Health inspection·September 11, 2024

F 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interviews, and policy review, the facility failed to allow a resident to remain in the facility and not transfer or discharge the resident without justification and proper documentation. This affected one (#61) resident out of three residents reviewed for transfer and discharge. The facility census was 53. Findings include: Review of the closed medical record for Resident #61 revealed an admission date of 05/27/21 and a discharge date of 08/20/24. Diagnoses included unspecified psychosis not due to a substance or known physiological condition, vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, anxiety disorder, bipolar disorder, and alcohol use, unspecified with alcohol-induced persisting dementia. Review of the quarterly Minimum Data Set (MDS) assessment, dated 07/01/24, revealed Resident #61 had moderately impaired cognition. Resident #61 was assessed to be independent for eating, oral hygiene, toileting, bathing, dressing, personal hygiene, bed mobility, and transfer. Review of the progress notes from 07/01/24 to 08/20/24 revealed no documentation related to discussion of transfer or discharge with Resident #61's guardian. Review of the incomplete Discharge summary dated [DATE] revealed Resident #61 was discharged to another nursing home. The summary indicated the reason for discharge was being incompatible with other residents on unit. Interview on 09/10/24 at 5:47 P.M. via telephone with Resident #61's guardian revealed he had not been involved in the discharge process. Resident #61's guardian stated the facility contacted him and informed him of concerns with Resident #61's behaviors, and he believed the facility did not want Resident #61 to remain a resident there. Resident #61's guardian reported he was unaware Resident #61 was being transferred to another facility until he was called to meet with staff and Resident #61 at the proposed new facility because Resident #61 had refused to stay. Resident #61's guardian also revealed that Resident #61 was returned to the facility and was ultimately transferred to another facility days later. Interview on 09/11/24 at 11:38 A.M. with the Director of Nursing (DON) revealed Resident #61's behaviors had escalated, and the decision was made after speaking with the guardian to transfer Resident #61 for safety reasons. (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 4 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 09/11/2024 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)