Health inspection·November 4, 2024

F 0624 Prepare residents for a safe transfer or discharge from the nursing home. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure Resident #115's guardian was informed and gave consent for Resident #115 to be discharged from the facility. This affected one resident ( Resident # 115) of the three residents reviewed for discharge. The facility census was 114. Residents Affected - Few Findings include: Review of the medical record revealed Resident #115 was admitted to the facility on [DATE] and discharged from the facility on 08/12/24. Guardian #392 was listed as the responsible party guardian and emergency contact #1. Resident #115's mother was the emergency contact #2. Medical diagnoses included pulmonary edema, Asperger's syndrome, diabetes, bipolar, hypertension, glaucoma, dependence on renal dialysis, depression, and anemia. Review of the Minimum Data Set ( MDS) 3.0 Discharge Return Not Anticipated assessment dated [DATE] revealed discharge was unplanned to home. Resident #115 had moderate impairment for decision making. Resident #115 displayed physical behaviors. Resident #115 needed set up for eating. Maximum assistance was needed for oral hygiene. Moderate assistance was needed for toilet hygiene, bathing and dressing. Resident #115 needed moderate assistance to roll left and right in bed, sit on the side of the bed, lie back in bed , stand and transfer from bed. Moderate assistance was needed to walk ten feet. Resident #115 received hemodialysis. Review of the Health Status Note dated 08/12/24 at 2:41 P.M. written by Licensed Practical Nurse (LPN) #344 , revealed Resident #115's mother stated she wanted to take Resident #115 home. The physician was notified. This note stated Residents guardian [NAME] was also notified of residents discharge from the facility. Review of the document titled Probate Court of Ashtabula County Letters of Guardianship, dated 08/07/23, revealed Catholic Charities of Ashtabula County shall be appointed Guardian of Resident #115, an incompetent and the duties of the Guardian shall be discharged by the appointed agent Guardian #392. As Guardian, powers were person only for an indefinite time period. The document was signed by the Probate Judge. Review of medical record Discharge summary dated [DATE] revealed Resident #115 was discharged from the facility to home and Resident #115's mother signed the Discharge Summary along with LPN #344. Interview with Healthcare Compliance Investigator( HCI) #391 on 11/04/24 at 8:34 A.M. revealed the facility allowed Resident #115 and his mother to sign themselves out because of behaviors Resident #115 was displaying. The legal guardian was not notified until after Resident #115 was discharged Page 1 of 2 365741 365741 11/04/2024 Ashtabula County Nursing Home 5740 Dibble Road Kingsville, OH 44048

F 0624 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few from the facility. This was not a planned discharge. The guardian wanted Resident #115 to remain in the facility. HCI #391 also stated the mother missed some health appointments while Resident #115 was home. Interview on 11/04/24 at 12:20 P.M. with Social Service Director ( SSD) #375 revealed Resident #115's discharge was considered an impromptu discharge. SSD #375 verified the facility did not have the legal guardianship paperwork in the medical record so they were not aware of it. SSD #375 stated during the next care conference social work would bring up no guardianship paperwork was in the chart. SSD #375 also stated the social worker did not set up skilled care for home because Resident #115's mom was to be the caregiver. Interview on 11/04/24 at 12:30 P.M. with Unit Manager Licensed Practical Nurse ( LPN) #344 revealed she called the physician to notify the physician of Resident #115's request to leave the facility. LPN #344 stated she did not call the guardian because there was no paperwork in the chart during Resident #115's discharge. LPN #344 stated she called the guardian when Resident #115 left. LPN #344 stated Resident #115 did not make safe decisions. LPN #344 stated the facility still discharged the resident despite the guardian not approving of the discharge. Interview on 11/04/24 at 12:40 P.M. with the Director of Nursing ( DON) revealed a text message was sent on 08/12/24 at 12:05 P.M. to physician regarding Resident #115 wanting a discharge home. The DON was unable to provide a text message to the guardian and could not verifying the guardian was notified by text or phone call on 08/12/24. The DON stated Resident #115 created an uproar with staff in the facility. Interview with Guardian #392 on 11/04/24 at 1:22 P.M. revealed she did speak with the nurse staff on Saturday 08/10/24 regarding Resident #115's behaviors and Resident #115 wanted to be discharged . Guardian #392 told the facility she did not agree with Resident #115's discharge to home. Guardian #392 stated she was notified on 08/12/24 during an unannounced visit at 2:00 P.M. to the facility to check on Resident #115. Guardian #392 stated she did not sign in because this was an unannounced visit. Guardian #392 stated the facility did not notify her prior to Resident #115's discharge and the guardian paper work should have been sent in with the hospital paperwork on admission. The Guardian #392 stated the facility did not call her on 08/12/24 prior to Resident #115 discharge because she had no missed calls or voice messages from the facility. Guardian #392 stated the facility did not prepare Resident #115 for a safe discharge. The Guardian stated Resident #115 had been placed at another facility and passed away in October 2024 due to complications from COVID-19 related pneumonia. Review of the facility policy titled, Notice of Transfer and/or Discharge, dated April 2011, revealed a resident or representative sponsor would be given 30 days notice of impending transfer or discharge from a facility except if the transfer was necessary for the resident welfare and the resident needs could not be met in the facility. Consent of Notice: the resident or representative sponsor would be provided the following information, the reason for discharge, the effective date, the location. This deficiency represents non-compliance investigated under Complaint Number OH00159196 365741 Page 2 of 2