Inspection·July 10, 2025

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure appropriate discharge for one of three sampled residents (Resident 1), when 1. The facility did not follow physician discharge orders;2. The 30-day notice of discharge was given to Resident 1 at time of discharge; 3. The facility failed to develop post discharge care follow up for a June neurology referral; 4. There was no physician discharge summary in the medical records; and5. Minimum Data Sheet (MDS - a federally mandated resident assessment tool) discharge assessment was incomplete and not submitted. These failures led to inappropriate discharge of Resident 1 from the facility and reduced the facility's potential in discharging Resident 1 safely.Findings:During a review of Resident 1's admission Record (AR), the AR indicated Resident 1 was admitted to the facility in April 2025 with diagnoses that included benign neoplasm of cerebral meninges (brain tumor), cognitive communication deficit, and symptoms and signs involving cognitive functions and awareness. Resident 1's MDS indicated Resident 1 had severe cognitive impairment.During a review of Resident 1's Order Summary Report (OSR), dated 7/3/25, the OSR indicated May discharge with home health RN (registered nurse)/PT (physical therapy- focuses on restoring, maintaining and improving a person's ability to move and function)/OT (occupational therapy- focuses on improving a person's ability to perform tasks, develop skills and maintain independence in their daily routine). During a review of Resident 1's Discharge Information/Recapitulation of Stay, dated 7/3/25, Resident 1 was discharged to .Hotel [name of hotel] . The form further indicated. Home Health Services Required & Home Health Agency Contact Information: [home health agency name] . (pending approval) .During a review of the information received by the Department, dated 7/8/25, the information indicated, .recovering from a craniotomy surgery (brain surgery) . (Resident 1) was discharged to a motel for several days. (Resident 1) was found near the hotel in Downtown Davis; confused. He was brought to (hospital name). (Resident 1) has been non-verbal during his hospitalization. (Resident 1) was not safe to discharge from Courtyard back to the community given his cognitive deficits.During a review of Resident 1's Speech Therapy Discharge summary, dated [DATE], the speech therapy notes indicated that Resident 1 .[had] difficulty following directions. [Resident 1] requires max [maximum] cues.memory impaired [decline in the ability to remember things whether recent events, past memories, or both].During a concurrent interview and record review on 7/10/25 at 2:53 p.m. with the Social Services Director (SSD), the SSD confirmed that Resident 1 was discharged to a hotel for three days. SSD reviewed and confirmed that home health agency was still pending and was not established prior to discharge. The SSD confirmed that the facility did not follow through on a June neurology referral and no documented evidence of post discharge care follow on the neurology appointment was in the medical records. During a concurrent interview and record review on 7/10/25 at 3:16 p.m. with the MDS Coordinator, the MDS Coordinator confirmed that cognition assessment and mood assessment were not done. During a concurrent interview and record review on 7/10/25 at 3:29 p.m. with (continued on next page) 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 Page 1 of 3 Event ID: 055922 Printed: 05/15/2026 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 055922 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyard Health Care Center 1850 East 8th Street Davis, CA 95616 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)