Health inspection·May 29, 2024

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interviews, and review of the facility policy, the facility failed to ensure a written discharge notice with provision of the discharge was provided to resident upon discharge to the community. This affected one resident (#56) out of three residents reviewed. The facility census was 53. Findings include: Record review for Resident #56 revealed the resident was admitted on [DATE] and discharged on 05/14/24. His diagnoses included, spondylosis, chronic obstructive pulmonary disease, coronary artery dissection, major depressive disorder, insomnia, hypertension, and alcohol abuse. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] for Resident #56, revealed the resident was cognitively intact. Resident #56 was dependent on facility staff for medication administration and independent with all other activities of daily living. Review of the nursing progress notes for Resident #56 dated 05/14/24 at 4:12 P.M. revealed the resident was discharged to a local hotel's address with all of his personal belongings, a courtesy bag, a list of medications and the resident reported an understanding of discharge instructions. The progress notes revealed no documented evidence of a written discharge notice with provision of the discharge being provided to resident upon discharge to the community or a discharge appeal being offered to the resident. Interview with the Social Service Designee (SSD) #128 on 05/29/24 at 10:26 A.M., revealed Resident #56 discharged to a local hotel on 05/14/24 and the facility agreed to pay for seven days at the hotel. SSD #128 stated she was on vacation when Resident #56 discharged on 05/14/24, however, prior to her leave, she referred Resident #56 to a program that could help with finding an apartment but there was nothing set up. SSD #128 verified there was no documented evidence of a discharge summary for Resident #56 and no documented evidence of a written discharge notice with provision of the discharge being provided to resident upon discharge to the community or a discharge appeal being offered to the resident. Interview with the Administrator and Director of Nursing (DON) on 05/29/24 at 10:45 A.M. revealed Resident #56's discharge was initiated due to the resident wanting to sign himself out all the time and stay with a friend. The Administrator stated they also learned of Resident #56 being listed as a sexual offender on 05/14/24. The Administrator indicated the facility discharged the resident on 05/14/24 and paid for a hotel room for seven days. The DON reported the resident was given a list of his medications upon discharge. The DON reported Resident #56's physician was aware of the discharge (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 7 Event ID: 365476 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 365476 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Astoria Place of Silverton 6922 Ohio Avenue Cincinnati, OH 45236 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)