Inspection·May 1, 2025

F 000 INITIAL COMMENTS

F 000 A complaint survey for complaint numbers 2025004300 and 2025005646, was conducted on 05/01/2025 at Trinity Regional Rehab Center. The facility was not in compliance with 42 CFR 483, Requirements for Long Term Care Facilities. Complaint #2025004300 had deficiencies cited at

F 622.

F 622 Transfer and Discharge Requirements

F 622 5/22/25 SS=G CFR(s): 483.15(c)(1)(i)(ii)(2)(i)-(iii) $483.15(c) Transfer and discharge- $483.15(c)(1) Facility requirements- (i) The facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless- (A) The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility; (B) The transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility; (C) The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident; (D) The health of individuals in the facility would otherwise be endangered; (E) The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. Nonpayment applies if the resident does not submit the necessary paperwork for third party payment or after the third party, including Medicare or Medicaid, denies the claim and the resident refuses to pay for his or her stay. For a resident who becomes eligible for Medicaid after 05/15/2025 106079 C 05/01/2025 TRINITY REGIONAL REHAB CENTER 2144 WELBILT BLVD TRINITY, FL 34655 ID PREFIX TAG PREFIX TAG DEFICIENCY) COMPLETION DATE

F 622 Continued From page 1

F 622 admission to a facility, the facility may charge a resident only allowable charges under Medicaid; or (F) The facility ceases to operate. (ii) The facility may not transfer or discharge the resident while the appeal is pending, pursuant to § 431.230 of this chapter, when a resident exercises his or her right to appeal a transfer or discharge notice from the facility pursuant to § 431.220(a)(3) of this chapter, unless the failure to discharge or transfer would endanger the health or safety of the resident or other individuals in the facility. The facility must document the danger that failure to transfer or discharge would pose. §483.15(c)(2) Documentation. When the facility transfers or discharges a resident under any of the circumstances specified in paragraphs (c)(1)(A) through (F) of this section, the facility must ensure that the transfer or discharge is documented in the resident's medical record and appropriate information is communicated to the receiving health care institution or provider. (i) Documentation in the resident's medical record must include: (A) The basis for the transfer per paragraph (c)(1) (i) of this section. (B) In the case of paragraph (c)(1)(A) of this section, the specific resident need(s) that cannot be met, facility attempts to meet the resident needs, and the service available at the receiving facility to meet the need(s). (ii) The documentation required by paragraph (c) (2)(i) of this section must be made by- (A) The resident's physician when transfer or discharge is necessary under paragraph (c) (1) (A) or (B) of this section; and 106079 C 05/01/2025 TRINITY REGIONAL REHAB CENTER 2144 WELBILT BLVD TRINITY, FL 34655 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETION DATE

F 622 Continued From page 2 (B) A physician when transfer or discharge is necessary under paragraph (c)(1)(i)(C) or (D) of this section. (iii) Information provided to the receiving provider must include a minimum of the following: (A) Contact information of the practitioner responsible for the care of the resident. (B) Resident representative information including contact information (C) Advance Directive information (D) All special instructions or precautions for ongoing care, as appropriate. (E) Comprehensive care plan goals; (F) All other necessary information, including a copy of the resident's discharge summary, consistent with §483.21(c)(2) as applicable, and any other documentation, as applicable, to ensure a safe and effective transition of care. This REQUIREMENT is not met as evidenced by: Based on interview and record review, the facility failed to honor a resident's right to a safe, orderly, and planned discharge for one (#1) of one resident discharged while an appeal was pending.

