Health inspection·February 17, 2023

F 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Allow resident to participate in the development and implementation of his or her person-centered plan of care. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and review of the facility policy, the facility failed to hold routine interdisciplinary team (IDT) care conferences for the residents. This affected four (Residents #1, #15, #16, and #32) of four residents reviewed for care conferences. The facility census was 50. Findings include: 1. Review of the medical record for Resident #16 revealed an admission date of 03/25/22. Diagnoses included metabolic encephalopathy, chronic obstructive pulmonary disease, diabetes mellitus type II, depressive disorder, anxiety disorder, insomnia, paranoid personality disorder, atherosclerotic heart disease, adult failure to thrive, convulsions, colostomy status, hemorrhagic condition, hypertension, mild cognitive impairment, and hallucinations. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #16 had intact cognition. Resident #16 required supervision setup help only for bed mobility, transfers, and toilet use. Review of the interdisciplinary team (IDT) Plan of Care Review Summaries from 01/01/22 to 02/15/23 revealed there was only one care conference held on 01/20/23 during the 13 months time period reviewed. There was no documentation if Resident #16 was invited to attend the care conference nor if the resident did or did not attend the care conference that was held on 01/20/23. Interview on 02/15/23 at 10:12 A.M. with Social Services (SS) #136 verified there was only one care conference held in 13 months for Resident #16. SS #136 verified there was no evidence if Resident #16 was invited to attend the care conference held on 01/20/23 and if the resident did or did not attend the care conference. SS #136 stated she had been working at the facility since December 2022 and trying to get everything caught up. She stated the residents were invited to the care conferences unless families requested the resident not be invited. She verified the facility was not able to provide documentation for additional quarterly care conferences for Resident #16. 2. Review of the medical record for Resident #15 revealed an admission date of 11/18/21. Diagnoses included atherosclerotic heart disease, heart failure, chronic kidney disease, schizoaffective disorder, bipolar type, borderline personality disorder, major depressive disorder, anxiety disorder, gastro-esophageal reflux disease, low back pain, low back pain, irritable bowel syndrome, conversion disorder, dysphagia, and constipation. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #15 had (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: 366303 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 366303 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highbanks Care Center 111 Lazelle Road East Columbus, OH 43235 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)