Health inspection·February 9, 2024

F 0623 Level of Harm - Potential for minimal harm Residents Affected - Many 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 closed record review and interview, the facility failed to provide written notice of discharge to two residents when they transferred to the hospital. This affected two residents (#13, #87) of three residents reviewed for hospitalization with the potential to affect all 73 residents as facility does not have a process in place for discharge or transfer notices. The facility census was 73. Findings included: 1. Record review revealed Resident #13 was admitted to the facility on [DATE] with diagnoses including adult failure to thrive, anemia, anxiety disorder, and muscle weakness. Review of a nursing note dated 12/19/23 at 10:05 A.M. by Licensed Practical Nurse (LPN) #114 revealed Resident #13 was seen by the facility nurse practitioner due to refusal to eat and edema to upper and lower extremities. The provider gave an order for Resident #13 to be sent to the hospital for evaluation. Resident #13's responsible party was notified by phone of the transfer. Review of Resident #13's record revealed no written notice of transfer or discharge. 2. Record review revealed Resident #87 admitted to the facility on [DATE] with diagnoses including intracranial injury with loss of consciousness, dementia, borderline personality disorder, type II diabetes, and personal history of traumatic brain injury. Review of a nursing note dated 01/17/24 at 2:01 P.M. by LPN #127 revealed Resident #87 was exhibiting agitation, pacing back and forth, raising her voice, and made the statement she wanted to kill herself and needs mental health. Resident #87 was placed on one to one supervision and the Director of Nursing was notified. Review of a nursing note dated 01/17/24 at 2:30 P.M. by Registered Nurse (RN) #148 revealed the physician was updated on Resident #87's behaviors and gave an order for Resident #87 to be sent to the hospital for a psychiatric evaluation. While awaiting transport, Resident #87 stated she wanted to harm herself by running out of the door, going into the street and getting hit by a car. Resident #87 made several attempts to leave and five staff members stood near the door to block the exit due to Resident #87 trying to push the door for 15 seconds until it opened. Resident #87 stated multiple times to the staff she needed psychiatric help. Resident's responsible party was made aware of the situation and in agreement to send Resident #87 to the hospital for evaluation. Review of Resident #87's record revealed no written notice of transfer or discharge on file. Page 1 of 3 365673 365673 02/09/2024 Embassy of Woodview 2770 Clime Road Columbus, OH 43223

F 0623 Level of Harm - Potential for minimal harm Residents Affected - Many Interview on 02/09/24 at 3:06 P.M. with Administrator confirmed there was not a written notice of transfer or discharge on file for Resident #13 or Resident #87. Administrator stated the facility does not have a process in place for discharge or transfer notices. Review of a policy titled Transfer and Discharge (including AMA) (dated 01/01/24) revealed once a resident is transferred or discharged from the facility, a transfer/discharge notice will be provided to the resident and the resident's representative in a language and manner in which they can understand. The notice should contain the specific reason and basis for the transfer or discharge, the effective date, the specific location, and an explanation of the right to appeal the transfer or discharge. This deficiency represents non-compliance investigated under Complaint Number OH00150275. 365673 Page 2 of 3 365673 02/09/2024 Embassy of Woodview 2770 Clime Road Columbus, OH 43223

F 0625 Level of Harm - Potential for minimal harm Residents Affected - Many 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 closed record review and interview, the facility failed to offer bed hold notices to two residents. This affected two residents (#13, #87) of three residents reviewed for hospitalization with the potential to affect all 73 residents as the facility does not have a process in place for bed hold notices. The facility census was 73. Findings included: 1. Record review revealed Resident #13 was admitted to the facility on [DATE] with diagnoses including adult failure to thrive, anemia, anxiety disorder, and muscle weakness. Review of a nursing note dated 12/19/23 at 10:05 A.M. by Licensed Practical Nurse (LPN) #114 revealed Resident #13 was seen by the facility nurse practitioner due to refusal to eat and edema to upper and lower extremities. The provider gave an order for Resident #13 to be sent to the hospital for evaluation. Resident #13's responsible party was notified by phone of the transfer. Review of Resident #13's record revealed no written notice of transfer or discharge. 2. Record review revealed Resident #87 was admitted to the facility on [DATE] with diagnoses including intracranial injury with loss of consciousness, dementia, borderline personality disorder, type II diabetes, and personal history of traumatic brain injury. Review of a nursing note dated 01/17/24 at 2:01 P.M. by LPN #127 revealed Resident #87 was exhibiting agitation, pacing back and forth, raising her voice, and made the statement she wanted to kill herself and needs mental health. Resident #87 was placed on one to one supervision and the Director of Nursing was notified. Review of a nursing note dated 01/17/24 at 2:30 P.M. by Registered Nurse (RN) #148 revealed the physician was updated on Resident #87's behaviors and gave an order for Resident #87 to be sent to the hospital for a psychiatric evaluation. While awaiting transport, Resident #87 stated she wanted to harm herself by running out of the door, going into the street and getting hit by a car. Resident #87 made several attempts to leave and five staff members stood near the door to block the exit due to Resident #87 trying to push the door for 15 seconds until it opened. Resident #87 stated multiple times to the staff she needed psychiatric help. Resident's responsible party was made aware of the situation and in agreement to send Resident #87 to the hospital for evaluation. Review of Resident #87's record revealed no written notice of transfer or discharge on file. Interview on 02/09/24 at 3:06 P.M. with Administrator confirmed there was not a written notice bed hold on file for Resident #13 or Resident #87. Administrator stated the facility does not have a process in place for bed hold notices. This deficiency represents non-compliance investigated under Complaint Number OH00150275. 365673 Page 3 of 3