Health inspection·April 22, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, family and staff interview, and facility policy review the facility failed to notify the family of a residents change of condition and transfer to local hospital for evaluation and treatment of stroke symptoms. This affected one resident (#44) reviewed for notification of change of condition. The facility census was 48. Findings include: Review of the medical record for Resident #44 revealed a re-admission date of 01/23/24 with a diagnosis of cerebral infarct (stroke). Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed the resident was cognitively intact. Review of the facility form titled HIPAA/PHI Authorization and Consent Form dated 12/23/23 from admission revealed Resident #44 identified his brother as his emergency contact. Review of the nursing progress noted dated 01/13/24 at 3:23 P.M. for Resident #44 revealed the nurse was called to the resident's room and was noted to have right sided facial droop. Resident #44 complained of feeling right sided numbness and tingling. Resident #44 was able to move his right hand some and able to squeeze with both hands. Vital signs for Resident #44 revealed a blood pressure of 171/95 millimeters of mercury (mm/Hg), a pulse of 90 beats per minute, a respiratory rate of 18 breaths per minute, and his oxygen saturation was 95%. The nurse called on-call physician for Resident #44's primary physician and left a message. The nurse then called the emergency number 911 on 01/13/24 at 9:00 A.M. two Emergency Medical Services (EMS) personnel arrived, and Resident #44 was transported to the nearest hospital for evaluation and treatment. Review of the nursing progress notes revealed no documentation of notification of the family or representative for Resident #44 following discharge from the facility for a change in medical condition. Interview on 04/22/24 at 2:15 P.M. with a family member of Resident #44 revealed the facility did not contact any family member regarding the transfer to the hospital for a change of condition. Interview on 04/22/24 at 3:40 P.M. with the Director of Nursing (DON) verified the family for Resident #44 was not notified of change of condition or transfer to hospital for stroke symptoms. Page 1 of 2 366162 366162 04/22/2024 Lutheran Home 1036 South Perry Street Napoleon, OH 43545

F 0580 Level of Harm - Minimal harm or potential for actual harm Review of the facilities policy titled Notification of Residents Condition revised 09/20 revealed the facility will notify POA or representative will be notified by nursing when there is a significant change in the residents physical, mental, or psychological status. This deficiency represents non-compliance investigated under Complaint Number OH00152599. Residents Affected - Few 366162 Page 2 of 2