Health inspection·April 25, 2019

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. Based on medical record review and staff interview, the facility failed to provide written notification to the resident and the resident representative family at the time of transfer to the hospital. This affected two (#47, #285) of three residents reviewed for hospitalization. The facility census was 142. Findings include: 1. Medical record review revealed Resident #47 had an admission date of 02/02/19. Diagnoses included malignant neoplasm of the colon, heart failure, anxiety, atrial fibrillation, and hypertension. Review of a nurse's progress note dated 03/06/19 at 2:53 P.M. revealed Resident #47 was admitted to the hospital for a gastrointestinal bleed. Review of the medical record for Resident #47 revealed no documented evidence of written notification of the transfer to the hospital was provided to the resident and the resident's representative. Interview on 04/24/19 at 7:37 A.M. with the Administrator verified the facility was not providing residents and their representatives written notice of transfer to the hospital. Further interview with the Administrator revealed the facility also had no policy to provide written notice of transfer to the hospital. 2. Medical record review revealed Resident #285 had an admission date of 04/15/19. Diagnoses included sepsis, end stage renal disease, heart failure, atrial fibrillation, hypertension, anxiety and major depressive disorder. Review of a nurse's progress note dated 04/22/19 revealed Resident #285 was admitted to the hospital for a blood transfusion. Review of the medical record for Resident #285 revealed no documented evidence of written notification of the transfer to the hospital was provided to the resident and the resident's representative. Interview on 04/24/19 at 7:37 A.M. with the Administrator revealed the facility was not providing residents and their representatives written notice of transfer to the hospital. Further interview with the Administrator revealed the facility also had no policy to provide written notice of transfer to the hospital. Review of the Ohio and Federal Nursing home Residents' [NAME] of Rights hand book dated 02/01/18 (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: 365685 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 365685 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE O'Neill Healthcare North Ridgeville 38600 Center Ridge Rd North Ridgeville, OH 44039 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)