Health inspection·March 21, 2024

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, admission packet review, review of facility documents and review of facility policy, the facility failed to ensure a written discharge notice was provided to residents and their representatives for a facility-initiated discharge. This affected one (#1) of three residents reviewed for discharge. The facility census was 80. Findings Include: Review of Resident #1's medical record revealed an admission date of 07/18/23 and a discharge date of 02/24/24. Diagnoses included pleural effusion (fluid around his lungs), Alzheimer's disease, dementia, cough, edema, shortness of breath and altered mental status. Review of Resident #1's Minimum Data Set (MDS) dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of four indicating Resident #1 was severely cognitively impaired. Resident #1 required partial assistance from staff with toilet use, bathing, and dressing. Resident #1 displayed no behaviors at the time of the review. Review of Resident #1's care plan canceled 02/29/24 revealed supports and interventions for dependence on staff for meeting emotional, intellectual, physical and social needs, self-care deficit, impaired cognitive function, risk for pain, and psychosocial wellbeing problem related to ineffective coping and dementia. Review of Resident #1's admission referral packet dated 07/14/23 revealed Resident #1's wife had reported Resident #1 had been confused, aggressive and cussing which was new for Resident #1. There was no indication Resident #1 was a registered sex offender. Review of Resident #1's progress notes revealed on 07/18/23 Resident #1 admitted to the facility. Social Services contacted Resident #1's wife and was informed Resident #1's wife and children had a difficult relationship with Resident #1 and provided some background information on their family life. Resident #1's wife indicated Resident #1 may need long term placement due to worsening disease process. Resident #1's wife reported she had power of attorney. There was no indication documented Resident #1 was a sex offender. On 07/20/23 a care conference was held. There was no information provided to the facility regarding Resident #1 being a sex offender. Further review of Resident #1's medical record found no evidence he was checked prior to admission Page 1 of 2 365898 365898 03/21/2024 Divine Rehabilitation and Nursing at Sylvania 5757 Whiteford Rd Sylvania, OH 43560

F 0623 in the sex offender database. Level of Harm - Minimal harm or potential for actual harm Review of Resident #1's medical record revealed the resident was discharged from the facility on 02/24/24 and was transferred to another facility. Review of Resident #1's Discharge Documentation found no discharge notice was provided for a facility-initiated discharge. Residents Affected - Few Review of the Sex Offender Data base revealed Resident #1 was categorized as a sexual predator and currently resided in the Cleveland area of Ohio. Resident #1 was convicted in the state of Michigan on 03/31/04. Review of the facility's undated form titled, Fast Pass Inquiry Form, revealed the facility would not accept new admissions with active tuberculosis, chest tube, tracheostomy, vent, peritoneal dialysis, pregnant resident, arterial lines, documented harm to self or others, and known sex offender. Interview on 03/20/24 at 10:32 A.M. with Social Services Director (SSD) #239 revealed Resident #1 was admitted to the facility and his sex offender status was not disclosed and the sex offender registry had not been checked prior to admission. SSD #239 verified once his sex offender status was discovered his wife was contacted, notified the facility was not able to have sex offenders, and discharge locations were provided. Resident #1's wife chose for Resident #1 to be transferred to another facility who was able to accept residents who were registered sex offenders. Interview on 03/20/24 at 11:01 A.M. with the Administrator and Director of Nursing (DON) verified the facility did not accept sex offenders into the facility. The Administrator verified once Resident #1's sex offender status was identified Resident #1's wife was notified of the need for transfer and Resident #1 was transferred to a sister facility who was able to take sex offenders. The Administrator stated the facility felt the situation with Resident #1 was an emergency safety risk and Resident #1 was put on one on one supervision until he was transferred to the other facility. The Administrator further verified an emergency or 30 day discharge notice was not provided to Resident #1 or the family. Review of the facility's admission packet revealed the facility would not transfer or discharge a resident from the facility except if the resident's welfare and needs could not be met or the health and safety of the resident, other residents or staff in the facility were endangered. The facility would give a written notice of discharge thirty days prior to then anticipated date of discharge unless the health and safety of the resident or others was endangered in which case notice would be made as soon as practicable. Review of the facility policy titled, Transfer and Discharge (Including AMA), revised February 2023 revealed generally a discharge notice must be provided at least 30 days prior to a facility-initiated transfer or discharge of the resident. Exceptions to the 30-day requirement when the transfer or discharge was effective because the health and/or safety of individuals in the facility would be endangered due to the clinical or behavioral status of the resident. In these exceptional cases the notice must be provided to the resident, resident's representative, and ombudsman as soon as practicable before the transfer or discharge. This deficiency represents non-compliance investigated under Complaint Number OH00151742. 365898 Page 2 of 2