Health inspection·December 26, 2024

F 0625 Level of Harm - Potential for minimal harm Residents Affected - Some Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the medical record, staff interview, and policy review, the facility failed to provide a notice of the bed hold policy to residents when transferred from the facility to a hospital. This affected five (#12, #20, #22, #50, and #102) of five residents reviewed for bed hold notices. The facility census was 44. Findings include: 1. Review of the medical record for Resident #50 revealed an admission date of 09/04/24 and a discharge date of 09/24/24. Diagnoses included hypertension, dysphagia, atrial fibrillation, and chronic diastolic heart failure. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #50 had intact cognition. Review of a nursing progress note dated 09/24/24 revealed Resident #50 was sent to the emergency room due to increased confusion. There was no documentation the resident was given a notice of the facility's bed hold policy. 2. Review of the medical record for Resident #12 revealed an admission date of 08/10/24. Diagnoses included lymphoma, acute on chronic systolic heart failure, hypertension, and atrial fibrillation. Review of the admission MDS assessment dated [DATE] revealed Resident #12 had intact cognition. Review of the nursing progress note dated 09/27/24 at 11:08 A.M. revealed Resident #12 was sent to the emergency room for abdominal pain. Further review of the nursing progress notes revealed the resident was admitted to the hospital. There was no documentation the resident was provided with a notice of the facility's bed hold policy. 3. Review of the medical record for Resident #22 revealed an admission date of 03/30/21. Diagnoses included osteomyelitis, type two diabetes mellitus, hypertension, and chronic kidney disease. Review of the quarterly MDS assessment dated [DATE] revealed Resident #22 had intact cognition. Review of a nursing progress note dated 11/26/24 at 9:57 P.M. revealed Resident #22 was admitted to the hospital for an infection. There was no documentation the resident was provided with a notice of the facility's bed hold policy. (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 3 Event ID: 365656 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 365656 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of New London The 204 W Main St New London, OH 44851 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)