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F0582
D

Incomplete Advance Beneficiary Notices Provided to Residents

Delaware, Ohio Survey Completed on 05-28-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide complete and accurate information on the Skilled Nursing Facility Advance Beneficiary Notice (ABN) forms for two residents. For one resident with multiple diagnoses including dementia, chronic kidney disease, and pressure ulcer, the ABN form was missing the required 'beginning on' date, which is necessary to inform the resident when they may become financially responsible for services. This omission was confirmed by the social worker during an interview. For another resident with diagnoses such as hypertension, COPD, vascular dementia, and dysphagia, the ABN form was also missing the 'beginning on' date and did not include the estimated cost per day or per service. The social worker confirmed these omissions during an interview. Review of the facility's policy indicated that the ABN should be fully completed to inform Medicare beneficiaries of their potential liability, but this was not followed in these cases.

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