Health inspection·August 20, 2024

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Based on medical record review, family interview, staff interview, and facility policy review, the facility failed to timely notify all resident representatives/guardians of a temporary discharge. This affected 61 residents (#83, #84, #85, #82, #87, #86, #62, #51, #55, #56, #6, #88, #29, #12, #63, #50, #73, #3, #28, #20, #75, #89, #61, #46, #90, #24, #32, #34, #35, #52, #15, #22, #23, #68, #91, #2, #76, #16, #36, #69, #39, #33, #7, #78, #60, #4, #5, #17, #13, #11, #79, #19, #14, #43, #41, #42, #8, #57, #92, #40, and #9) of 91 residents residing in the facility at the time of the emergency temporary discharge. Findings Include: Interview with Administrator on 07/30/24 at approximately 10:30 A.M. revealed the facility had an emergency which resulted in the temporary evacuation of all residents beginning on 07/22/24 around 12:30 P.M. due to the electricity to the facility being shut off. The Administrator revealed some of the resident family members/representatives were contact during that time, but the facility was not able to contact all family members/representatives until the next day (07/23/24) due to the facility not having electricity and their inability to charge cell phones and computers. The Administrator revealed staff finished contacting resident representatives and family members the next day after the staff went home and charged all their. The Administrator revealed all residents were transferred to safe places by 11:30 P.M. on 07/22/24. Review of facility medical and notification records revealed the following dates and times the facility first contacted residents/representatives regarding the immediate evacuation of the facility: Resident #83 representative was contacted on 07/23/24 at 9:00 A.M., a voicemail message was left. Resident #84 family was contacted on 07/23/24 at 9:15 A.M., was not able to leave a voicemail message. Resident #85 representative was contacted on 07/23/24 at 10:00 A.M., the phone was disconnected. Resident #82 representative was contacted on 07/23/24 at 10:00 A.M., spoke with the representative. Resident #87 representative was contacted on 07/23/24 at 10:30 A.M., phone was disconnected. Resident #86 emergency contact was contacted on 07/23/24 at 11:00 A.M., phone was disconnected, but her friend was called on 07/23/24 at 11:00 A.M. also and spoke with her. Page 1 of 4 366207 366207 08/20/2024 Bella Terrace Rehabilitation and Nursing Center 1520 Hawthorne Avenue Columbus, OH 43203

F 0623 Resident #62 family was contacted on 07/23/24 at 11:30 A.M., a voicemail message was left. Level of Harm - Minimal harm or potential for actual harm Resident #51 family was contacted on 07/23/24 at 2:00 P.M., spoke with the family member. Resident #55 family was contacted on 07/23/24 at 2:10 P.M., spoke with the family member. Residents Affected - Some Resident #56 emergency contact was contacted on 07/23/24 at 2:20 P.M., spoke with the contact. Resident #6 family was contacted on 07/23/24 at 4:15 P.M., spoke with family member. Resident #88 family was contacted on 07/23/24 at 2:40 P.M., spoke with family member. Resident #29 family was contacted on 07/23/24 at 11:30 A.M., spoke with family member. Resident #12 representative was contacted on 07/23/24 at 2:00 P.M., spoke with representative. Resident #63 family was contacted on 07/23/24 at 2:20 P.M., spoke with family. Resident #50 family was contacted on 07/23/24 at 2:10 P.M., spoke with family. Resident #73 representative was contacted on 07/23/24 (unknown time), phone was disconnected. Resident #3 family was contacted on 07/23/24 at 2:30 P.M., spoke with family. Resident #28 family was contacted on 07/23/24 at 2:45 P.M., a voicemail message was left. Resident #20 family was contacted on 07/23/24 at 9:00 A.M., spoke with family member. Resident #75 emergency contact was contacted on 07/23/24 (unknown time), the person who answered said it was the wrong number. Resident #89 emergency contact was contacted on 07/23/24 at 12:30 P.M., could not leave a voicemail message. Resident #61 family was contacted on 07/23/24 at 12:00 P.M., spoke with family member. Resident #46 family was contacted on 07/23/24 at 1:45 P.M., spoke with family member. Resident #90 family was contacted on 07/23/24 at 11:345 A.M., a voicemail message was left. Resident #24 representative was contacted on 07/23/24 at 9:15 A.M., a voicemail message was left. Resident #32 family was contacted on 07/23/24 at 4:00 P.M., a voicemail message was left. Resident #34 family was contacted on 07/23/24 at 11:30 A.M., spoke with family member. Resident #35 representative was contacted on 07/23/24 at 11:45 A.M., a voicemail message was left. Resident #52 family was contacted on 07/23/24 at 1:00 P.M., spoke with family member. 366207 Page 2 of 4 366207 08/20/2024 Bella Terrace Rehabilitation and Nursing Center 1520 Hawthorne Avenue Columbus, OH 43203

