Otterbein-cridersville

F 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

informed staff of the incident and the nurse on duty was contacted. The nurse on duty accompanied STNA #111 during questioning by the police at the facility and then she was walked to the time clock. STNA #111 was suspended pending investigation and subsequently terminated. The DON stated the police spoke to Resident #10 and she did not want to press charges; the DON shared a skin assessment and interview of Resident #10 was completed and not reveal any concerns. Resident #10 was assessed by the Medical Director as well as a psychiatric services and had no negative outcome noted. The staff were interviewed and each denied knowledge of the incident and were not aware STNA #111 had taken any pictures of Resident #10, or any other resident. Interview on 11/26/25 at 11:03 A.M with Resident #10 revealed she was informed by the police STNA #111 had taken a picture of her while she was in the whirlpool. Resident #10 shared she was told the picture was a side view. Resident #10 stated she did not know the picture was being taken by STNA #111. Review of the facility policy titled, Abuse, Mistreatment, Neglect, Exploitation and Misappropriation of Resident Property revised 10/25/22 documented residents have the right to be free from abuse, neglect, exploitation and misappropriation of property. Review of the facility policy titled, Social Networking Policy revised 03/31/23 documented partners are expected to protect the privacy of residents and elders. Partners may not publicly discuss residents or disclose photographs. Partners are prohibited from displaying private or public information about residents, especially anything that would be deemed as demeaning to residents. The deficient practice was corrected on 08/09/25, when the facility implemented

the following corrective actions: On 08/07/25, Resident #10 was assessed by facility staff with no adverse findings, the POA and the Medical Director were notified and there were was no evidence of emotional or psychosocial harm. On 08/07/25, STNA #111 was removed from the facility and placed on administrative leave. On 08/08/25, education was provided to all staff regarding the Resident Abuse policy, Elder Abuse policy and Social Media policy. Staff were not permitted to work until the education was completed. On 08/08/25, Resident #10 was assessed by both the Medical Director and psychological services with no adverse findings. On 08/08/25, all interviewable residents were interviewed to ensure they did not have a concern for privacy and safety. No residents voiced concerns in these areas or of care from the staff. On 08/08/25, a skin assessment was completed on all non interviewable residents with no concerns. On 08/08/25, management reviewed the incident, investigation and initiated a follow up plan to prevent reoccurrence. On 08/09/25, interview audits were initiated of at least two residents to ensure no concerns for privacy and safety. On 08/09/25, interview audits were initiated of at least three staff to confirm compliance with social media and abuse policy. This deficiency represents non-compliance investigated under Complaint Number 2595612.

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

Otterbein-Cridersville

100 Red Oak Drive Cridersville, OH 45806

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 - Minimal harm or potential for actual harm Residents Affected - Few

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

on 11/26/25 at 11:03 A.M with Resident #10 revealed she was informed by the police STNA #111 had taken a picture of her while she was in the whirlpool. Resident #10 shared she was told the picture was a side view. Resident #10 stated she did not know the picture was being taken by STNA #111. Review of the facility policy titled, Abuse, Mistreatment, Neglect, Exploitation and Misappropriation of Resident Property revised 10/25/22 documented residents have the right to be free from abuse, neglect, exploitation and misappropriation of property. Review of the facility policy titled, Social Networking Policy revised 03/31/23 documented partners are expected to protect the privacy of residents and elders. Partners may not publicly discuss residents or disclose photographs. Partners are prohibited from displaying private or public information about residents, especially anything that would be deemed as demeaning to residents. The deficient practice was corrected on 08/09/25, when the facility implemented the following corrective actions:

On 08/07/25, Resident #10 was assessed by facility staff with no adverse findings, the POA and the Medical Director were notified and there were was no evidence of emotional or psychosocial harm. On 08/07/25, STNA #111 was removed from the facility and placed on administrative leave. On 08/08/25, education was provided to all staff regarding the Resident Abuse policy, Elder Abuse policy and Social Media policy. Staff were not permitted to work until the education was completed. On 08/08/25, Resident #10 was assessed by both the Medical Director and psychological services with no adverse findings. On 08/08/25, all interviewable residents were interviewed to ensure they did not have a concern for privacy and safety. No residents voiced concerns in these areas or of care from the staff. On 08/08/25, a skin assessment was completed on all non interviewable residents with no concerns. On 08/08/25, management reviewed the incident, investigation and initiated a follow up plan to prevent reoccurrence. On 08/09/25,

interview audits were initiated of at least two residents to ensure no concerns for privacy and safety. On 08/09/25, interview audits were initiated of at least three staff to confirm compliance with social media and abuse policy. This deficiency represents non-compliance investigated under Complaint Number 2595612.

Event ID:

Facility ID:

If continuation sheet