Jennings Hall

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **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 Resident #74 was treated with respect and dignity. This affected one resident (#74) out of three residents reviewed for respect and dignity. The facility census was 168. Findings include:Review of the medical record revealed Resident #74 was admitted to the facility on [DATE REDACTED] with diagnoses including transient cerebral ischemic attack, heart failure, atrial fibrillation, hypertension, obstructive sleep apnea, peripheral autonomic neuropathy, anxiety disorder, abnormalities of gait and mobility, dysphagia, insomnia, muscle weakness, essential tremor, and foot drop. Review of the Minimum Data Set (MDS) 3.0 quarterly assessment revealed Resident #74 a Brief

Interview of Mental Status (BIMS) score of 15 out of 15, indicating intact cognition. Interview on 10/16/25 at 11:51 A.M. with Resident #74's responsible party revealed that during review of video camera footage placed in Resident 74's room, she observed staff telling Resident #74 she was fat. Resident #74's responsible party reported the incident to the facility's administration for further investigation. Observation

on 10/21/25 at 11:20 A.M. of video submission dated 08/08/25 with the Administrator, the Chief Nursing Officer and Director of Nursing (DON) #303 revealed Care Partner (CP) #495 was alone in Resident #74's room and stated, Are you alright Big Mama? Interview on 10/21/25 at 11:55 A.M. with DON #303 revealed CP #495 was counseled in the past not to use derogatory terms when caring for Resident #74. Interview on 10/21/25 at 1:20 P.M., Resident #74 stated she felt sometimes staff could be mean to her. Interview on 10/21/25 at 1:23 P.M. with CP #495 revealed she made a statement to Resident #74 that she was thick but did not have an offensive intention. CP #495 stated DON #303 counseled her not to use terms that would offend a resident. Interview on 10/21/25 at 2:13 P.M. with DON #303 revealed CP #495 had used the term Big Mama to Resident #74, and Resident #74 felt offended with the term and felt disrespected. Review of a facility document dated 05/19/25 revealed CP #495 was disciplined and counseled not to use verbally abusive language to residents prior to the 08/08/25 incident. Review of the facility policy titled Residents' Rights, dated 06/12/18, revealed residents would be free from discrimination and reprisal from the facility in exercising their rights. This deficiency represents non-compliance investigated under Complaint Number

1. 2642861. 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

10/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Jennings Hall

10204 Granger Road Garfield Heights, OH 44125

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 0620 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Not require residents to give up Medicare or Medicaid benefits, or pay privately as a condition of admission; and must tell residents what care they do not provide. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review, interview and review of the facility policy, the facility failed to ensure admission paperwork was signed as required. This affected one resident (#74) of three residents reviewed for admission. The facility census was 168. Findings include:Review of the medical record revealed Resident #74 was admitted to the facility on [DATE REDACTED] with diagnoses including transient cerebral ischemic attack, heart failure, atrial fibrillation, hypertension, obstructive sleep apnea, peripheral autonomic neuropathy, anxiety disorder, abnormalities of gait and mobility, dysphagia, insomnia, muscle weakness, essential tremor, foot drop.

Review of the Minimum Data Set (MDS) 3.0 quarterly assessment revealed Resident #74 had a Brief

Interview of Mental Status (BIMS) score of 15 out of 15, indicating intact cognition. Interview on 10/16/25 at 11:00 A.M. with Resident #74's responsible party revealed she was concerned because the facility had called her stating they did not have Resident #74's admission paperwork, and she was told she needed to fill out the admission paperwork again. Review of the admission packet provided by the Administrator on 10/20/25 for new admission residents, revealed the admission Agreement, assignment of benefits, authorization of representative, resident personal funds, suite hold and leave of absence, authorization for professional services, special financial Power of Attorney (POA), release of information to the facility and from the facility, information consent form, photo consent form, mail authorization form, contact information form, and organizational practices. The Administrator was unable to produce a signed copy of Resident #74's admission Agreement. On 10/20/25 at 9:37 A.M. an interview with the Administrator verified Resident #74's admission paperwork was not signed and should be completed at the time of admission. The Administrator stated when the facility performed audits of admission Agreements, they discovered Resident #74 did not have a signed admission Agreement. The facility had reached out to Resident #74's responsible party inquiring if she had a copy of the admission Agreement. The Administrator stated Resident #74's admission Agreement was not lost; it was not done. Interview on 10/20/25 at 4:04 P.M. with Resident #74's responsible party revealed the facility had contacted her to sign the facility admission Agreement because

the facility admissions coordinator did not generate the document for her. Review of the facility's policy titled Admissions, dated 03/24/16, revealed and admission team met periodically as needed. Completed applications were reviewed to determine if the facility could properly serve the applicant. An application was deemed completed and ready for review by the admission team when it contained the completed admission application including completed financial disclosure, a completed pre-admission physical or medical transfer and copies of applicant's social security card, Medicare card and copies of all secondary medical insurance. This deficiency represents non-compliance investigated under Complaint Number 2642861.

