Inspection·October 14, 2022

F 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. Based on record review and interview the facility failed complete the recapitulation of stay, discharge summary and failed to implement a discharge plan of care for one (R37) resident out of one resident reviewed for discharge in a sample list of 22 residents. Findings include: R37's Undated Face Sheet documents an admission date of 6/19/22 and discharge date of 8/1/22. R37's Comprehensive Care Plan does not include a focus area, goal nor interventions for discharge. R37's Medical Record does not include a recapitulation of stay summary nor any copies of information sent with R37 at time of discharge. R37's Interdisciplinary Team meeting and Social Service progress notes do not include discharge summary information. On 10/13/22 at 12:11 PM V3 Social Service Director (SSD) stated I did not know a recapitulation of stay needed to be completed. I have not done one of those for any of the discharges since I have worked here. There is no summary of any kind. (R37) was admitted to facility for a short-term rehabilitation stay and planned to return to home after therapy released (R37). (R37) was sent home with home health services, medications as prescribed, and therapy was to continue. I set all this up for (R37) but did not write any of it down. I guess I should have looked back. 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: 146113 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 146113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenup Rehab and Nursing 300 North Marietta Street Greenup, IL 62428 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)