Tuckerman Rehabilitation And Healthcare Center

F 0551

Give the resident's representative the ability to exercise the resident's rights.

Level of Harm - Minimal harm or potential for actual harm

Based on record review and interview, it was determined that the facility failed to honor the wishes of the resident representative and allow the resident to stay at the facility while receiving hospice services. This was evident for 1 (#3) of 2 residents reviewed for discharge. The findings include:An interview with Resident #3's representative (RR) on 10/30/25 at 1:39 PM revealed that they were informed by the Social Services Director (SSD) the facility wanted to discharge the resident because they were unable to provide hospice services at the facility. The RR reported that s/he told facility staff they wanted the resident to stay at the facility and receive hospice care instead of taking the resident home. The RR reported that it was after they appealed the discharge two times, attempted to find another nursing home but were denied because of the wound care, and feeling pressured by facility staff to take the resident home; they finally took the resident home. A medical record review on 10/28/25 at 9:44 AM revealed a progress note dated 6/18/25 written by

the SSD, that documented she tried to issue a Notice of Medicare Non-Coverage (NOMNC) with a discharge date of 6/19/25, but the resident's family did not sign the NOMNC. Further noting, SSD explained again that resident can not be on Hospice at [facility name].On 10/31/25 at 10:30 AM a review of the grievance filed by the RR on 6/9/25 revealed that s/he made the Director of Nursing (DON) aware that they did not want the resident discharged . The family voiced concerns about taking the resident home because

the spouse had dementia. The resolution was to have the family appeal the NOMNC, however this was misleading because Medicare will cover hospice care in a facility, but the family may be required to pay for room and board. On 11/5/25 at 10:30 AM a review of the facility's contract with a hospice provider revealed that the facility had an agreement with them to come to the facility and provide hospice for their residents.

An interview with the SSD on 10/29/2025 11:46 AM confirmed that she had informed the family that the resident could not stay at the facility for hospice care. She was informed during an interdisciplinary team meeting that Resident #3 wasn't participating in rehab and needed to be discharged with hospice care. She reported that the facility provided short-term rehab services, and they discharged resident once they needed hospice care and/or long-term care. The Director of Nursing (DON) was interviewed on 10/29/25 at 12:52 PM and reported that Resident #3 was rapidly declining and failed to participate in rehab and needed hospice care. She reported that they discharge residents when they needed hospice care and/or long-term care. She further reported that the facility was able to provide care for a resident in need of hospice services, but they preferred to discharge them. On 10/29/25 at 12:11 PM an interview with the Nursing Home Administrator (NHA) confirmed that Resident #3 was discharged because of his/her need for hospice care. He stated that they will provide it for a few days until they can discharge the resident to an inpatient hospice or hospice at home. He confirmed that the facility was a dually certified facility, meaning they accepted residents for rehabilitation and long-term care. Cross reference F-F627

Residents Affected - Few

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

Event ID:

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Tuckerman Rehabilitation and Healthcare Center

5550 Tuckerman Lane North Bethesda, MD 20852

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)

F 0605 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

without pulling and biting them, and s/he would stay in bed. When asked if this was chemically restraining

the resident, she stated she had that concern, but thought it was better that the resident could participate in

the community. On 11/4/25 at 12:46 PM the Director of Nursing (DON) reported that she expected staff to monitor residents with routine psychotropics for the behaviors they were given the medication to control.

She stated that when it was an as needed medication then she expected the nurses to document the behaviors they were having to indicate why it was given. She stated the goal was to try nonpharmacological interventions and then administer the as needed medication. She agreed that Alzheimer's was not an appropriate diagnosis for the quetiapine. Reviewed that the resident had an as needed order for lorazepam with no stop date. She agreed that it should have had a stop date of 14 days. Reviewed the concerns. She reported that she would look at the resident's record for behavior monitoring and documentation for the lorazepam and get back to the surveyor. A subsequent interview with the DON on 11/5/25 at 11:01 AM revealed she was unable to provide additional documentation that the resident was adequately monitored for the quetiapine. She reported that she was unable to find the documentation for the lorazepam. She stated she spoke with RN #2, who felt that she had not explained herself well to the surveyor and wrote a statement. However, this was after surveyor intervention. She agreed that the consent stating that all nonpharmacological interventions were exhausted that was signed on admission was not appropriate. The concerns were reviewed with the Nursing Home Administrator on 11/5/25 at 4:03 PM.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Tuckerman Rehabilitation and Healthcare Center

5550 Tuckerman Lane North Bethesda, MD 20852

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)

F 0620

services.

Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Tuckerman Rehabilitation and Healthcare Center

5550 Tuckerman Lane North Bethesda, MD 20852

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)

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

documentation that the facility was unable to meet the needs of the resident and what those needs were. A note written by Nurse Practitioner (NP) #1 on 8/18/25 revealed she wanted palliative care continued until

the resident was transferred to long-term care. Further review of the NP's notes failed to reveal documentation that the facility was unable to provide care for the resident. A note written by the Social Services Director (SSD) on 8/18/25 that Notice of Medicare Non-Coverage (NOMNC) was issued to the family with services ending on 8/20/25. In another note on 8/18/25, SSD documented the attending physician was made aware of the discharge to the community, the resident was going home with continued rehab services, and the family was appealing the NOMNC. Further review revealed that there was no documentation that indicated the resident's needs could not be met at the facility. An interview on 10/30/25 at 12:25 PM with Resident #4's family member revealed they were not aware of the limited services provided by the facility. She stated that she was told that the resident was not participating in rehab so she needed to be discharged to a long-term care facility. She stated that she was trying to get the resident into

a home of their choice but because of the pending Medicaid application she was unsuccessful. On 11/4/25 at 11:26 AM an interview with the attending physician revealed that Resident #4 was not a good candidate for the facility's short-term rehabilitation program. He stated that the staff were not trained to deal with the resident's behaviors due to the advanced stages of dementia. He reported the resident was sent to another facility that had a memory care unit. The findings were discussed with the DON on 11/5/25 at 10:44 AM and

she confirmed the resident was discharged due to the need for a memory care unit. Cross Reference: F-F551 and F-F628

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Tuckerman Rehabilitation and Healthcare Center

5550 Tuckerman Lane North Bethesda, MD 20852

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)

F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.

Based on record review and interview, it was determined that the facility failed to issue a 30-day notice to residents when they planned to discharge them. This was evident for 2 (#3 and #4) of 2 residents reviewed for an inappropriate discharge. The findings include:Notice of Medicare Non-Coverage (NOMNC) is issued to a resident when their Medicare Part A coverage is going to end. Medicare Part A designates a certain number of days it will cover a stay in a nursing home. 1. A medical record review for Resident #3 on 10/28/25 at 9:44 AM revealed the Social Services Director (SSD) wrote on 6/16/25 that she attempted to issue a Notice of Medicare Non-Coverage (NOMNC) with the last date of coverage as 6/18/25 and a discharge date of 6/19/25. She noted the family declined to sign it, and she explained to them that the resident cannot be in hospice care at the facility. (A NOMNC was not required for a resident who was choosing hospice care because these services were covered by Medicare, but the resident's room and board may not be covered). Further review of the medical record failed to reveal that the resident and resident representative were notified in writing the reason for the discharge at least 30 days prior to discharge. During an interview on 10/30/25 at 1:39 PM with Resident #3's representative (RR), s/he reported that the family did not want the resident to be discharged home with hospice services because

they felt it would be hard on the spouse who had dementia. The RR reported they were not issued a 30 day notice to inform them of the discharge and the basis of the discharge. The RR confirmed they had been issued a NOMNC which was confusing because the resident had Medicare days left. An interview with the SSD on 10/29/25 at 11:46 AM revealed she was told during a utilization review meeting to issue the NOMNC because the resident was no longer progressing in rehabilitation services. She stated that the facility discharged their residents when they stopped participating in therapy and needed long term care or hospice services. She confirmed that the resident's family had not initiated the discharge home. She reported that she assisted the family to set up hospice care at home. The SSD confirmed that she had not sent a 30-day discharge notice to the resident and the resident representative. An interview with the Director of Nursing (DON) on 10/29/25 at 12:52 PM revealed the facility discharged the resident because s/he needed hospice services. During an interview with the Nursing Home Administrator on 10/29/25 at 1:31 PM he confirmed that the resident was discharged because of the need for hospice care and they do not provide that service at the facility. Reviewed the concerns with him. 2. A medical record review for Resident #4 on 10/30/25 at 11:40 AM revealed a progress note written by the Social Services Director (SSD) on 8/18/25 that a Notice of Medicare Non-Coverage (NOMNC) was issued to the family with services ending on 8/20/25. In another note on 8/18/25, SSD documented the attending physician was made aware of the discharge to the community, the resident was going home with continued rehab services, and the family was appealing the NOMNC. Further review of the medical record failed to reveal a 30 - day discharge notice was issued to the resident's representative. An interview with the Nursing Home Administrator (NHA) and the Director of Nursing (DON) on 10/31/2025 9:56 AM revealed the resident was discharged because

they determined the resident would benefit from a memory care unit. During an interview with the Social Services Director (SSD) on 10/31/25 at 1:02 PM, she confirmed that she issued a NOMNC to Resident #4's family and not a 30 - day notice of discharge. Concerns were reviewed with the NHA and DON on 11/5/25 at 11:00 AM. Cross Reference: F-F627

Event ID:

Facility ID:

If continuation sheet