Inspection·October 31, 2024

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and policy review the facility failed to begin the discharge planning process upon admission. This affected one (Resident #39) of one residents reviewed for choices. The facility census was 62. Findings included: Record review revealed Resident #39 admitted to the facility on [DATE] with diagnoses including chronic and acute respiratory failure, muscle weakness, and difficulty in walking. Review of an assessment titled Interdisciplinary Care Conference Summary dated 10/04/24 revealed Resident #39 would receive long term care and would apply for Medicaid. Review of the sign in sheet for the care conference revealed only the social worker and nursing staff signed in. The resident and family did not sign in. Review of an admission minimum data set (MDS) completed on 10/08/24 revealed Resident #39 remained cognitively intact, had no behaviors, and had a discharge goal to remain in the facility. Review of a care plan dated 10/22/24 revealed Resident #39 would remain in the facility for long term care for the best interest of the residents and a discharge to the community would not be pursued. Interview on 10/28/24 at 1:27 P.M. with Resident #39 revealed he wanted to go home on Wednesday (10/30/24) and the surveyor informed the Administrator and Social Worker. Interview on 10/30/24 at 8:19 A.M. with Resident #39 revealed he had not spoken to the Social Worker regarding discharge planning. Resident #39 stated his wife would be visiting the facility at 10:30 A.M. and would take care of everything. Review of a discharge planning note dated 10/30/24 at 8:25 A.M. by the Social Worker revealed he spoke with Resident #39 and his wife, who decided the resident would discharge home on [DATE] with home health services. There was no further documentation regarding discharge planning or care conference in the medical record. Interview on 10/30/24 at 8:35 A.M. with the Social Worker revealed he was working on an unplanned discharge after being informed on Tuesday (10/29/24) Resident #39 wanted to go home. The Social (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 6 Event ID: 365578 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 365578 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Majestic Care of New Lexington 920 South Main Street New Lexington, OH 43764 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)