Inspection·May 24, 2023

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 medical record review, staff and hospital staff interviews and policy review, the facility failed to provide a timely discharge notice to a resident. This affected one (#75) of three residents reviewed for discharge. The facility census was 72. Findings include Medical record review for Resident #75 revealed an admission date of 04/26/23. Diagnoses include schizoaffective disorder, cerebral infarction, expressive language disorder, aphasia, hemiplegia and hemiparesis of right dominant side, seizures, depression, anxiety, migraine, mood affective disorder, hallucinations, behavioral disorders, and insomnia. Review of the discharge not anticipated Minimum Data Set (MDS) assessment dated [DATE] for Resident #75 revealed the resident was severely impaired cognition. Resident #75 was coded with physical, verbal, and behavioral symptoms directed at self and others, rejection of care, and wandering during the assessment period. Resident #75 was supervised for bed mobility, transfers, eating and toileting. Review of the plan of care for Resident #75 revealed the resident has a psychosocial well-being problem actual or potential related to schizoaffective diagnosis, with anxiety, insomnia, depression, traumatic brain injury, mood disorder and behavioral disorders including hallucinations. Interventions include allow the resident time to answer questions and to verbalize feelings perceptions, and fears as needed (PRN). Consult with pastoral care, social services, psych services, when conflict arises, and remove resident to a calm safe environment. Review of the progress notes for Resident #75 dated 04/30/23 at 2:16 P.M. revealed the resident refused to come back into building after smoke break, aide redirected Resident #75 multiple times, with continued refusals to reenter the facility. Resident #75 proceeded to punch staff in shoulder. Resident #75 refused to come in building, proceeded to the exit gate started pulling on gate, resident turned around started to be more combative by hitting, kicking, and punching staff. Staff called for help via cell phone, resident took cell phone and hit it against the gate. Resident #75 forcefully pushed gate and broke gate. Nurses came to intervene, and 911 called. Resident #75 was sent to hospital for evaluation. Review of the progress note for Resident #75 dated 04/30/23 at 3:40 P.M. revealed emergency room nurse from hospital called facility and advised Resident #75 was diagnosed with a urinary tract infection (UTI) and are sending resident back to the facility. (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: 365558 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 365558 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011 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)