revealed an admission date of 11/15/24 with diagnoses including heart failure, hypertension, diabetes and depression.Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE REDACTED] revealed Resident #1 had intact cognition.Review of SRI tracking number 258489 dated 03/21/25 revealed

the facility Business Office Manager (BOM) #505 discovered multiple charges on Resident #1's bank statement related to DoorDash and Lyft. It was noted Resident #1 did not make these charges. The Administrator was updated, and the bank statement showed a total amount of $3,941.66 that was charged to Resident #1's bank account. The police were notified. The facility unsubstantiated the SRI stating evidence was inconclusive that misappropriation occurred.Review of the facility investigation for SRI tracking number 258489 revealed resident #1 was interviewed, his debit card was cancelled and the bank fraud department was assisting in the unapproved charges. There were no interviews with staff or like residents related to the SRI.Interview on 11/13/25 at 9:56 A.M. with BOM #505 revealed when Resident #1 went to the store to take money out of his account, it would not release his funds. When Resident #1 returned to the facility, BOM #505 offered to assist in reviewing his account. BOM #505 received bank statements and noted charges the facility knew Resident #1 did not make. BOM #505 stated they called the police and filed a police report, cancelled Resident #1's debit card, called the bank who did an investigation. BOM #505 stated the bank reversed three months of charges but were unable to go back further as this had been going on for approximately six months. Interview on 11/13/25 at 10:46 A.M. with

the Administrator verified she had not interviewed staff or residents related to the misappropriation of Resident #1's debit card and ultimately $3,941.66. She stated the case is at the Attorney General's office, and they had requested copies of Resident #1's bank statements. The Administrator stated she unsubstantiated the SRI for misappropriation because the facility did not know who took Resident #1's money. Interview on 11/18/25 at 1:40 P.M. with Resident #1 revealed he thought a staff member or another resident had taken his debit card and charged on his account. He stated his debit card was always in his room unless he went out to the store. He stated he was not aware of the status of the investigation.Review of the facility policy titled, Abuse, Mistreatment, Neglect, Exploitation and Misappropriation of Resident Property, dated 10/24/22, and last reviewed October 2023, revealed misappropriation of a resident's property was defined as the deliberate misplacement, exploitation, or wrongful temporary or permanent use of a resident's belongings or money without the resident's consent. During an investigation, the person investigating the incident should interview the resident, the accused and all witnesses. Witnesses generally include anyone who witnessed, came in close contact with the resident the day of the incident and employees who worked closely with the accused employee or alleged victim.This deficiency was an incidental finding identified during the complaint investigation.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 0606 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

for LPN #824 revealed a hire date of 06/25/24. There was no evidence in the personnel file that the following were completed for LPN #824 prior to hire: abuse registry check, NAR check, and reference checks. Review of the facility's background check log revealed LPN #824 was not listed on the log for June 2024.On 11/13/25 at 8:20 A.M., an interview with HR Director #509 confirmed reference checks were not completed prior to hire. She stated reference checks were not completed because they could proceed with hiring individuals as long as two attempts had been made to complete the reference checks. HR Director #509 confirmed there was no evidence that NAR checks and abuse registry checks were completed.On 11/13/25 at 1:14 P.M., an interview with RDO #567 verified the NAR review for LPN #824 was timestamped 11/13/25 at 10:47 A.M. and RDO #567 stated at least we did it today. RDO #567 confirmed LPN #824 was not on the background check log for June 2024.On 11/13/25 at 1:14 P.M., an interview with RDO #567 said

in the past for reference checks, they attempted to call twice and the attempts were documented if there was no answer.7. Review of the personnel file for CNA #558 revealed a hire date of 09/23/25. There was no evidence in the personnel file that reference checks were completed for CNA #558 prior to hire. The reference check forms indicated contacts were unable to be reached.On 11/13/25 at 8:20 A.M., an

