The Oaks-brevard

to participate in experimental research, and to formulate an advance directive.

observation, record reviews and resident and staff interviews, the facility failed to maintain advance

directive (Resident #23).The findings included:Resident #23 was admitted to the facility on [DATE].

An admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #23 was cognitively intact.

During an interview on [DATE] at 10:42 AM, Resident #23 stated he was a Do Not Resuscitate (DNR) and had informed the facility upon admission he had a DNR in place. Resident #23 stated that DNR meant staff would not provide Cardiopulmonary Resuscitation (CPR) if needed.A review of Resident #23's physician orders revealed an order for an advanced directive of DNR dated [DATE].A review of Resident #23's Electronic Medical Record (EMR) revealed the advanced directive banner at the top of Resident #23's EMR page documented DNR as his advance directive.Review of the advance directive notebook kept at the nurse's station revealed there was no advance directive on file for Resident #23.On [DATE] at 2:41 PM, an interview was conducted with Nurse #1, who was assigned to Resident #23 on [DATE].

Nurse #1 explained that if she had needed to immediately determine a resident's advanced directives, she would have looked in the advance directives notebook kept at the nurse's station or in the resident's EMR on the computer.

Nurse #1 indicated the Interim Director of Nursing (DON) was responsible for ensuring the code forms were in the notebook stored at the nurse's station.An observation and interview were conducted with the Interim DON on [DATE] at 2:55 PM.

The Interim DON confirmed she was responsible for ensuring the advanced directives notebook matched the orders in the EMR and for obtaining the provider's signature on the DNR form for residents with DNR orders in the EMR.

After review and observation of the advanced directives binder, the Interim DON confirmed Resident #23 had a DNR order in the EMR and his DNR form was not present in the advanced directives notebook.

She stated the DNR form should have been in the advanced directives binder, but with all the changes at the facility, it had been missed.An interview was conducted with the Administrator on [DATE] at 2:12 PM.

The Administrator stated the code status information in the advanced directives binder and the EMR should have matched. He expected staff to check for code status in the advanced directives binder or in the EMR.

345462 03/05/2026

The Oaks-Brevard 300 Morris Road Brevard, NC 28712

During an interview on 03/05/26 at 2:13 PM, the Administrator revealed the MDS Coordinator was responsible for issuing a NOMNC at least two days in advance of skilled services ending.

The Administrator stated he would have expected Resident #97 to have received a NOMNC when her Medicare Part A skilled services ended, per regulatory guidelines.2. Resident #6 was admitted to the facility on [DATE].A Notice of Medicare Non-Coverage (NOMNC) revealed the notice was discussed with and signed by Resident #6 on 11/13/25 which indicated her Medicare Part A coverage for skilled services would end on 11/15/25. Resident #6 remained in the facility.Review of Resident #6's medical record revealed no evidence a SNF ABN was reviewed with or provided to Resident #6.

During an interview on 03/04/26 at 11:28 AM, the Minimum Data Set (MDS) Coordinator revealed she was responsible for issuing NOMNCs and SNF ABNs.

She explained therapy staff informed her when a resident's Medicare Part A coverage for skilled services were ending and she spoke with the provider to make sure there wasn't something else the resident could be skilled for that therapy wasn't aware of, such as wounds. If there was nothing else that could be skilled, she then completed and reviewed the applicable notices with the resident or their RP.

The MDS Coordinator stated she just forgot to provide a SNF ABN to Resident #6 when the NOMNC was issued.

During an interview on 03/05/26 at 2:13 PM, the Administrator revealed the MDS Coordinator was responsible for issuing a NOMNC at least two days in advance of skilled services ending and a SNF ABN if the resident remained in the facility and/or appealed the NOMNC.

The Administrator stated he would have expected Resident #6 to have received a SNF ABN when her Medicare Part A skilled services ended, per regulatory guidelines.

345462 03/05/2026

The Oaks-Brevard 300 Morris Road Brevard, NC 28712

Determination Notification letter dated 11/03/25 revealed Resident #6 had a Level II PASRR with no

last reviewed/revised 01/12/26, revealed no care plan that addressed the Level II PASRR specialized

submitted requests for Level II PASRR evaluations when needed and the MDS Coordinator was responsible for developing the care plan if a resident had a Level II PASRR.

During an interview on 03/04/26 at 4:05 PM, the MDS Coordinator confirmed she was responsible for developing resident care plans.

She confirmed Resident #6 had a Level II PASRR and a care plan should have been developed.

The MDS Coordinator stated it was an oversight.

During an interview on 03/05/26 at 2:13 PM, the Administrator revealed it was his expectation that residents with a Level II PASRR determination would have care plans developed per regulatory guidance.