Health inspection·April 24, 2024

F 0624 Prepare residents for a safe transfer or discharge from the nursing home. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure Resident #135 received appropriate discharge instructions. This finding affected one resident (#135) of three residents reviewed for discharge instructions. Residents Affected - Few Findings include: Review of the medical record revealed Resident #135 was admitted on [DATE] and discharged on 03/29/24 with diagnoses including diabetes, essential hypertension, and muscle weakness. Review of Resident #135's Report and Decision of the Hearing Officer form dated 02/22/24 revealed the resident won the appeal, and the facility may not discharge and transfer the resident based on non-payment. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #135 exhibited intact cognition. Review of the Notice of Discharge and Transfer form dated 02/28/24 revealed Resident #135 was being discharged for an unpaid balance of $11,520.00. The resident did not appeal the second notice. Review of the progress note dated 03/19/24 at 10:22 A.M. indicated Resident #135 was encouraged to come talk with Licensed Social Worker (LSW) #808 about the discharge. The resident reported that he would come later. Review of an email dated 03/21/24 at 2:09 P.M. from Regional Director of Finance #813 to LSW #808 revealed the email was a follow-up to make sure there were solid plans in place for Resident #135's discharge before the end of the month. The resident's last covered day was on 01/25/24. Review of an email dated 03/22/24 at 9:32 A.M. from LSW #808 to Regional Director of Finance #813 indicated Resident #135 was introduced to a group home owner yesterday, and he was unwilling to have a conversation with him. Review of Resident #135's progress note dated 03/25/24 at 1:54 P.M. indicated the durable medical equipment (DME) would be delivered to the facility on [DATE]. Review of the progress note dated 03/29/24 at 4:08 P.M. indicated Resident #135 was discharged home with all belongings, prescriptions, and medications. Review of Resident #135's billing statement revealed the resident owed the facility $20,480.00. Page 1 of 2 365192 365192 04/24/2024 Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130

F 0624 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 04/23/24 at 8:21 A.M. with Licensed Practical Nurse (LPN) #804 indicated she discharged Resident #135 home and provided all the prescriptions and medications that were available in the facility. She stated she was aware that he was going to a bed and breakfast but did not have further information to provide. Interview on 04/23/24 at 9:48 A.M. with LSW #808 indicated Resident #135 was discharged but would not go over the discharge plans with him. LSW #808 stated the resident owned a home, but the home was not safe to live in, and he had attempted to talk to the resident about a group home, an apartment or other lodging. He stated the resident said he was going to a bed and breakfast but would not provide that information to him. Interview on 04/23/24 at 3:00 P.M. with the Administrator confirmed Resident #135's medical record did not contain documented evidence the resident was discharged home with complete and accurate discharge instructions including a list of the resident's medications, the last dose received of those medications, the resident's diet, any follow-up physician visits, and the resident's activity level. Review of the Discharge Planning policy dated 07/17/20 revealed the process that generally began on admission and involved identifying each resident's discharge goals and needs, developing and implementing interventions to address them, and continuously evaluating them throughout the resident's stay to ensure a successful discharge. This deficiency represents non-compliance investigated under Master Complaint Number OH00152684. 365192 Page 2 of 2