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, (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: 365365 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 365365 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Urbana Health & Rehabilitation Center 741 E Water Street Urbana, OH 43078 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)