interview with HR Director #509 confirmed reference checks were not completed prior to hire. She stated reference checks were not completed because they could proceed with hiring individuals as long as two attempts had been made to complete the reference checks. On 11/13/25 at 1:14 P.M., an interview with RDO #567 said in the past for reference checks, they attempted to call twice and the attempts were documented if there was no answer.8. Review of the personnel file for CNA #554 revealed a hire date of 09/23/25. There was no evidence in the personnel file that reference checks were completed for CNA #554 prior to hire. The reference check forms indicated contacts were unable to be reached.On 11/13/25 at 8:20 A.M., an interview with HR Director #509 confirmed reference checks were not completed prior to hire. She stated reference checks were not completed because they could proceed with hiring individuals as long as two attempts had been made to complete the reference checks. On 11/13/25 at 1:14 P.M., an interview with RDO #567 said in the past for reference checks, they attempted to call twice and the attempts were documented if there was no answer.This deficiency was an incidental finding identified during the complaint investigation.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record reviews, interviews, facility self-reported incident (SRI) reviews and facility policy review, the facility failed to timely investigate and report the results of the investigations to the State agency within five business days as required related to an allegation of physical abuse for Resident #41 and an allegation of misappropriation for Resident #50. This affected two residents (#41 and #50) of four residents reviewed for facility SRIs. The facility census was 45.Findings include:1. Review of the medical record for Resident #41 revealed an admission date of 04/12/24. Diagnoses included depression, alcohol abuse, arthritis, anxiety and kidney failure.Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE REDACTED] revealed Resident #41 was cognitively intact. He was independent in all activities of daily living (ADL) to include eating, toileting, showering, oral hygiene, personal hygiene and dressing.Review of SRI tracking #261288 dated 06/05/25 and timed 8:46 P.M. revealed Resident #41 was outside smoking when he began arguing with Resident #55, an assisted living (AL) resident. During the exchange, Resident #41 fell to the ground and reportedly poked Resident #55 in the eye. The facility investigated the incident by interviewing other residents, placing Resident #55 on 15-minute checks, conducting skin assessments on all residents and educating staff on abuse. The facility unsubstantiated physical abuse occurred. The facility investigation was completed on 06/13/25 at 4:09 P.M., six business days.2. Review of the medical record for Resident #50 revealed and admission date of 08/22/24 and a discharge date of 04/25/25. Diagnoses included chronic obstructive pulmonary disease (COPD), diabetes, high cholesterol, respiratory failure, arthritis and malnutrition.Review of the quarterly MDS assessment dated [DATE REDACTED] revealed Resident #50 was cognitively intact. He required set-up help for eating, dressing, and oral care and required supervision for toileting, personal hygiene and showering.Review of SRI tracking #257892 dated 03/05/25 and timed 2:06 P.M. revealed Resident #50 reported his wallet, identification (ID), debit card and $500 was missing from his room. The facility investigated the allegation by interviewing other residents, encouraging the resident to keep important items in a lock box which the resident refused, and interviewing staff who had worked with

the resident within the days prior to the allegation. Resident #50 could not recall when the items had gone missing. The facility unsubstantiated misappropriation occurred. The facility investigation was completed on 03/17/25 at 6:54 PM., eight business days.Interview 11/17/25 at 12:59 P.M. with the Administrator confirmed the SRI investigations for Residents #41 and #50 were not completed and reported to the State agency within five business days. She confirmed investigations should be concluded within five business days, unless extenuating circumstances were identified and included in the report. She confirmed she had no evidence to support the need for a longer investigation for SRI's #261288 or #257891, and the investigations were not completed and submitted to the State agency timely.Review of the facility policy titled Abuse, Mistreatment, Neglect, Exploitation and Misappropriation of Resident Property, dated October 2023, revealed investigations would be completed within five days unless there were special circumstances causing the investigation to continue beyond those five days.This deficiency was an incidental finding identified during the complaint investigation.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

1. 3. Review of the medical record for Resident #50 revealed and admission date of 08/22/24 and a discharge

date of 04/25/25. Diagnoses included chronic obstructive pulmonary disease (COPD), diabetes, high cholesterol, respiratory failure, arthritis and malnutrition.

