Health inspection·June 18, 2025

F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and review of facility transfer notices, the facility failed to ensure appropriate transfer/discharge notifications were made to the state Ombudsman office. This affected three residents (#16, #22 and #23) of three resident records reviewed for discharge. The census was 18. Findings include: 1. Review of Resident #16's medical record revealed he was admitted to the facility on [DATE]. Diagnoses included hydrocephalus, Alzheimer's disease with early onset, depression, dysarthria, and anarthria. Review of Resident #16's admission 5-day Minimum Data Set (MDS) assessment dated [DATE] revealed his cognition was moderately impaired. He required supervision or touching assistance for eating and partial/moderate assistance for oral hygiene, toileting, shower/bathing, dressing and personal hygiene. Review of Resident #16's physicians orders revealed an order to discharge the resident home with Physical Therapy, Occupational Therapy, Speech Therapy, a home health aide and nursing services with current medications on 01/13/25. Review of the progress notes revealed on 01/13/25 at 1:10 P.M., Resident #16 was discharged from the facility via a family car accompanied by his sister. Review of facility documentation, transfer notices, and the residents medical record revealed there was no documented evidence that the Office of the State Long Term Care (LTC) Ombudsman was aware/notified of Resident #16's transfer/discharge. Interview on 06/18/25 at 11:09 A.M. with the Director of Nursing verified the Ombudsman was not notified of Resident #16's discharge. 2. Review of Resident #22's medical record revealed he was admitted to the facility on [DATE]. Diagnoses included acute respiratory failure, bacterial pneumonia, anxiety, dementia, stage three chronic kidney disease, and atrial fibrillation. Review of Resident #22's admission 5-day Minimum Data Set (MDS) assessment dated [DATE] revealed his cognition was not intact. He required supervision or touching assistance for eating, oral hygiene and personal hygiene and substantial/maximal assistance for toileting and shower/bathing. (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 6 Event ID: 366411 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 366411 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Robert A Barnes Center 2225 Taylor Park Drive Reynoldsburg, OH 43068 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)