Health inspection·September 18, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, policy review and interview, the facility failed to develop a discharge plan of care. This affected one resident (#75) of four sampled residents. The facility census was 73. Findings include: Closed medical record review revealed Resident #75 was admitted on [DATE] with diagnoses including cerebral infarction, diabetes mellitus type-1, tracheostomy and anoxic brain injury. Resident #75 was discharged from the facility on 08/14/24. Review of the electronic mail correspondence (dated 07/12/24) between Resident #75's power of attorney and Social Service Designee (SSD) #177 revealed additional information was needed from a home care provider of products/services regarding any and all orders being placed that SSD #177 had placed. Review of the quarterly Minimum Data Set 3.0 (MDS) assessment (dated 07/31/24) revealed Resident #75 was moderately impaired for daily decision-making and had no active discharge planning or referrals made regarding discharge for the resident. Review of the Nursing Note dated 08/14/24 revealed Resident #75 was discharged from facility with her significant other, supplies and medications. Review of the record revealed no evidence of a discharge plan of care. On 09/16/24 at 2:49 P.M., interview with Social Service Designee (SSD) #177 revealed Resident #75 was admitted in April (2024) and upon admission the plan was to discharge back to the community. The resident and her power of attorney had decided to return to North Carolina and SSD #177 began working on setting up supplies and equipment in North Carolina. SSD #177 verified she had been speaking with providers trying to set things up and provided emails sent including one dated 07/12/24. SSD #117 verified she did not develop a discharge plan of care for Resident #75 because she was afraid she would forget to update it. SSD #177 stated she normally does one upon admission but it was undecided as to the resident's discharge plans at that time. SSD #177 verified she had been working on discharge plans for about a month prior to Resident #75's discharge, had not developed a discharge plan of care and the MDS assessment dated [DATE] was not accurate for discharge planning. Review of the policy: Discharge Planning Process (dated 2023) revealed the facility was to develop and implement an effective discharge planning process that focused on the resident's discharge goals. The expected goals and outcomes regarding discharge was to be determined upon admission, routinely (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 6 Event ID: 365152 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 365152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Schoenbrunn Healthcare 2594 East High Avenue New Philadelphia, OH 44663 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)