Health inspection·June 20, 2024

F 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure resident assessments were completed timely. This affected one (#41) of two residents review for discharged resident assessments. The census was 43. Residents Affected - Few Findings include: Review of the closed medical record review revealed Resident #41 was admitted on [DATE] and discharged home on [DATE]. Diagnoses included fracture of unspecified part of neck of left femur, hypertensive chronic kidney disease, chronic kidney disease stage 4, essential (primary) hypertension, non-Hodgkin lymphoma, and unspecified osteoarthritis. Review of the Minimum Data Set (MDS) assessment, dated 01/09/24, revealed the resident had an admission assessment completed. No further MDS assessments were entered. Interview on 06/18/24 at 4:37 P.M., with Licensed Practical Nurse (LPN) #559 and Corporate Registered Nurse (RN) #591 verified Resident #41 did not have a discharge MDS assessment completed. 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: 365387 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 365387 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Briar Hill Health Campus 600 Sterling Dr North Baltimore, OH 45872 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)