Health inspection·September 7, 2023

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, hospital record review, review of the facility assessment, review of facility policy and interviews with facility and hospital staff, the facility failed to ensure Resident #82 was allowed to return to the facility following a hospitalization for a psychiatric evaluation. This affected one resident (#82) of three residents reviewed for transfer/discharge. The facility census was 82. Findings include: Review of the medical record for Resident #82 revealed an admission date of 06/09/23 and diagnoses including schizophrenia, chronic obstructive pulmonary disease, type two diabetes, and cirrhosis of the liver. Resident #82 was his own responsible party and was discharged to the hospital on [DATE] for a psychological evaluation after displaying aggressive behaviors towards staff on 08/22/23. Resident #82's payer source was Medicaid. Review of Resident #82's admission Minimum Data Set (MDS) 3.0 assessment, dated 06/22/23, revealed Resident #82 had intact cognition. The assessment revealed the resident had no delirium, inattention, no disorganized thinking, no delusions, no verbal or physical symptoms towards others and overall, no behavioral symptoms. The resident was independent for bed mobility, transfers, dressing, and personal hygiene. Review of a social service note dated 08/07/23 revealed Resident #82 had a planned discharge date of 09/12/23 to an assisted living facility. Review of progress notes dated 08/13/23 to 08/22/23 revealed Resident #82 was engaging in unsafe behaviors of giving residents on pureed diets hard food on multiple occasions despite redirection by staff, was being verbally abusive towards staff on several occasions and smoking from a pipe on the premises despite it being a non-smoking facility. On 08/21/23 the Director of Social Services (DSS) took notice of immediate discharge to Resident #82's room. Resident #82 slammed the door on the DSS's arm, took the notice, balled it up and threw it in the trash. Review of the facility document titled The Avenue Care and Rehab Discharge Notice dated 08/21/23 revealed the facility issued Resident #82 an emergency discharge notice on 8/21/23 due to the safety of individuals in the home was endangered and engaging in illegal activity. The notice indicated the name and address of another facility to discharge Resident #82. This address/facility was a different facility than the assisted living location he was planned to discharge to on 09/12/23. Review of a progress note dated 08/22/23 at 6:50 P.M. revealed Resident #82 became aggressive with Page 1 of 2 366394 366394 09/07/2023 Avenue Care and Rehabilitation Center, The 4120 Interchange Corporate Center Road Warrensville Heights, OH 44128

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few staff and towards other residents. The nurse practitioner was present, and a new order was written to send Resident #82 to the hospital for a psychiatric evaluation. Review of the hospital document titled Careport Printable Review Referral, dated 08/24/23 and authored by the hospital's Licensed Social Worker (LSW) #729 revealed Resident #82 had been diagnosed with dementia with behavioral disturbance and the hospital notified the facility Resident #82 would be discharged back to the facility on [DATE]. Further review of the facility records for Resident #82 showed no evidence the facility staff collaborated with the hospital to fully evaluate Resident #82's status throughout the hospitalization to determine if he could return to the facility. Interview on 09/06/23 at 8:15 A.M. with the hospital LSW #729 revealed Resident #82 was admitted to the hospital for a psychological evaluation. On 08/24/23 Resident #82 was assessed by social services and psychiatry and was determined not to be a threat to self or anyone else. Resident #82 was approved for discharge back to the facility on [DATE], and the facility was refusing to take him back saying they had initially discharged him on 08/21/22 from the facility. Interview with the Administrator on 09/06/23 at 10:03 A.M. verified an immediate discharge notice was given to Resident #82 on 08/21/23. The Administrator explained the immediate discharge notice was issued after a white powdery substance suspected to be illegal drugs was found in Resident #82's room at the bedside and Resident #82 was a harm to other residents. Resident #82 refused to sign the discharge notice and on 08/22/23 was sent to the hospital for a psychiatric evaluation due to behaviors. Interview on 09/06/23 at 10:53 A.M. with the Administrator verified the facility did not intend to readmit Resident #82, and verified the hospital had sent notice to the facility Resident #82 was cleared from the hospital to discharge back to the facility on [DATE]. Review of the Facility Assessment, dated 08/29/23, revealed the facility did provide care and services for residents with psychiatric/mood disorders including schizophrenia and behaviors requiring intervention. The facility also provided care for neurological disorders including dementia. All referrals for care are reviewed by the clinical team to determine if the facility has ability to provide services. Services provided are further identified in the section labeled Specific Care or Practices. General description of care includes manage the medical conditions issues causing psychiatric symptoms and behavior, identify and implement interventions to help support individuals with issues such as other psychiatric diagnosis . Other special care needs provided for behavioral health needs include psychiatrist and or psychologist services. Review of the facility policy titled Admission, Transfer, Discharge, date revised 11/2022, indicated the facility would maintain a standard of ethical behavior that focused on the relationship between the organization and other healthcare facilities. The facility would provide for safe and appropriate admission, transfer and discharges as needed. This deficiency represents non-compliance investigated under Complaint Number OHOO146050. 366394 Page 2 of 2