Health inspection·April 18, 2023

F 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed medical record review, interview, and policy review, the facility failed to ensure Resident #1's discharge summary included a comprehensive post-discharge plan of care. This affected one resident (Resident #1) of three residents reviewed for discharge. The facility census was 73. Findings include: Review of the closed medical record for Resident #1 revealed an admission date of 11/07/22. Diagnoses included cerebral infarction, chronic obstructive pulmonary disease, acute respiratory failure, depressive episodes, anxiety, muscle weakness, and neuromuscular dysfunction of the bladder. The resident was discharged home on [DATE]. Review of the physician orders, dated 11/10/22, revealed an order for oxygen at two liters (L) per nasal cannula. Review of the discharge care plan, dated 11/13/22, revealed the resident's plan was to discharge to home with home health services. Review of the Five-Day Minimum Data Set (MDS) assessment, dated 11/14/22, revealed the resident had intact cognition and received oxygen therapy. Further review of the closed medical record revealed a physician order dated 11/25/22, to discharge Resident #1 to home with home health of choice and physical/occupational/registered nurse/aide services, to continue same medications/treatments, to keep all follow-up appointments and follow-up with the primary care provider in one week. Review of the Discharge summary, dated [DATE], revealed the date of the scheduled first visit with the home health care agency was not documented, the durable medical equipment (DME) provider and contact information was not documented, and the order for oxygen at two liters per nasal cannula was not documented. During interview on 04/17/23 at 3:12 P.M., the Director of Nursing (DON) confirmed Resident #1's Discharge summary, dated [DATE], did not include information regarding the order for oxygen at two liters per nasal cannula, the DME provider or contact information, and did not indicate the start date of home health services, all part of the post-discharge plan of care. Review of facility policy titled, Discharge Planning and Managing Length of Stay, undated, revealed (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 2 Event ID: 366331 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 366331 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sienna Skilled Nursing & Rehabilitation 250 Cadiz Road Wintersville, OH 43953 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)