Review of the quarterly MDS assessment dated [DATE REDACTED] revealed Resident #50 was cognitively intact. He required set-up help for eating, dressing and oral care and supervision for toileting, personal hygiene, and showering.

Review of SRI tracking #257892 dated 03/05/25 revealed Resident #50 reported his wallet, identification (ID), debit card and $500 were missing from his room. The facility investigated the allegation by interviewing other residents, encouraging Resident #50 to keep important items in a lock box which the resident refused, and interviewing staff who had worked with the resident within the days prior to the allegation.

Resident #50 could not recall when the items had gone missing. The facility unsubstantiated the complaint regarding misappropriation.The investigation revealed Resident #50 could not recall the exact date the items went missing, giving as many as three different dates within the week prior. Other residents were interviewed about whether they had seen Resident #50 with a wallet or large sums of money; however, no residents were asked if they were missing any personal items, other than clothing, or large sums of money.

Interview on 11/13/25 at 2:38 PM with the Administrator revealed she could not confirm if all staff had been interviewed regarding the misappropriation, since Resident #50 could not recall exactly when the items went missing. She also confirmed the facility did not complete personal inventories; therefore, it could not be determined if Resident #50 did in fact own a wallet. She confirmed the investigation was not thorough.

Review of the facility policy titled Abuse, Mistreatment, Neglect, Exploitation and Misappropriation of Resident Property dated October 2023, revealed as part of an investigation regarding abuse, mistreatment, neglect, exploitation or misappropriation of resident property, the facility would interview the affected resident, the accused resident, and all witnesses where applicable. If there were no witnesses, the

interview pool would be expanded.

This deficiency was an incidental finding identified during the complaint investigation.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 0627 Level of Harm - Minimal harm or potential for actual harm

because the resident's health has improved sufficiently so that the resident no longer needs the services provided by the facility or the services provided by a specialized unit, the safety or health of individuals in

the facility is endangered, or the resident has failed after reasonable and appropriate notice to pay for the care and services provided by the facility.This deficiency was an incidental finding identified during the complaint investigation.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 0686

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Level of Harm - Minimal harm or potential for actual harm

Based on record review, observation, interview and facility policy review, the facility failed to ensure pressure ulcer treatments were completed as ordered for resident #5. This affected one resident (#5) of three residents reviewed for pressure ulcers. The facility census was 45.Findings include:Review of the medical record for Resident #5 revealed an admission date of 04/08/24 with diagnoses including multiple sclerosis and pressure ulcer stage IV (a severe, open wound with full-thickness tissue loss that extends down to the muscle, bone, or other supporting structures like tendons or joints) of the penis.Review of the physician's orders for Resident #5 revealed he had an order dated 07/30/25 to cleanse the penis with soap and water, apply Skin Prep (forms a protective barrier on the skin) to the left penis peri wound area, apply collagen filler to the wound and cover with an abdominal (ABD) pad at bedtime. Review of the Medication Administration Record (MAR) for November 2025 revealed nursing had performed Resident #5's treatment to his penis on 11/11/25.Observation on 11/12/25 at 8:30 A.M. of wound care and Foley catheter care to Resident #5 revealed the wound treatment to the pressure ulcer to his penis was not in place. Resident #5 stated the treatment had come off during incontinence care the previous night, and staff had not replaced

the wound dressing. Licensed Practical Nurse (LPN) #522 verified there was no dressing in place.Interview and update on 11/12/25 at 8:55 A.M. with the Administrator related to Resident #5's wound treatment not being in place as ordered by Nurse Practitioner (NP) #500. The Administrator asked if the resident had updated staff that the dressing had come off. The wound dressing was to his penis in his incontinence brief where staff would have seen the dressing was not intact. The Administrator agreed staff should have noted

