Health inspection·May 31, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, medical record review, and policy review, the facility failed to notify the family/representative of changes in a resident's condition and when there was a change in room. This affected one resident (Resident #85) of three residents reviewed for change in status and notification. The facility census was 86. Findings Include: 1. Resident #85, was admitted to the facility on [DATE] with diagnoses including metabolic encephalopathy, chronic respiratory failure, congestive heart failure, high blood pressure, post traumatic stress disorder, tracheostomy, a gastrostomy, chronic obstructive pulmonary disease, atrial fibrillation, heart disease, and methicillin resistant staph aureus (MRSA) pneumonia. The resident was transferred to the hospital on [DATE] and did not return to the facility. Review of the room changes for Resident #85 revealed he was admitted to room [ROOM NUMBER]. On [DATE] he was transferred to room [ROOM NUMBER] and moved again on [DATE] he was moved to room [ROOM NUMBER]. There was no documentation regarding the room changes or why they were made. Interview with the Administrator on [DATE] at 1:15 P.M. revealed he thought the facility was no longer required to notify families of room changes due to a waiver issued by the federal government during the world wide pandemic. The Administrator indicated he thought the waiver expired on [DATE]. He confirmed the family should still have been notified of the room changes. Review of the Centers for Medicare and Medicaid Services (CMS) QSO-21-17-NH letter dated [DATE] and updated on [DATE], revealed the emergency blanket waivers related to notification of Resident Room or Roommate changes ended in [DATE]. 2. Review of the progress notes for Resident #85 revealed on [DATE] he was sent to the local emergency room (ER) for respiratory distress. The was no documentation found notifying the family regarding Resident #85's transfer to the hospital. An interview with the Administrator on [DATE] at 3:20 P.M. confirmed whenever a resident experiences a change in condition, the family/responsible party were to be notified. An interview with the Director of Nursing (DON) on [DATE] at 4:10 P.M. revealed Licensed Practical Nurse (LPN) #131 was the nurse providing care to Resident #85 on [DATE] when he was transferred to the hospital. The DON said she was unaware the family was not notified of the transfer. The DON Page 1 of 2 365539 365539 05/31/2023 Warren Nursing & Rehab 2473 North Rd NE Warren, OH 44483

F 0580 contacted LPN #131 on [DATE] who confirmed she did not notified the family regading the transfer. Level of Harm - Minimal harm or potential for actual harm Review of the facility's Change in Condition policy, last revised [DATE], revealed if a resident experiences a change in physical, mental, psychosocial status, or is transferred to the hospital then the resident's representative was to be notified. Residents Affected - Few Review of the facility's Room Change/Roommate Assignment policy, last revised [DATE], revealed prior to changing a room or roommate assignment all parties involved in the change and their representatives will be given notification of the change. This deficiency is an example of non-compliance for Complaint #OH00142492. 365539 Page 2 of 2