F 0623 Resident #15 representative was contacted on 07/23/24 at 3:30 P.M., spoke with representative. Level of Harm - Minimal harm or potential for actual harm Resident #22 representative was contacted on 07/23/24 at 3:45 P.M., spoke with representative. Resident #23 representative was contacted on 07/23/24 at 3:00 P.M., spoke with representative. Residents Affected - Some Resident #68 guardian was contacted on 07/23/24 at 3:15 P.M., spoke with guardian. Resident #91 guardian was contacted on 07/23/24 at 1:00 P.M., spoke with guardian. Resident #2 representative was contacted on 07/23/24 at 1:15 P.M., spoke with representative. Resident #76 family was contacted on 07/23/24 at 1:30 P.M., spoke with family member. Resident #16 representative was contacted on 07/23/24 at 1:45 P.M., spoke with representative. Resident #36 family was contacted on 07/23/24 at 2:45 P.M., spoke with family member. Resident #69 family was contacted on 07/23/24 at 3:00 P.M., spoke with family member. Resident #39 representative was contacted on 07/23/24 at 3:15 P.M., spoke with representative. Resident #33 family was contacted on 07/23/24 at 3:30 P.M., spoke to family member. Resident #7 representative was contacted on 07/23/24 at 10:30 A.M., spoke with representative. Resident #78 representative was contacted on 07/23/24 at 10:50 A.M., spoke with representative. Resident #60 representative was contacted on 07/23/24 (unknown time), spoke with representative. Resident #4 family was contacted on 07/23/24 at 3:48 P.M., unknown if spoke to family member. Resident #5 representative was contacted on 07/23/24 at 3:49 P.M., unknown if spoke to representative. Resident #17 representative was contacted on 07/23/24 at 3:50 P.M., unknown if spoke to representative. Resident #13 family was contacted on 07/23/24 at 4:12 P.M., unknown if spoke to family member. Resident #11 family was contacted on 07/23/24 at 3:53 P.M., unknown if spoke to family member. Resident #79 family was contacted on 07/23/24 at 4:17 P.M., a voicemail message was left. Resident #19 representative was contacted on 07/23/24 at 4:29 P.M., a voicemail message was left. Resident #14 representative was contacted on 07/23/24 at 4:26 P.M., a voicemail message was left. Resident #43 family was contacted on 07/23/24 at 4:43 P.M., unknown if spoke to family member. 366207 Page 3 of 4 366207 08/20/2024 Bella Terrace Rehabilitation and Nursing Center 1520 Hawthorne Avenue Columbus, OH 43203

F 0623 Resident #41 family was contacted on 07/23/24 at 4:48 P.M., unknown if spoke to family member. Level of Harm - Minimal harm or potential for actual harm Resident #42 family was contacted on 07/23/24 at 4:46 P.M., a voicemail message was left. Resident #8 representative was contacted on 07/23/24 at 4:25 P.M., unknown if spoke to representative. Residents Affected - Some Resident #57 representative was contacted on 07/23/24 at 4:30 P.M., unknown if spoke to representative. Resident #92 representative was contacted on 07/23/24 at 4:20 P.M., unknown if spoke to representative. Resident #40 representative was contacted on 07/23/24 at 4:31 P.M., a voicemail message was left. Resident #9 family was contacted on 07/23/24 at 4:52 P.M., unknown if spoke to family member. Interview with Regional Director of Operations #107 on 08/19/24 at 3:45 P.M. revealed the facility had the capability of sending a message to all family members/representatives at one time, similar to what would be used if they had a positive COVID-19 case in the building when they were required to notify all parties about that case. Review of facility Emergency Procedure-Immediate Evacuation policy, dated January 2011, revealed no documentation regarding the processes of notifying family/representatives if the residents have to be evacuated. Review of facility Change in a Resident's Condition or Status policy, dated May 2017, revealed the facility shall promptly notify the resident, his or her attending physician, and representative (sponsor) of changes in the resident's medical/mental condition and/or status. Unless otherwise instructed by the resident, a nurse will notify the resident's representative when a decision has been made to discharge the resident from the facility. The nurse will record in the resident's medical record information relative to changes in the resident's medical/mental condition or status. This deficiency represents non-compliance investigated under Complaint Number OH00156156. 366207 Page 4 of 4