F 622 1. Resident declines return to facility. Reports she is doing well at home SS spoke with case manager to follow-up on any outstanding equipment/care needs. SS spoke with resident all ordered/requested equipment has been received- written confirmation from resident 2. No other residents have been issued a 30 day discharge notice. Audit completed of discharges home for last 30 days. All have been called and all have received ordered DME 3. NHA/SS educated on discharge requirements pending hearing by Company Compliance Officer. NHA educated SS staff on ensuring delivery of ordered DME prior to dc. Receptionist to complete followup phone calls to Findings Included: During a telephone interview on 05/01/2025 at 2:32 p.m., Resident #1 stated she was discharged from the facility on 04/29/2025 while awaiting a hearing discharge. She stated she called to file the appeal on what she thought was the 10th day, but the facility told her she filed the appeal on the 11th day and would still be discharged home. The resident stated she was not ready to come home and could not afford to pay her portion of the bill. She stated she could not go home without a sit-to-stand lift which she C 05/01/2025 106079 2144 WELBILT BLVD TRINITY, FL 34655 PREFIX TAG COMPLETION DATE

F 622 Continued From page 3 F 622 required for transfers. Resident #1 stated she discharged residents home to ensure was still waiting for an upright walker because completion of delivery she cannot really stand. She stated she was 4. NHA/designee to complete monthly incontinent and could not access her bathroom at audit of any 30 day discharge notices her house due to it being too small. Resident #1 given to ensure none discharged prior to stated she had been forced to wear adult briefs hearing if appeal has been filed. and was dependent on her [male family member] NHA/designee to complete weekly audit of to change her. Resident #1 stated she never discharges to ensure delivery of ordered wanted her [male family member] to have to DME. NHA/designee to bring results to bathe and change her. She said, "It is monthly QA meeting until resolved. uncomfortable to have my [male family member] bathe and provide incontinence care. It is not dignified." The resident stated the previous Wednesday she sat in a soiled brief all day because, "I was embarrassed". Resident #1 stated waiting to be assisted has caused her some redness in her private area. She stated a nurse was supposed to come came out and help get her change into a clean brief. She stated she was approved for 28 hours of nursing care a week and was still working on setting up a schedule with the provider to be able to provide her with incontinence care at least twice a day. She said, I want to spread out the nursing hours, so I don't have to have my [male family member] provide my incontinence care or my showers." Resident #1 stated her discharge appeal hearing was scheduled on 05/06/2025. Review of Resident #1's Admission record revealed an admission date of 10/22/2024 and a discharge date of 04/29/2025. Resident #1 was admitted to the facility with diagnoses to include encounter for surgical aftercare following surgery on the digestive system, chronic hepatic failure without coma, chronic obstructive pulmonary disease, unspecified, chronic respiratory failure with hypoxia, acute on chronic diastolic (congestive) heart failure, lymphedema, not C 05/01/2025 TRINITY REGIONAL REHAB CENTER 2144 WELBILT BLVD TRINITY, FL 34655 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETION DATE

F 622 Continued From page 4

F 622 elsewhere classified, morbid (severe) obesity due to excess calories, dysphagia, unspecified, depression, unspecified, and anxiety disorder, unspecified. Review of a quarterly Minimum Data Set (MDS) dated 04/15/2025 showed a Brief Interview for Mental status (BIMS) score of 15/15 indicating intact mental cognition. Review of a care plan for Resident #1 initiated on 10/22/2024 showed the resident wishes to return home with her [family member] upon improvement of her condition. Interventions included to discuss with resident/family representative discharge planning process such as Investigate needs for returning home such as cooking, cleaning, shopping, medical equipment, financial resources, meals, pharmaceutical needs, physician follow-up, respite care, Home healthcare, Lifeline, adult protective service, live- in care provider transportation etcetera. Review of a Physical Therapy (PT) discharge summary evaluation dates of service 1/20/2025 - 4/11/2025 showed a goal for transfers, patient will safely perform functional transfers with Min (minimal) A [assist] with reduced risk for falls in order to decrease level of assistance from caregivers. Under comments it showed, "transfers continue to vary from Mod A (moderate assistance) x1 (person) to assist x2 (persons]. Therapy recommended use of sit to stand at home for safety. For ambulation: it showed, patient will ambulate up to 60 ft (feet) with upright RW (Rollator walker), CGA (Contact Guard Assist), in order to safely enter/exit her bathroom at home. The evaluation showed at discharge on 4/11/2025 the resident was ambulating 35 ft with C 05/01/2025 TRINITY REGIONAL REHAB CENTER 2144 WELBILT BLVD TRINITY, FL 34655 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETION DATE

