Bella Terrace Rehabilitation And Nursing Center

Review of policy titled

medication must initial the resident's MAR on the appropriate line after giving each medication and

label three times to verify the right resident, right medication, right dose, right time and right route of administration before giving the medication.

366207 01/29/2026

Bella Terrace Rehabilitation and Nursing Center 1520 Hawthorne Avenue Columbus, OH 43203

Observation and interview on 01/12/26 at 4:52 P.M. with Resident #11 in room [ROOM NUMBER]

NUMBER] confirmed her wardrobe drawers were stuck together, and she wasn't able to open one

Additionally, the lights were all on and it was still very dim.x. room [ROOM NUMBER] had damaged laminate around the sink, torn paint on the wall near the entrance, water damage on the ceiling on the back right corner, and holes in the wall outside the room from where an apparent soap dispenser was removed. y.

Observation and interview on 01/12/26 at 5:10 P.M. with Resident #16 in room [ROOM NUMBER] revealed he would like more light. He had all the lights on in the room and it was still very dim.On 01/13/26 between 10:12 P.M. and 11:28 A.M. the Maintenance Director #258, the Regional Maintenance Director #605 and the Regional [NAME] President of Plant Operations #511 toured the areas mentioned and verified the described areas had not been maintained.5.

Observations on 01/13/26 between 9:04 A.M. and 9:24 A.M. revealed the following:a.

Observation and interview on 01/13/26 at 9:04 A.M. with Resident #18 in room [ROOM NUMBER] revealed a very loose handrail by the toilet and rust near the pipe. Resident #18 confirmed he did use that bathroom.

The sink was missing enamel, and the edge of the sink was sharp.

There was exposed dry wall on the corner by the sink, the wall was missing paint, and the drywall was ripped in the back area.

There were stains on the ceiling right above the head of the bed and Resident #18 said they were unsettling because he didn't know what they were.

The light above the sink was also missing the cover.b.

Observation and interview on 01/13/26 at 9:24 A.M with Resident #22 who was in bed in room [ROOM NUMBER] revealed the sink did not have hot water.

The wall around the sink had a two-inch strip around the side and the back of the sink that was unpainted.

The resident wasn't sure why they didn't have a chair in the room anymore either, but they wanted one.c. room [ROOM NUMBER] was missing drywall on the corner by the sink and the trim was loose.

There was paint missing across the length of the bed.

The front door had significant scuff marks.d. In the common area outside of room [ROOM NUMBER], there were chunks of wall missing by the bookcase, the hallway railing was marred for the length of the railing and spots of paint were missing on the wall. On 01/13/26 between 10:12 P.M. and 11:28 A.M. the Maintenance Director #258, the Regional Maintenance Director #605 and the Regional [NAME] President of Plant Operations #511 toured the areas mentioned and verified the described areas had not been maintained.6.

Observations on 12/30/25 at 12:10 P.M. in the front lobby and hallway areas, there was approximately two inches of dark grime along the edge of the flooring by the walls in the main lobby and hallway by the elevator to the resident's rooms.

This grime was observed to be present on the floor each day until 01/12/26 09:58 A.M. when the housekeeper was observed to be scraping the floor.Interview on 01/12/26 at 9:58 A.M. with Housekeeper #232 confirmed the grime along the edge of the floor in the lobby and adjacent hallways. He said it was buildup of wax accumulation and that it hadn't been there long.7.

Observation and interview on 01/12/26 at 10:10 A.M. of the shower room in the memory care area revealed there was an approximately two foot by 5 inch area on the wall with white paint in the corner of a tan wall and an overhead fan covered in dust.

Certified Nursing Assistant #337 verified both.

She said she didn't know who was responsible for cleaning the fan dust.Observation and interview on 01/13/26 at 9:40 A.M. in shower room on the third floor revealed there were five wet towels piled on the floor in the shower area.

Certified Nursing Assistant (CNA) #248 confirmed the towels were there.

She said a resident must have taken a shower overnight.

