Health inspection·October 2, 2023

F 0660 Plan the resident's discharge to meet the resident's goals and needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interviews with staff and the resident's emergency contact, and policy review, the facility failed to implement an effectivprovide a resident and/or emergency contact training on a mechanical lift and meal arrangements for a safe discharge. This affected one (#1) of three residents reviewed for discharge. The facility census was 45. Residents Affected - Few Findings include: Closed record review for Resident #1 revealed he was admitted on [DATE] with diagnoses including a fractured heel, history of pulmonary embolism, diabetes mellitus with neuropathy, and heart disease. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #1 had intact cognition, was dependent on two staff for Hoyer lift transfers and did not ambulate. Resident #1 was his own person with an apartment in the community. His former wife was listed as his only emergency contact. Review of the physician orders dated 08/29/23 revealed an order for Resident #1 to discharge from the facility with home health nursing services and a Hoyer lift for transfers. Review of the discharge care plan revised on 05/03/23 with a target date of 12/01/23 revealed Resident #1's goal was to return to an appropriate and safe placement when medically stable. The interventions included connecting with community resources including the case manager and educating the resident and/or family on any required safety precautions for transfers and mobility. Review of a care plan conference summary dated 08/24/23 revealed Resident #1 refused to participate in the conference. A Hoyer lift and sling was ordered for home use and home health referral completed. Review of a transfer notice dated 09/08/23 revealed Resident #1 was transferring to his apartment because his health improved and he no longer needed the services of the facility. Review of the Discharge summary dated [DATE] revealed Resident #1 was sent home with two medical appointments arranged, appropriate medication prescriptions, incontinence supplies, and transportation and home health services. Resident #1 was total care for lift transfers and toilet use at that time. There was a note the Hoyer lift was delivered to his home on [DATE]. There was no evidence the staff educated Resident #1 or his former wife regarding safe Hoyer lift transfers into his wheelchair or evidence of meal arrangements in the notes or discharge summary. Interview with the Administrator on 10/02/23 at 8:15 A.M. revealed Resident #1 did not ambulate, Page 1 of 2 365365 365365 10/02/2023 Urbana Health & Rehabilitation Center 741 E Water Street Urbana, OH 43078

F 0660 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few refused to get out of bed most of the time, and did not cooperate with therapy or staff during his stay. Resident #1 was very unhappy and had a former wife that visited almost daily and brought him fast food per his request. A friend of the resident was present at discharge on [DATE] and helped with his belongings and followed the transportation company to his home. Telephone interview with Resident #1's former wife on 10/02/23 at 10:00 A.M. revealed she did not know how to use a Hoyer lift and the facility staff never offered to educate her or Resident #1 regarding safe transfers. There were no meal arrangements such as meals on wheels that he had at home prior to his admission to the facility. She was the only person other than home health caring and providing meals for the resident. Interview with the Director of Nursing on 10/02/23 at 12:40 P.M. verified no education was provided by their staff to Resident #1 or his former wife regarding Hoyer lift transfers. Interview with Social Service Designee (SSD) #50 and the Administrator on 10/02/23 at 1:25 P.M. verified there was no training regarding safe Hoyer transfers with Resident #1 or his former wife and no evidence of meal arrangements such as meals on wheels. SSD #50 verified she did not communicate to Resident #1's case manager with Home Choice during Resident #1's stay and notified Home Choice after Resident #1 discharged from the facility three days later 09/11/23. Review of the policy titled Discharge Planning Policy, dated 11/2016, revealed the discharge needs of each resident were identified and resulted in the development of a discharge plan to effectively transition them to post discharge care. The resident and caregiver were involved in the development of the discharge plan that considered the support persons capacity and capability to perform required care. This deficiency represents non-compliance investigated under Complaint Number OH00146826. 365365 Page 2 of 2