F 622 Continued From page 5

F 622 upright FWW [Front Wheeled Walker], CGA, WC [Wheelchair] to follow. For standing, the goal showed patient will increase dynamic standing balance to fair spontaneously righting self when needed in order to reduce the risk for falls and prepare for transfers. At discharge on 4/11/2025, the assessment showed Resident #1's performance was fair, Min (A) [minimal assist or UE [upper extremity] support to stand w/o [without] LOB [Loss of Balance] and to reach ipsilaterally [on the same side of the body], unable to weight shift. The evaluation revealed the resident could stand- supported for a duration of 1-3 minutes. Discharge recommendations showed wheelchair as primary mode of mobility, sit to stand lift, lift chair, upright walker for ambulation as tolerated, home health services. Review of an Occupational Therapy (OT) progress note for Resident #1 dated 04/16/2025 revealed, discussed recommended equipment for home which includes bedside commode, toileting aide, female urinal, reacher, sock aid, hospital bed, 2ww [wheeled walker], upright walker, sara [sit-stand] lift. Review of a social services progress note for Resident #1 dated 04/22/2025 showed, in home medical provider has delivered a hospital bed, 3:1 commode and wheelchair for Resident #1 .... Social Services is having difficulty locating a sit to stand lift. Social services was told by multiple DME (Durable Medical Equipment) organizations that the product is on back order and or items are being leased. This writer reached out to Medicaid case worker to see if transitional funds could purchase the lift for Resident #1. Social services awaiting response from Medicaid. **106079** **C** **05/01/2025** **TRINITY REGIONAL REHAB CENTER** **2144 WELBILT BLVD** **TRINITY, FL 34655** PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETION DATE **F 622** Continued From page 6 Review of a social services progress note for Resident #1 dated 05/01/2025 showed this writer spoke with Resident #1 upon returning home. "She was approved for 28 hours of caregiver services ... a schedule has not been established as of yet ... Resident #1 inquired about when she would be receiving the upright walker and reclining lift chair. This writer states she will reach out to Medicaid case worker to follow up. Resident #1 also asked about bathroom modifications and furniture removal. An e-mail was sent to Medicaid case worker for follow - up." Review of a psychology progress note for Resident #1 dated 04/08/2025 revealed Resident #1 reported feeling sadness and worry. She reported that she is going home this week and feels overwhelmed with setting her home to be ready for her arrival. She reported worry, thoughts rumination and anxiety. She reported that she has an outpatient psychiatric provider. She will continue treatment with. Feelings explored and validated. Short term goal explored with the patient, who engaged in therapy and intervention. Psychologist collaborated with the patient to explore coping strategies to manage negative mood symptoms using psychoeducation. Review of a psychology progress note for Resident #1 dated 04/02/2025 revealed Resident #1 reports some increased anxiety this week due to personal stressors and uncertainty about her future. She has been given 30-days' notice due to financial issues and is expected to move home with her [male family member]. She worries about her independence and being able to care for herself. She admits her [male family member] can help some but is looking into home health. **F 622** DEPARTMENT OF MEDICARE & MEDICAID SERVICES SUMMARY OF DEFICIENCIES 106079 C 05/01/2025 TRINITY REGIONAL REHAB CENTER 2144 WELBILT BLVD TRINITY, FL 34655 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETION DATE