She said the staff normally would remove them if they were told about them.Observation and interview on 01/22/26 at 1:05 P.M. in the shower room on the third floor there was a pile of wet towels in the room.

Certified Nursing Assistant (CNA) #248 confirmed the towels were there.

She said she didn't know who was covering the area.These deficiencies represent non-compliance investigated under Master Complaint Number 2699666, 2591930, 1295681, and 1295679.

366207 01/29/2026

Bella Terrace Rehabilitation and Nursing Center 1520 Hawthorne Avenue Columbus, OH 43203

from a pest's infestation.

This had potential to affect all 82 residents.Findings include:Observation on

including insects that resembled spiders and cockroaches (roaches)) along the walls near the windows.Interview on 12/31/25 at 8:59 A.M. with Resident #88 who said the roaches aren't living with us, we are living with them.

She said they put roach traps around and are trying to [eradicate the cockroaches].

She said the roaches come out when the housekeeper mops.

She said she sees the roaches climbing up the walls and she has fears they will fall down on her.Interview on 12/31/25 at 9:34 A.M. with Maintenance Director #258 revealed they had an issue with cockroaches, but he felt it was getting better. He said they switched [pest] companies three months ago and now he no longer had cockroaches running across his desk.Observation on 12/31/25 at 9:35 A.M. of the second-floor common area revealed multiple dead insects (a variety of insects including insects that resembled spiders and cockroaches (roaches)) on the windowsill by the entrance to memory care.

Interview on 01/05/26 at 9:27 A.M. with Resident #87 revealed she saw the cockroaches in her room and in the hallways and she saw them come out of the kitchen.

She said she was killing half a dozen a day.

She said it had slowed down some, but she wished they would have fumigated the whole place.Interview on 01/05/26 at 7:22 A.M. with Resident #56 revealed he would have one or two cockroaches in his room but mostly he saw them in the hallways.Interview on 01/05/26 at 2:48 P.M. with Resident #90 revealed she felt the insect issues were bad, but they had gotten better.Interview on 01/05/26 at 4:10 P.M. with Regional Maintenance Director #605 revealed the resident in room [ROOM NUMBER] was a hoarder. He said when the resident was away from his room, they went in to get rid of the trash including empty shampoo bottles and empty grocery bags and he said they found a cockroach infestation in there and brought the exterminators in on this day for that room. He said they were German cockroaches.Observation and interview on 01/06/26 at 10:36 A.M. revealed a cockroach crawling up the wall in the third-floor shower room.

Regional Maintenance Director #605 was present and confirmed that it was a German cockroach.Interview on 01/07/26 at 11:45 A.M. with Resident #74 revealed she didn't have too many bug issues where she was on the third floor.

She said on the first and second floors they [cockroaches] were everywhere.Observation and interview on 01/08/25 at 8:29 A.M. revealed two cockroach traps in the kitchen by the door.

Dietary Supervisor #238 said they had issues with cockroaches, but he felt it had gotten better.Interview on 01/12/26 at 10:36 A.M. with Resident #50 revealed she didn't want housekeeping to come in her room because she believed they brought the insects in with their mops.Interview on 01/12/26 at 2:39 P.M. with Resident #27 revealed the place was roached out. He elaborated and stated they were everywhere and they came out at night. He noted he saw one two days ago.

Interview on 01/12/26 at 3:04 P.M. with Resident #268 revealed she saw roaches come out from under her bed.Interview on 01/12/26 at 3:25 P.M. with Resident #35 revealed his biggest complaint was the cockroaches because they were repulsive.Observation on 01/13/26 at 11:07 A.M. revealed the exterminator approaching maintenance managers and asking them where he should focus.Review of pest control work orders dated 09/09/25, 09/29/25, 10/06/25, 10/17/25, 10/22/25, 10/29/25, 12/08/25, 12/16/25 and 01/05/26 revealed they were treating both individual rooms and common areas and the primary issue and focus on the visits were the eradication of cockroaches.

This deficiency represents non-compliance investigated under Master Complaint Number 2699666, 2593662, 2591930, 1295681, and 1295679.