the dressing had come off during incontinence care and updated the nursing staff that a new treatment would be needed.Review of the undated facility policy titled Pressure Injury Treatment revealed pressure injuries would be treated with consistent treatment protocols to aid in the healing process. This deficiency was an incidental finding identified during the complaint investigation.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review, observation, interview and review of the facility policy, the facility failed to maintain a safe smoking environment for Resident #13. This affected one resident (#13) of two residents reviewed for smoking. The facility census was 45.Findings include:Review of the medical record for Resident #13 revealed an admission date of 03/24/23 with diagnoses including schizophrenia, muscle weakness, and hypertension.Review of the physician's orders for Resident #13 identified an order for supervised smoking with a smoking apron beginning 01/23/25.Review of the care plan dated 07/28/25 revealed Resident #13 was at increased risk for injury related to smoking cigarettes. Interventions included, but were not limited to, supervision at all times while smoking (07/28/25) and a smoking apron to be worn while smoking (07/28/25).Review of the smoking and safety assessment dated [DATE REDACTED] revealed Resident #13 required supervision for smoking due to dropping ashes on self, unable to light tobacco or marijuana safely, an unable to extinguish tobacco or marijuana safely. The assessment did not have utilize smoking apron marked as an intervention or apply smoking apron marked as a clinical suggestion.Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE REDACTED] revealed Resident #13 had a Brief Interview for Mental Status (BIMS) score of six, which was indicative of severe cognitive impairment.On 11/17/25 at 1:42 P.M.,

an observation of the facility's designated smoking area in the courtyard revealed there were three residents present, including Resident #13, and no facility staff. Resident #13 was smoking a cigar at this time and was not wearing a smoking apron. There were no staff in the vicinity to verify this observation.On 11/17/25 at 2:30 P.M., an interview with the Administrator and Assistant Director of Nursing (ADON) #504 verified Resident #13 was one of two supervised smokers in the facility. On 11/18/25 at 8:33 A.M., an

observation of the facility's designated smoking area in the courtyard revealed there were three residents present, including Resident #13, and no facility staff. Resident #13 extinguished a cigarette and disposed of

it at this time. During the observation, Resident #16 entered the courtyard, lit a cigarette and started smoking, then dropped the cigarette on the ground without extinguishing the cigarette. Resident #13 picked up Resident #16's cigarette off the ground and Resident #13 began smoking it. Resident #13 was not wearing a smoking apron. There were no staff in the vicinity to verify this observation.On 11/18/25 at 8:52 A.M., an interview with the Director of Nursing (DON) and ADON #504 confirmed again that Resident #13 was a supervised smoker. The DON stated she educated Resident #13 the previous day on the facility's designated supervised smoking times. The DON also stated if Resident #13 was smoking, someone else must have provided him with cigarettes without their knowledge.On 11/18/25 at 9:27 A.M., an interview with Regional Nurse #566 verified Resident #13 had a physician's order for supervised smoking with a smoking apron.On 11/18/25 at 9:48 A.M., an interview with the Administrator stated the smoking apron was ineffective for Resident #13 because he continued dropping ashes on himself in the areas the smoking apron did not cover. She further stated the intervention had previously been changed to a smoking jacket instead and that jacket was stored in the DON's office.Review of the facility's policy for smoking, dated 04/28/25, indicated smoking would be supervised by staff or volunteers during supervised smoking times for supervised smokers and all smoking material, cigarettes, cigars, lighters, electronic smoking devices and chargers would be kept at the nurse's station or designated area for supervised smokers.This deficiency was an incidental finding identified during the complaint investigation.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

record signs and symptoms of urinary tract infections and notify the medical provider, and position catheter bag and tubing below the level of the bladder and away from the entrance room door. There were no interventions identified in the care plan related to the provision of Foley catheter care.On 11/10/25 at 3:00 P.M., an interview with the Director of Nursing (DON) verified Resident #5 returned from the hospital on [DATE REDACTED] with a Foley catheter in place and there were no orders for catheter care until 03/06/25 (10 days later). The DON also verified the TAR and progress notes at this time.On 11/12/25 at 8:30 A.M., an

interview with Resident #5 stated residents did not get the care they needed, and incontinence care was not provided timely.This deficiency represents non-compliance investigated under Complaint Number

