Health inspection·November 22, 2023

F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Let each resident or the resident's legal representative access or purchase copies of all the resident's records. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure Resident #80's family members were provided the proper procedure and documents necessary to access the resident's medical records from the facility. This finding affected one (Resident #80) of three residents reviewed for medical records. Findings include: Review of Resident #80's medical record revealed the resident was initially admitted don 01/05/23, readmitted on [DATE] and discharged on 04/25/23 with diagnoses including malignant neoplasm of the rectum with a colostomy. Review of Resident #80's medical record revealed the record listed the resident was the guarantor, one daughter as the power-of-attorney (POA) and emergency contact number one and another daughter as emergency contact number two. Review of Resident #80's Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited intact cognition. Interview on 11/20/23 at 11:20 A.M. with Business Office Manager (BOM) #820 indicated Resident #80's daughter called to request a copy of the medical record and she was unsure of the date. BOM #820 indicated she told the family the record was part of the estate and they would have to talk to their attorney. BOM #820 did not provide Resident #80's POA/family with any necessary documents and resources to request the medical records from the facility. Telephone Interview on 11/20/23 at 12:24 P.M. with Corporate #822 with the BOM present indicated a family member may request a copy of the medical records if they fill out the facility Request for Medical Records form as well as a Next of Kin Affidavit. Corporate #822 stated if the facility had both of those documents, then the facility would provide the information requested from the family. Telephone interview on 11/20/23 at 12:39 P.M. with Resident #80's daughter confirmed she requested a copy of the medical record on 10/16/23 from BOM #820 and she was told that she needed to contact an attorney as the medical record was now part of the estate. Resident #80's daughter confirmed the facility did not provide the resources and information needed to appropriately request the resident's medical records from the facility. Review of the Medical Records Requests Policy revised 12/18/17 indicated the clinical record was the property of each facility. The information contained in the clinical record belonged to the (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 8 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 11/22/2023 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)