Health inspection·December 3, 2024

F 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to timely notify the hospice provider of Resident #62's change in condition, resulting in an unwanted transfer to the Emergency Department (ED). This affected one resident (Resident #62) of three residents reviewed for falls. The facility census was 61. Findings include: Review of the medical record for Resident #62 revealed an admission date of 08/07/19 and a discharge date of 11/11/24. Diagnoses included Alzheimer's disease, muscle weakness, altered mental status, hypertension, and congestive heart failure. Review of the comprehensive Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #62 was severely cognitively impaired. She required supervision for eating, partial to moderate assistance for oral and personal hygiene, substantial to maximum assistance for toileting, dressing, and was dependent for showering. She received hospice services. Review of the nurses' note dated 10/01/24 at 12:53 P.M. revealed Resident #62 was admitted to hospice services. The hospice nurse asked the facility to call hospice anytime the resident had a fall. Review of the nurse's note dated 11/01/24 at 11:15 P.M. revealed Resident #62 was found sitting on the floor just outside her bedroom door. She was assessed for injuries with none found at the time. She was assisted back to her wheelchair and returned to her bed. Resident #62's daughter and physician were notified within approximately 15 minutes of the fall. Review of the nurse's note dated 11/02/24 2:15 A.M. revealed Resident #62 was up in her wheelchair at the nurse's station when she began crying. Resident #62 reported having pain in her left hip. The physician was notified and ordered a transfer to the ED at 2:25 A.M. Resident #62's daughter was notified of the transfer to the ED on 11/02/24 at 3:02 A.M. and hospice was notified of the fall, change on condition, and transfer to the ED on 11/02/24 at 8:10 A.M. Resident #62 was admitted to the hospital for a left hip fracture. Review of the physician's orders for November 2024 revealed the family did not want Resident #62 sent to the ED for any reason, which began on 11/02/24. Interview on 12/03/24 at 1:11 P.M. with the Director of Nursing (DON) confirmed hospice was not notified of the fall or change in condition for Resident #62 in a timely manner. Page 1 of 2 366329 366329 12/03/2024 Hampton Woods Nursing Center, Inc 1525 East Western Reserve Road Poland, OH 44514

F 0849 Level of Harm - Minimal harm or potential for actual harm Interview on 12/03/24 at 1:23 P.M. with Hospice Executive Director #206 confirmed they should be notified immediately if a residents' needs changed, or a fall occurred. This deficiency represents noncompliance investigated under Master Complaint Number OH00159686. Residents Affected - Few 366329 Page 2 of 2