F 622 Continued From page 7

F 622 Review of a social services progress note for Resident #1 dated 03/18/2025 revealed, 30-day nursing home transfer and discharge notice issued to residents. Copy of notice provided to residents. Pt (patient) verbalizes that she is aware of reason for discharge -states "She is not paying her portion of what is due." Copy of discharge notice to be sent to ombudsman office. Review of a social services progress note for Resident #1 dated 04/01/2025 revealed, this writer spoke with the Ombudsman Office who confirms Resident #1 has filed a fair -hearing appeal. The appeal was filed on 3/31/2025. Due to not meeting the 10-day deadline, discharge may move forward. Should the resident win the appeal it is understood that she will re-admit to the facility. Review of the Nursing home transfer and discharge notice revealed a notice was given on 3/18/2025. Reason for discharge or transfer: "Your bill for services at this facility has not been paid after reasonable and appropriate notice to pay." The notice was presented by the Nursing Home Administrator (NHA) and signed on 3/18/2025. Resident or resident representative signed on 3/18/2025. Review of the State of Florida Department of children and family office of appeals hearings order revealed a request for a hearing was filed by the petitioner on 3/28/2025. The request is based on an action by the respondent to discharge the petitioner. Review of a social services progress note for Resident #1 dated 04/04/2025 revealed, facility received letter from office of appeal hearings. 106079 C 05/01/2025 TRINITY REGIONAL REHAB CENTER 2144 WELBILT BLVD TRINITY, FL 34655 ID PREFIX TAG PREFIX TAG DEFICIENCY) COMPLETION DATE

F 622 Continued From page 8

F 622 Resident #1 filed her appeal on 3/28/2025. The ombudsman office was notified on 3/31/2025. Requested documents have been sent to the appeals officer. Review of the order scheduling hearing for Resident #1 revealed a hearing was scheduled for Tuesday, May 6, 2025, time 1:00 PM, place: by telephone. Review of resident #1's Discharge Summary dated 04/29/2025 showed, patient discharged at 11:45 am with all medications and narcotics except OTC (Over The Counter) meds. Patient understood medication regime and ileostomy teaching done weeks prior to discharge, and she is fluent with ostomy changing and care. All belongings packed up and sent with pt. All discharge instructions are sent with patient. During an interview on 05/01/2025 at 12:49 p.m., the Social Services Director (SSD) stated Resident #1 was issued a discharge notice in March for nonpayment. She stated the ombudsman had notified the facility Resident #1 had filed an appeal. The SSD stated since the resident filed the appeal on the 11th day, they could continue with the discharge. During an interview 05/01/25 at 2:28 p.m., the Department of Children and Families, office of Appeals Hearings office administrator confirmed Resident #1 had appealed the discharge from the facility and had an upcoming hearing scheduled on May 6, 2025, at 1:00 p.m. The office administrator confirmed the facility, and the resident had been furnished copies of the hearing notice. During an interview on 05/01/2025 at 3:34 p.m., 106079 C 05/01/2025 TRINITY REGIONAL REHAB CENTER 2144 WELBILT BLVD TRINITY, FL 34655 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETION DATE

F 622 Continued From page 9 the NHA stated Resident #1 was discharged prior to her appeal date because she filed the appeal on the 11th day. The NHA confirmed knowing the resident had a pending appeal prior to her discharge. The NHA confirmed the facility had received the hearing notice for the upcoming hearing on May 6, 2025. Review of a facility policy titled Transfer or Discharge notice dated December 2016 showed a policy statement, our facility shall provide a resident and/or the resident's representative (sponsor) with a thirty (30)-day written notice of an impending transfer or discharge. Policy interpretation and implementation showed: 3. The resident and/or representative (sponsor) will be notified in writing of the following information: a. The reason for the transfer or discharge. b. The effective date of the transfer or discharge. c. The location to which the resident is being transferred or discharged. d. A statement of the resident's rights to appeal the transfer or discharge, including: (1). The name, address, email and telephone number of the entity which receives such requests. (2). information about how to obtain, complete and submit an appeal form; and (3). how to get assistance completing the appeal process. 11. In determining the transfer location for a resident, the decision to transfer to a particular location will be determined by the needs, choices and best interests of that resident.

F 622 35961016 C 05/01/2025 TRINITY REGIONAL REHAB CENTER 2144 WELBILT BLVD TRINITY, FL 34655 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE

N 000 INITIAL COMMENTS

N 000 A complaint survey for complaint numbers 2025004300 and 2025005646 was conducted on 05/01/2025 at Trinity Regional Rehab Center. The facility had no deficiencies at the time of the survey. 05/15/25 STATE FORM 8899 4EQ111