1. 2615467. Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 0697 Level of Harm - Minimal harm or potential for actual harm

policy in place to ensure pain management was provided to residents who required such services, including assessment of pain and working in collaboration the physician and/or prescriber to prevent and manage a resident's pain. Review of the document revealed the facility did not implement the policy.This deficiency represents non-compliance investigated under Master Complaint Number 2658947.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 0710 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Clinical Director of Wound Care for CareMed, who held a contract with the facility to provide medical services. She confirmed she was not wound certified, and NP #500 did not have anyone supervising her who was wound certified, nor was she herself wound certified. She revealed NPs were able to provide wound debridement and did not need to be certified.Interview on 11/18/25 at 1:30 P.M. with NP #500 confirmed she was not a wound certified NP but was the facility Wound NP.Interview on 11/19/25 at 2:16 P.M. with the Administrator, Regional Nurse #566 and Regional Director of Operations #567 confirmed they were now aware the facility did not have a physician overseeing wound care treatment.Review of the facility policy titled Medical Director Responsibilities, dated 04/28/25, revealed The Medical Director was responsible for overseeing the medical care of all residents within the facility and ensuring the appropriateness and quality of medical care and medically related care. The facility Medical Director signed

the agreement on 03/06/25.This deficiency was an incidental finding identified during the complaint investigation.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 0740 Level of Harm - Minimal harm or potential for actual harm

indicated the physician would be notified of suspected use. The Administrator confirmed the facility had a contracted drug rehabilitation program in place and she was unable to explain why there was no facility policy addressing confirmed use of illicit substances among residents.

On 11/18/25 at 10:04 A.M., an interview with SSD #531 stated Resident #41 had been kick

Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 0759

Ensure medication error rates are not 5 percent or greater.

Level of Harm - Minimal harm or potential for actual harm

Based on record review and interview, the facility failed to ensure Resident #13 received medications as ordered. This affected one resident (#13) of eight residents reviewed for medication administration. The facility census was 45.Findings include:Review of the medical record for Resident #13 revealed an admission date of 03/24/23 with diagnoses including schizophrenia, hypertension and history of falling.Review of the medication error investigation by the Director of Nursing (DON) dated 09/23/25 at 3:42 P.M. revealed Licensed Practical Nurse (LPN) #568 administered the wrong medication to Resident #13.

LPN #568 stated he had two different residents' medications in the top of his medication cart in medication cups. Resident #13 was in the hallway and stopped so the nurse could provide his medication. When LPN #568 reached into the medication cart, he knocked over the two different residents' medication cups in the drawer. He then replaced the medications in the cups and administered Resident #13 his medications. After Resident #13 took the medications, LPN #568 noted that he had given him the other resident's narcotic medication Tramadol (opioid medication for pain).Review of the physician's orders for Resident #13 for September 2025 revealed he did not have a physician's order for Tramadol 50 milligrams (mg). Interview on 11/05/25 at 3:39 P.M. with the DON verified LPN #568 made a medication error when giving Resident #13 Tramadol 50 mg which was not ordered. She also stated LPN #568 was no longer at the facility, and nursing staff were not to pre-pour multiple residents' medications at one time.Review of the facility policy titled Administering Medications, dated 04/28/25, stated the individual administering medications must verify the resident's identity before giving the resident his/her medications. The medications must be administered in accordance with the orders.This deficiency represents non-compliance investigated under Master Complaint Number 2658947 and Complaint Number 2615467.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review, observation, interview and facility policy review, the facility failed to ensure medications were properly stored. This affected one resident (#38) of three reviewed for proper medication storage. The facility census was 45.Findings include:Review of the medical record for Resident #38 revealed and admission date of 10/20/25. Diagnoses included fracture of the left foot, difficulty walking, and muscle weakness.Review of the self-medication administration assessment dated [DATE REDACTED] revealed Resident #38 required assistance to administer oral medication.Review of the comprehensive Minimum Data Set (MDS) assessment dated [DATE REDACTED] revealed Resident #38 was cognitively intact. He required substantial to maximum assistance with toileting and showering, partial assistance with personal hygiene and was independent and eating in oral care.Review of the physician's orders for October 2025 revealed the resident began taking Bactrim (used to treat bacterial infections) 800 milligrams (mg) one tablet by mouth two times per day for a urinary tract infection (UTI) on 11/03/25 and was to take the medication for a period of seven days.Review of the care plan dated 11/05/25 revealed Resident #38 had a UTI and was receiving antibiotic therapy. Interventions included administering medications per the providers' orders, encouraging periods of rest and maintaining universal precautions when providing resident care.Observation and interview on 11/05/25 at 9:34 A.M. with Resident #38 revealed a clear plastic cup at Resident #38's bedside with what appeared to be a white pill in the cup. Resident #38 confirmed there was an antibiotic in the cup which he was told he did not need any more, so he did not take it.Observation and interview on 11/05/25 at 9:38 A.M. with certified nurse aide (CNA) #542 confirmed the observation of the pill in the cup at Resident #38's bedside. She also confirmed she was aware nurses were supposed to observe residents taking medications and medications should not be left with residents.Review of the facility policy titled Administering Medications, dated 04/28/25, revealed medications would be administered within one hour of their prescribed time frame unless otherwise specified. If a medication was withheld, refused or given at a time other than the scheduled time, the individual administering the medication would document the medication as refused on the Medication Administration Record (MAR), and residents could only self-administer their own medications if the attending physician in conjunction with the interdisciplinary care planning team had determined the resident had the decision making capacity to do so safely.This deficiency was an incidental finding identified during the complaint investigation.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 0835 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

