Inspection·May 15, 2025

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined the facility failed to ensure that the discharge process honored the resident's preferences and goals and failed to demonstrate that the discharge was appropriate and necessary, for one of six sampled residents (Resident 1). Findings include: Clinical record review revealed the resident was admitted to the facility on [DATE] with diagnosis to include, Wernicke's Encephalopathy (an acute inflammatory hemorrhagic encephalopathy caused by thiamine deficiency, often associated with chronic alcoholism or malnutrition, characterized by loss of muscle coordination, visual disturbances such as diplopia, and confusion), alcohol-induced psychotic disorder, alcoholic cirrhosis of the liver without ascites, and nicotine dependence. Documentation indicated the resident was cognitively intact. While it was noted that the resident had a legal guardian, the facility was unable to produce documentation confirming guardianship status during the survey. A review of a social services note dated May 6, 2025, at 5:49 P.M. revealed, I allowed time for Resident 1 to vent his feelings related to his admission. The resident voiced his desire to move to a different facility located in a neighboring city. The social worker documented that she would contact the guardian the following day to discuss the resident's wishes. A review of a social services note dated May 8, 2025, at 11:14 A.M. revealed, Social Services received a visit from Resident 1's Guardian today. This worker informed the Guardian that the resident would like to move to a facility in a local city. The guardian gave permission for the resident's records to be sent to two local skilled nursing facilities. However, a social services note dated May 15, 2025, at 8:14 A.M., indicated the resident was being transferred to a facility located several hours away from the current facility, contradicting the resident's stated desire to remain in a local setting. A nurses note dated May 15, 2025, at 9:39 A.M. revealed the resident was discharged from the facility to facility identified as located several hours distance away. During an interview conducted on May 15, 2025, at 2:00 P.M., the facility social services worker stated that Resident 1 had clearly expressed his desire to be transferred to a local skilled nursing facility that permitted smoking. The social worker could not explain why the discharge did not align with the resident's expressed preferences, nor was there documentation justifying why an 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: 395984 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 395984 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Creekside 45 North Scott Street Carbondale, PA 18407 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)