Inspection·July 30, 2024

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interviews, and the Centers for Medicare & Medicaid Services (CMS) website, the facility failed to allow Resident #95 to return to the facility after being sent out to the hospital. This affected one resident (#95) out of three residents reviewed for discharge. The facility census was 94. Findings include: Review of the closed medical record for Resident #95 revealed an admission date 06/20/24 and a discharge date of 07/17/24. Diagnoses included displaced fracture of medial condyle of left femur, delusional disorders, unspecified disorder due to known physiological condition, unspecified mental disorder due to known physiological condition, and bipolar disorder. Review of the discharge return not anticipated Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #95 was cognitively intact. The resident required set up or clean up assistance for eating and oral hygiene; supervision or touch assistance for upper body dressing and personal hygiene; and was dependent on staff for toileting, shower/bathe self, lower body dressing, and putting on and taking off footwear. For mobility, the resident required partial/moderate assistance for sitting to lying and lying to sitting and was dependent on staff for chair/bed to chair transfer and tub/shower transfer. Review of the progress note dated 07/17/24 and time stamped at 12:55 P.M. for Resident #95 revealed on 07/17/24 with physician at bedside, the resident requested to go to the hospital and be evaluated because she felt the physician was an [expletive] idiot and had the worst cramps of her life. The resident stated she didn't wish to return to the facility at that time. Resident Rights were reviewed with the resident, and she was assured that the choice of placement was her right. Review of the late entry progress noted dated 07/18/24 and time stamped at 2:30 A.M. revealed Resident #95 was returning via stretcher from hospital. Transportation staff stated the resident did not get admitted to the hospital and it was our responsibility to still 'house' the resident. Resident #95 stated she had no idea she was not allowed to return to the facility. The Director of Nurse (DON) was called and confirmed Resident #95 was not to return. The transportation staff left the facility with the resident and stated the facility would be hearing from the hospital and from their transportation company. Interview on 07/30/24 at 10:47 A.M. and 3:46 P.M. with Ombudsman # 500 revealed Resident #95 called the Ombudsman's office on Friday, 07/19/24, from the hospital emergency room stating on Wednesday, 07/17/24, she had been sent out to the hospital for constipation. The ambulance brought her back to (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 2 Event ID: 366113 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 366113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Liberty Health Care Center Inc 1355 Churchill Hubbard Rd Youngstown, OH 44505 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)