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

10/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Jennings Hall

10204 Granger Road Garfield Heights, OH 44125

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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

#74 also stated an aide hit her head with her head (note dated 08/08/25) because the bed went up and down. It was horrible. Interview on 10/20/25 at 11:14 A.M. with Director or Therapy #587 revealed if a resident was dependent on staff for mobility, two staff members were needed to assist for mobility. Resident #74 was dependent on staff for chair-to-bed transfers to ensure resident and staff safety. Observation on 10/20/25 at 4:01 P.M. of Resident #74 revealed she was lying on her back in bed and was not able to turn left or right in bed. Interview on 10/21/25 at 11:30 A.M. with NP #583 revealed Resident #74 required a high level of care, and it would be best for two staff members to care for Resident #74 because Resident #74 was dependent on staff for all mobility and activities of daily living. NP #583 stated Resident #74 was injured in the sling (note dated 06/07/25), and Resident #74 complained of pain. Resident #74 also stated

an aide's face collided with her face when an aide turned her (note dated 08/08/25). The previous facility had suggested two staff members for all Resident #74's care. Observation and interview on 10/21/25 at 1:00 P.M. with Administrator Resident#584, the Administrator, Chief Nursing Officer, and the DON viewed a video dated 06/06/25 at 7:05 P.M. that revealed Resident #74 was observed to be sitting in a recliner with one aide in the room that performed the ceiling lift. The aide raised the ceiling lift with straps attached to the sling and ceiling lift and resident positioned in the sling. Resident #74's right hand was over the sling in a bent position. Resident #74's left arm was observed to be extended straight up between the sling strap and

the ceiling lift. Resident #74's arm extended up as the ceiling lift rose up toward the ceiling. Resident #74's left arm remained extended until the aide lowered the resident to the bed. Resident #74's face was noted to be in distress during the transfer. After the aide replaced the ceiling lift in the charger, the aide asked Resident #74, Which arm is it? the aide touched Resident #74's left arm and ask if it was this one. Resident #74 stated, yes. Resident #74 was observed to moan in pain when the sling was removed and during the lift. Resident #74 stated it was because of the Hoyer lift. The DON #stated the aide used the hygiene sling

during the lift, and it was not the whole-body sling and verified both arms should be bent outside the sling, not extended. Observation and interview on 10/21/25 at 1:15 P.M. with Administrator Resident #584, the Administrator, Chief Nursing Officer and the DON revealed a video dated 08/08/25 at 6:13 A.M. revealed one aide was providing peri-care to Resident #74 alone in Resident #74's room. When the aide rolled Resident #74 to the right-side edge of the bed, the bed dropped down. The aide grabbed Resident #74's body and bumped Resident #74's head. The aide stated I'm sorry three times and asked Resident #74 if

she was bleeding. The aide stated, this bed went down , I didn't want you to fall, I tried to catch you because I felt the bed going down. Resident #74 was observed to lay in bed with her hand holding her head. The DON stated two staff members should roll Resident #74 in bed because Resident #74 was dependent on care. Interview on 10/21/25 at 1:23 P.M. with Care Partner #495 revealed on 08/08/25 she was changing Resident #74 when she heard the bed click. Care Provider #495 was concerned that Resident #74 was going to fall, so she grabbed the resident; her glasses hit Resident #74 in the face. Care Provider #495 stated two staff members were needed for ceiling lifts and to turn Resident #74. (There was only one staff member in the room at the time of the incident). Review of the facility policy titled Ceiling Lifts, dated February 2006, revealed the ceiling lift would be used for any resident who displayed the functional need and met the criteria for use. The ceiling lift would be used according to product guidelines, and the appropriate number of staff members would be used. This deficiency represents non-compliance investigated under Complaint Number 2642861.

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

10/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Jennings Hall

10204 Granger Road Garfield Heights, OH 44125

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 and interview, the facility failed to ensure medications were secured until consumed by residents. This affected one resident (#87) of 25 residents (#28, #42, #52, #53, #56, #64, #75, #84, #87, #114, #116, #117, #122, #124, #127, #132, #139, #142, #146, #153, #154, #162, #165, #166, and #167) residing on the Main Level [NAME] Unit. The facility census was 168. Findings include:Review of the medical record for Resident #87 revealed an admission date of 12/12/24 with diagnoses including type two diabetes mellitus, primary generalized osteoarthritis, and chronic diastolic heart failure. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE REDACTED] revealed Resident #87 had intact cognition. Interview on 10/16/25 at 9:11 A.M. noted Resident #87 sitting at a table

in the dining room. Interview with the resident revealed no concerns; however, further observations revealed

a medication cup sitting on the table filled with 19 medications. No medications were controlled medications. Interview on 10/16/25 at 9:13 A.M., the Director of Nursing (DON) observed the medication cup filled with medications. The DON then stated, this is wrong to have the medications sitting on the table without staff. The facility was unable to provide a policy related to ensuring medications were consumed by residents. This deficiency represents non-compliance investigated under Complaint Number 2642861.

Event ID:

Facility ID:

If continuation sheet