Health inspection·July 14, 2023

F 0660 Plan the resident's discharge to meet the resident's goals and needs. 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 #83's discharge was orderly and included accurate medications provided to the resident upon discharge home. This finding affected one (Resident #83) of four residents reviewed for discharges. Residents Affected - Few Findings include: Review of Resident #83's medical record revealed an admission date of 03/28/23 and a discharge date of 04/12/23 with diagnoses including major depressive disorder, muscle weakness and cognitive communication deficit. Review of Resident #83's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed she exhibited severe cognitive impairment. Review of Resident #83's nursing progress note dated 04/12/23 at 11:00 A.M. revealed she was discharged home with the brother and the medications were sent with the resident. The medications were reviewed along with the discharge orders. Review of Resident #85's medical record revealed an admission date of 03/25/23 and a discharge date of 04/20/23 with diagnoses including schizoaffective disorder, bipolar disorder and low back pain. Review of Resident #85's admission MDS 3.0 assessment dated [DATE] revealed he exhibited moderate cognitive impairment. Review of Resident #85's physician orders revealed an order dated 03/25/23 for Gabapentin (for nerve pain) give 200 mg (milligrams) by mouth three times a day for low back pain; an order dated 03/26/23 for Sertraline (Zoloft) 50 mg (antidepressant) give one time a day for bipolar/schizophrenia; and an order dated 04/01/23 for Metformin 500 mg give one tablet two times a day for diabetes. Telephone interview on 07/14/23 at 9:56 A.M. of Resident #83's brother with the Director of Nursing (DON) and Assistant Director of Nursing (ADON) #805 present revealed the resident was discharged home with three of her medication cards and three of Resident #85's medication cards. Resident #83's brother confirmed the resident did not consume any of the medications that belonged to Resident #85. Interview on 07/14/23 at 10:35 A.M. with ADON #805 confirmed Resident #83 was discharged home with three medication cards that belonged to Resident #85 including Gabapentin, Zoloft and Metformin and the brother brought the medications back to the facility. ADON #805 was unclear of how many tablets of Resident #85's Gabapentin, Zoloft and Metformin medications were on the medication cards when (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: 366127 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 366127 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodlands Health and Rehab Center 6831 North Chestnut Street Ravenna, OH 44266 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)