Administrator did not provide any evidence of this call.Interview on 11/19/25 at 10:38 A.M. with QBHS #809 and #810 revealed they thought facility administration was not effective in supporting their efforts regarding resident drug and alcohol abuse. Several concerns had been brought to the Administrator, and the response had always been she would need to talk to corporate; there was never follow up from the Administrator beyond that discussion. Both QBHS #809 and #810 confirmed they had weekly meetings with

the Administrator, and the DON and ADON #504 would attend when available. They would review residents and concerns regarding drug and alcohol use. The Administrator often took notes but did not seem to follow through with concerns that were discussed in these meetings.Interview on 11/19/25 at 10:46 A.M. with the Administrator revealed she did not feel there were communication concerns with Stepping Stones, and felt concerns brought up by Stepping Stones staff were addressed by facility administration. She denied Stepping Stones brought concerns regarding general care and treatment at the facility to her and confirmed

they had weekly meetings but denied there was a formal agenda or summary of the meeting discussions.

She was unable to state what concerns had recently been brought to her attention.5. On 11/12/25 at 12:31 P.M. the survey team was notified by Medical Director (MD) #569 he had officially resigned. He revealed there was too much going on at the facility that he was not informed of, and the Administrator could not tell him what his contract said regarding how much notice he had to work after giving notice of resignation.Interview on 11/13/25 at 2:29 P.M with Ombudsman #826 revealed she felt the facility was putting out fires to address concerns that had arisen in the facility; she felt the facility did not often follow through after a change was made, and there was an overall lack of oversight.Interview on 11/19/25 at 11:23 A.M. with RDO #567 revealed in light of the recent survey findings, corporate employees planned to spend more time overseeing the facility and had begun questioning if the clinical team was appropriate for the facility.Interview on 11/19/25 at 1:47 P.M. with the Administrator and Regional Nurse #566 revealed they could provide no evidence that concerns brought to their attention by the survey team including lack of documentation, alleged drug use in the facility, wound care, neglect, customer service and SRI's had ever been addressed through the quality assurance or QAPI program. They confirmed none of these issues have been identified by anyone in administration prior to the current survey. The Administrator confirmed

