Health inspection·February 25, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident interview, staff interview and policy review, the facility failed to provide transportation to a scheduled medical appointment. The affected one Resident ( #17), of three residents reviewed for transportation to medical appointments. The facility census was 42. Residents Affected - Few Findings include: Resident #17 was admitted on [DATE] with diagnoses that included acute embolism and thrombosis of femoral vein, acute respiratory failure with hypoxia, Systemic Inflammatory Response Syndrome (SIRS) of non-infectious origin without acute organ dysfunction, pneumonia, sepsis, pressure ulcer of sacral region, atherosclerotic heart disease, chronic kidney disease, lymphedema, neutropenia, metabolic encephalopathy, chondrocalcinosis of left knee, urinary tract infection, tachycardia, dysphagia, altered mental status, and localized edema. Review of quarterly minimum data set (MDS) 3.0 dated 01/23/25 revealed Resident #17 was cognitively intact with a brief interview of mental status score (BIMS) of 13 out of 15. Resident #17 has no impairment of range of motion in upper extremities but had impairment noted in both lower extremities. Resident #17 used a walker for transfers and a wheelchair for mobility. Review of wound care appointment notes indicated resident attended wound clinic at an outside appointment on 12/16/24, 12/23/24, and 12/30/24 for a pressure ulcer on the coccyx. On 12/30/24 the wound physician sent Resident #17 to the emergency room for increased swelling in her legs, general lethargy and feeling unwell. Resident #17 was hospitalized from [DATE] to 01/02/25 and was seen by the wound physician prior to discharge. The resident was then seen in the wound clinic 01/06/25, 01/13/25, 01/20/25 and 01/27/25. Resident #17 was due to be seen 02/02/25 but was hospitalized from [DATE] to 02/05/25 and was seen by the wound physician while an in-patient. The resident missed the appointment on 02/10/25 and was seen 02/17/25 and 02/24/25. Interview on 02/09/25 at 4:30 P.M. with the administrator confirmed the 02/10/25 appointment was missed and stated the van driver was tied up with another outside appointment and couldn't make it back in time. Review of policy Transportation Guidelines last review date 08/31/17 revealed transportation may be provided from the hospital to the campus, to medical appointments by bus or car, for campus outings and various trips. The Transportation Assistant (TA) is required to complete all required training before operating a vehicle. Any campus without a TA position should arrange transports through an outside agency. Then a TA is not doing transports they should assist with life enrichment activities. There should be a master transportation schedule. Contracts with local vendors are also appropriate (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 5 Event ID: 366475 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 366475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Smiths Mill Health Campus 7320 Smiths Mill Road New Albany, OH 43054 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)