Inspection·April 27, 2023

F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Let each resident or the resident's legal representative access or purchase copies of all the resident's records. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of the facility medical record request log, staff interview, and facility policy review, the facility failed to provide copies of requested medical records in a timely manner. This affected one (#72) of three residents reviewed for resident rights. The census was 69. Findings include: Resident #72 was admitted to the facility on [DATE]. Diagnoses include type II diabetes, hypertensive heart and chronic kidney disease with heart failure, chronic obstructive pulmonary disease, difficulty walking, low back pain, other hypertrophic osteoarthropathy, rheumatoid arthritis, anxiety disorder, morbid obesity, muscle weakness, other chronic pain, spinal stenosis, chronic kidney disease (stage III), schizoaffective disorder, dementia, major depressive disorder, and anemia. Review of Resident #72's minimum data set (MDS) assessment, dated 11/11/22, revealed she had a severe cognitive impairment. Review of Resident #72 medical records revealed she had a severe cognitive impairment, so members of her family were deemed to be their responsible parties and could make medical decisions on her behalf. Review of facility medical records request log revealed Resident #72 family requested medical records on 01/06/23. The facility did not provide the medical records until 02/06/23. Also, Resident #72 family requested medical records on 04/17/23. As of 04/27/23, the facility had not provided those medical records. Interview with Director of Nursing (DON) on 04/27/23 at 9:45 A.M. and 10:30 A.M. and Administrator on 04/27/23 at 8:30 A.M. and 2:25 P.M. confirmed the dates in which Resident #72 family requested the records and the date in which they provided the records to the family. They confirmed it was more than 48 hours after the request. They confirmed they make copies of the medical records, send them to their corporate legal team to review, and then they will provide the medical records to the family. Review of facility Request for Medical Records policy, dated August 2018, revealed it is the policy of the facility to comply with requests for medical records if the requesting party is legally authorized to request the record. Upon receipt, and prior to the release of any legal documents or requested record, the Administrator and the DON will be notified and given a copy of the request. The Administrator will notify the appropriate corporate staff and send a copy of that request. The facility (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 2 Event ID: 365329 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 365329 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Embassy of Marion 175 Community Drive Marion, OH 43302 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)