Health Center At The Renaissance

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

receiving a new phone and the incident of alleged abuse was not reported to the State Survey Agency. The Administrator also revealed CNA #718 and LPN #894 no longer were employed by the facility. The Administrator confirmed and verified the above findings at the time of the interview.Review of the mandatory training for all staff revealed the facility educated staff on sensitivity care on 06/16/25, 07/14/25, and 08/11/25 approximately three months after the incident.Review of the facility document titled New Hire Orientation dated 09/25/25 revealed the staff were educated on abuse policy and protocols.Review of the staff education revealed staff were educated on abuse, neglect, and exploitation on 09/01/25.Review of the facility document titled Abuse, Neglect, Misappropriation, and Exploitation Policy revised 11/28/16, revealed

the facility had a policy in place that all residents had a right to be free from abuse, neglect, misappropriation of resident property, and exploitation, including but not limited to, corporal punishment, involuntary seclusion, and any physical or chemical restraint not required to treat the resident's medical symptoms. Further review of the policy revealed alleged violations would be reported to the State Survey Agency. Review of the document revealed the facility did not implement the policy in regard to the allegation.This deficiency represents noncompliance investigated under Complaint Number 1374287 (OH00164161).

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

10/06/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Health Center at the Renaissance

26376 John Rd Olmsted Twp, OH 44138

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

#718 was unprofessional and mocked the resident and sent a video clip of the incident in question. The Administrator revealed prior to reviewing the video clip, CNA #718 was sent home, and subsequently, after watching the video clip, CNA #718 was placed on the DNR list. The video clip revealed Resident #48 was in process of being transferred into bed by CNA #718 and LPN #894 via Hoyer lift when Resident #48 made a moaning noise indicating pain. CNA #718 asked Resident #48 if she was doing something wrong and mimicked the noise made by Resident #48. Once Resident #48 was in bed, CNA #718 walked towards the bathroom while mimicking Resident #48's moaning noise. Review of additional video clips with the Administrator and DON present, revealed CNA #718 provided incontinence care to Resident #48 while in bed. The resident was heard yelling out in pain and CNA #718 stated, You have to help me and stop resisting. CNA #718 was then observed with both hands placed on Resident #48's right hip and pushed him onto his left side as he yelled out in pain. LPN #894 then entered the resident's room and asked him to verify and confirm his name. CNA #718 continued to attempt to turn Resident #48 on his left side while he yelled out in pain. LPN #894 then placed both hands on Resident #48's right side to hold him in place on his left side, while CNA #718 continued to provide care. LPN #894 was heard asking Resident #48 if he was in pain and then stated, I just gave you Tylenol. CNA #718 was then heard telling Resident #48 to turn towards her. Resident #48 was observed not to be moving towards CNA #718, when CNA #718 was then observed placing both hands on Resident #48 left side of his body and pulling him all the way over onto his right side and holding him in place. Resident #48 continued to yell out in pain while CNA #718 asked What's the matter? After completing Resident #48 care, CNA #718 was then seen pushing Resident #48 bed using her upper legs against the wall. Review of the SRI tracking system located within the Ohio Department of Health (ODH) for certification and licensing website revealed no incidents regarding Resident #48. Interview on 09/25/25 at 8:01 A.M. with the Administrator revealed the incident of alleged abuse was not reported to the State Survey Agency. The Administrator confirmed and verified the above findings at the time of the interview. Review of the facility document titled Abuse, Neglect, Misappropriation, and Exploitation Policy revised 11/28/16, revealed the facility had a policy in place that all residents had a right to be free from abuse, neglect, misappropriation of resident property, and exploitation, including but not limited to, corporal punishment, involuntary seclusion, and any physical or chemical restraint not required to treat the resident's medical symptoms. Further review of the policy revealed alleged violations would be reported to the State Survey Agency. Review of the document revealed the facility did not implement the policy in regard to the allegation. This deficiency represents noncompliance investigated under Complaint Number 1374287 (OH00164161).

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

10/06/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Health Center at the Renaissance

26376 John Rd Olmsted Twp, OH 44138

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 - Actual harm Residents Affected - Few

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

often educated following falls and was encouraged to use the call light (however, these interventions were noted to be ineffective). The DON indicated she believed education was an adequate intervention for Resident #2 to prevent falls as the resident was resistive to changes in care and it maintained his independence without restricting him. The DON confirmed Resident #2 sustained a fracture following the fall which occurred on 02/10/25 while being assisted by CNA #899 to transfer when the CNA failed to ensure adequate hands-on assistance was being provided to the resident. Interview on 09/25/25 at 9:45 A.M. with Physical Therapy Assistant (PTA) #989 and Occupational Therapist (OT) #991 revealed Resident #2 required one staff assistance for transfers with contact guard assist (CGA) at the time of the fall on 02/10/25. It was noted Resident #2 was inconsistent with recommendations to call for assistance and had a history of poor follow-through. Review of the facility policy, Falls Policy, dated August 2024 revealed all residents would receive adequate supervision, assistance, and devices to aide in prevention of falls. This deficiency represents non-compliance investigated under Complaint Number 1374286 (OH00161744).

Event ID:

Facility ID:

If continuation sheet