Inspection·May 1, 2023

F 0583 Keep residents' personal and medical records private and confidential. 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 obtain a release of medical records prior to sending resident medical records to another nursing facility. This affected one (#8) of three residents reviewed for transfers. The facility census was 85. Residents Affected - Few Findings include: Review of the medical record revealed Resident #8 was admitted on [DATE]. Diagnoses included unspecified fracture of shaft of the right fibula and tibia, generalized anxiety disorder, muscle weakness, essential (primary) hypertension, hypothyroidism, Alzheimer's disease with late onset, nonexudative age-related macular degeneration, and mixed hyperlipidemia. Review of Resident #8's Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was moderately cognitively impaired. Review of power of attorney (POA) documentation dated 04/08/22 verified Resident #8 had family named as the power of attorney. Review of a progress note dated 02/28/23 revealed the Administrator and social services met to review an increase in Resident #8's physical aggression, increase in calling, and attention seeking behavior. Facility staff spoke with Resident #8's POA regarding possible placement in a facility with more specialized dementia care. Resident #8's POA voiced agreement and asked for names of possible facilities for alternate placement. Review of a progress note dated 02/28/23 revealed it was expressed to Resident #8's POA of the possibility of the behaviors advancing to where the resident was no longer appropriate for the facility. Resident #8's POA was informed social services would investigate possible options for alternate placement when it was decided that was Resident #8's best option. Review of a progress note dated 03/01/23 revealed Resident#8's POA was in agreement with a transfer to a psychiatric hospital in another facility and provided a list of three facilities in order of preference. Review of a progress note dated 03/01/23 revealed social services called the psychiatric facility Resident #8's POA was in agreement with and nurses notes and a medication list was sent. Further review of the progress note revealed the facility indicated they would call back if they would accept Resident #8. (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: 365447 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 365447 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookview Healthcare Center 214 Harding Street Defiance, OH 43512 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)