the facility had not been working on any specific areas of improvement for several months. Review of the Administrator's personnel file revealed a hire date of 07/15/24. Review of the undated facility Job Description for the Administrator revealed the primary purpose of the position was to direct the day-to-day functions of the facility in accordance with federal, state, and local standards, guidelines, and regulations that govern nursing facilities to assure the highest degree of quality care can be provided to residents at all times. The description revealed that the Administrator was expected to plan, develop, organize, implement, evaluate and direct the facilities' programs and activities in accordance with guidelines issued by the Regional Director of Operations, and assist department directors in the development, use and implementation of departmental policies and procedures and professional standards of practice. The Administrator signed the job description on 07/15/24.Review of the undated Job Description for the DON revealed the primary purpose of the position was to provide direct nursing care to the residents, to supervise the day-to-day nursing activities performed by certified nursing assistants (CNAs), monitor the performance of CNAs and unlicensed personnel and to provide education and counseling. Supervision would occur in accordance with current federal, state and local standards, guidelines and regulations that govern the facility to ensure the highest degree of quality care is maintained at all times. The DON signed

the job description, but it was undated.This deficiency was an incidental finding identified during the complaint investigation.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 0880

Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or potential for actual harm

Based on record review, observation, interview and facility policy review, the facility failed to maintain proper infection control practices while providing wound care for Resident #12. This affected one resident (#12) of two residents observed for wound care. The facility census was 45.Findings include:Review of the medical

record for Resident #12 revealed an admission date of 09/09/25 with diagnoses including congestive heart failure, diabetes mellitus and chronic venous ulcers of bilateral lower extremities.Review of the physician's orders for Resident #12 revealed an order dated 09/10/25 for enhanced barrier precautions (EBP) (infection control intervention designed to reduce transmission of multidrug-resistant organisms in nursing homes) due to wounds.Review of the care plan dated 09/10/25 for Resident #12 revealed he had EBP related to open wounds requiring a dressing. Interventions included using gowns and gloves when providing high-contact resident care activities including wound care.Observation was performed on 11/10/25 at 1:45 P.M. of wound care to Resident #12's right heel by Licensed Practical Nurse (LPN) #504. Outside of Resident #12's room by his door revealed signage stating he was on EBP, and everyone must clean their hands before entering and when leaving, wear gloves and gown for high contact activities including wound care that required a wound dressing due to skin openings. There was personal protective equipment (PPE)

in a cart down the hall from Resident #12's room. LPN #504 cleansed her hands and donned gloves. She then proceeded and completed wound care without donning a gown. LPN #504 was questioned if Resident #12 had a physician's order for EBP, and she stated that he was on EBP and the cart with the PPE was in

the hallway. She verified she had not donned a gown prior to wound care with Resident #12.Review of the facility policy titled, Enhanced Barrier Precautions, dated 04/01/24, revealed EBP was indicated for residents with wounds.This deficiency represents non-compliance investigated under Complaint Number

1. 2615467. Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Merriman

209 Merriman Rd Akron, OH 44303

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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and

the public.

Based on observation, interview, work request review and facility policy review, the facility failed to ensure all areas of the facility were in good repair. This had the potential to affect all 45 residents residing in the facility.Findings include:Observation on 11/17/25 at 8:01 A.M. on the nursing unit revealed a glass door leading outside had broken, shattered glass overing the bottom half of the door. Interview at the time of the

observation with the Director of Nursing (DON) confirmed the broken glass door and reported it had been that way for approximately two weeks.Interview on 11/17/25 at 8:09 A.M. with the Administrator revealed

the broken glass door was used by families and ambulances and the facility was aware the door was in need of repair but did not know what had happened and had not yet been able to repair it, although quotes had been obtained. She was unsure how long the door had remained unrepaired.Review of the work request form dated 10/29/25 revealed a request to repair the broken glass on the ambulance door. The form revealed calls had been made for quotes to repair the glass. There was no follow-up information available for review.Review of the facility policy titled Home-Like Environment revealed the facility would provide residents with a safe, clean, comfortable and homelike environment including maintaining cleanliness and comfort in all resident areas, providing housekeeping and maintenance services to maintain an orderly and comfortable interior. Concerns were to be reported and addressed promptly.This deficiency represents noncompliance investigated under Complaint Number 2656875.

Event ID:

Facility ID:

If continuation sheet