Health inspection·May 15, 2025

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the facility policy, the facility failed to ensure Resident #63's comprehensive care plan was revised regarding her desire to live in the community and failed to assist Resident #63 with her discharge planning. This affected one resident (#63) out of three residents reviewed for discharge planning. The facility census was 62. Findings include: Review of the closed medical record for Resident #63 revealed an admission date of 12/31/24 with diagnoses including multiple sclerosis (MS), diabetes, anxiety disorder, bipolar disorder, schizoaffective disorder and major depression. Review of the care plan dated 12/31/24 revealed Resident #63's discharge planning was long-term placement. The care plan revealed Resident #63 stated she would stay at the facility, for now. Interventions included allowing resident choices, assessing resident's understanding and ability in safety during transfers, mobility, and activities of daily living, and offering opportunity to verbalize feelings related to placement. Review of the nursing note dated 12/31/24 at 2:41 P.M. and completed by Social Service Designee (SSD) #604 revealed she met with Resident #63, and she stated her plan was to stay at the facility, for now. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #63 was cognitively intact and had no behaviors. Review of the nursing note dated 03/27/25 at 11:51 A.M. and completed by Former Administrator #605 revealed Former Administrator #605 and Former Director of Nursing (DON) #608 met with Resident #63 as she returned from the hospital emergency department today, 03/27/25. Resident #63 reported that she wanted to leave the facility and get an apartment. She reported she planned to contact an apartment complex to see if she could move there. Resident #63 revealed she had been previously evicted from the apartment complex as she owed the complex money and had a melt down while living at the complex. Resident #63 revealed she was hopeful the apartment complex would reconsider. The note revealed she was offered assistance with discharge and/or transfer, but Resident #63 declined stating she did not want to go to another facility. There were no other nursing notes regarding follow up with Resident #63 regarding her request to leave the facility and/or discharge planning. Review of the nursing note dated 04/07/25 at 8:00 A.M. completed by Registered Nurse (RN) #607 Page 1 of 2 366326 366326 05/15/2025 Geneva Center for Rehabilitation and Nursing 1140 South Broadway Geneva, OH 44041

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few revealed Resident #63 signed herself out and placed her mother as her responsible party with her mother's phone number and included she anticipated returning at 4:00 P.M. and was dressed appropriately for the weather. Review of the nursing note dated 04/07/25 at 10:10 A.M. completed by RN #607 revealed Resident #63 left at this time. Review of the nursing note dated 04/07/25 at 8:58 P.M. completed by RN #613 revealed Resident #63 called the facility and stated, have them get my stuff, I will be there tomorrow and before the nurse could ask any questions she hung up. Review of the nursing note dated 04/08/25 at 1:06 P.M. completed by Former Administrator #605 revealed she received a call from Facility Driver #606 who reported she located Resident #63, but Resident #63 refused to return to the facility as Resident #63 stated she rather be homeless than be in a facility. Facility Driver #606 asked Resident #63 if she would sign an against medical device (AMA) form, and Resident #63 stated she would not sign any papers for the facility. Interview on 05/13/25 at 9:47 A.M. with SSD #604 revealed when Resident #63 first moved in she stated she was fine with living at the facility as indicated in the care plan. She revealed Resident #63 then expressed a desire to live in the community and not at the facility. She revealed Resident #63 had expressed an interest in moving to an apartment complex, but she had been evicted previously as she owed the complex money. She offered to send referrals to other facilities, but Resident #63 did not want to live in another facility. She verified she had not discussed other community options, and Resident #63's care plan was not revised indicating her request to not live at the facility and/or interventions regarding her interest in returning to the community. Interview on 05/14/25 at 10:42 A.M. and 11:21 A.M. with Resident #63's mother (Power of Attorney of Healthcare) revealed Resident #63 had expressed an interest not to live at a facility as she wanted to live in the community. Resident #63's mother felt the facility did not assist her daughter in finding any community options and/or offer any interventions to work towards a discharge according to Resident #63's preference. She felt Resident #63 had no other option but to just leave the facility. Review of the facility policy labeled, Comprehensive Person- Centered Care Planning Policy and Procedure, dated 2025, revealed the facility would provide each resident with the right to a dignified existence, self- determination, and access to persons and services. The policy revealed in consultation with the resident and resident's representative regarding the resident's preference and potential for future discharge, the facility would document whether the resident desired to return to the community and any referrals to local contact agencies and/or appropriate entities. The policy revealed discharge plans were to be in the comprehensive care plan as appropriate. The policy revealed the facility would develop and implement an effective discharge planning process that focused on resident's discharge goals, and the preparation of effective transition to post discharge care. The care plan revealed if the resident indicated an interest in returning to the community the facility must document any referrals to local contact agencies or other appropriate entities. The facility would update the care plan in response to information received from referrals and if the discharge to the community was determined to not be feasible then the facility must document who made that determination and why. This deficiency represents non-compliance investigated under Complaint Number OH00165526. 366326 Page 2 of 2