Health 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. Page 1 of 2 365558 365558 05/24/2023 The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011

F 0623 Level of Harm - Minimal harm or potential for actual harm Review of the progress note for 04/30/23 at 6:50 P.M. revealed in-house psychologist sent over pink slip referral for Resident #75 to be transferred to psychiatric facility. Spoke with emergency room (ER) nurse at hospital and advised they are going to transport her back to facility at this time with an order of antibiotics for UTI. Resident #75 will be on one-on-one (1-on-1) until we get confirmation from psychiatric facility. Administrator and all parties are notified. Residents Affected - Few Review of the Ohio Department of Mental Health and Addiction Services application for emergency admission dated 04/30/23 for Resident #75 revealed the resident has become increasingly agitated and aggressive. Resident #75 currently represents a substantial risk of harm to others based on her violet behavior today. Resident #75 physically attacked multiple staff members including punching and hitting. Staff are now concerned for their safety and for the residents in the facility. Resident #75 destroyed facility property. Redirection and medication have been ineffective, and her current needs outweigh what the facility is able to provide. Please admit for stabilization. Further review of Resident #75's medical record revealed there was a discharge notice issued to the resident on 05/17/23. Review of the facility transfer notice to the Ombudsmen dated 05/01/23 revealed Resident #75 was sent to the hospital on [DATE]. Interview with facility Social Worker Designee (SWD) #9 on 05/24/23 at 1:58 P.M. stated Resident #75 was sent to hospital and then diagnosed back to the facility with a UTI. SSD #9 stated Resident #75 was being returned to the facility and the resident was in route when she started biting/attacking the emergency medical technician (EMT) and was taken to a different hospital. SWD #9 stated she received a request for her PASARR from a place at another facility and they have accepted her. SWD #9 stated she was told by management to start looking for alternate placement as the facility was not going to accept her back due to her behavior. Interview on 05/24/23 at 2:49 with the Administrator verified she advised the hospital social worker that the facility would not be accepting Resident #75 return to the facility due to aggressive behaviors and did not provide a discharge notice until 05/17/23. Administrator stated she was unable to recall when she advised the hospital that she would not be able to take Resident #75 back, but it was before the discharge notice was sent. The Administrator further stated she was not aware of the requirement to send a discharge notice to the resident or representative until alerted by another Administrator. Interview on 05/26/23 at 2:19 P.M. with Hospital Licensed Social Worker (LSW) #502 stated the hospital attempted to discharge Resident #75 back to the nursing facility on 05/09/23 and was advised by the Nursing Home Administrator the facility would not be accepting her back at this time due to her behaviors. Review of facility policy titled Transfer and Discharge, dated 02/28/23, revealed when a facility-initiated transfer is made the facility will issue a notice in writing at least 30 days prior to the transfer. This deficiency represents non-compliance investigated under Complaint Number OH00142720. 365558 Page 2 of 2