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 (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: 366394 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 366394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue Care and Rehabilitation Center, The 4120 Interchange Corporate Center Road Warrensville Heights, OH 44128 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)