Sapphire Rehabilitation And Care Center

F 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

assessment of the resident's ability to safely leave the facility due to potential decision-making impairment related to alcohol use, no communication or attempts to contact the hospital regarding the resident's status and no behaviors documented. Facility staff continued to document through 08/15/25 the resident remained hospitalized (no hospital identified) with no mention the resident had refused to sign an AMA form and left

the facility or make mention the resident had discharged from the facility. The facility policy titled Resident Leave of Absence, dated 12/2024, revealed that all residents leaving the facility must have orders for supervised or unsupervised leave of absence. Residents leaving the facility on leave of absence must sign out when leaving. Prior to opening the door to allow a resident to leave, the nurse would verify the leave of absence order and would communicate the leave of absence with the receptionist. Staff observing a resident leaving the premises and having doubts about the resident being properly signed out, should notify their supervisor at once. The nurse would document in a progress note the time the resident leaves the facility and if known, the purpose. Review of the Facility Assessment Tool dated 07/31/25 revealed the number/average or range of residents with behavioral health needs was four to five residents, and those with active or current substance use disorders were four to five residents. The assessment revealed the facility managed the medical conditions and medication-related issues causing psychiatric symptoms and behavior, identify and implement interventions to help support individuals with issues such as dealing with anxiety, care of someone with cognitive impairment, care of individuals with depression, trauma/post-traumatic stress disorder, and other psychiatric diagnoses, intellectual or developmental disability. Emotional support and mental well-being and support with helpful coping mechanisms would be provided. The facility would identify hazards and risks for residents. Behavioral and mental health providers were available to provide services to residents.This deficiency represents noncompliance investigated under Complaint Number 2596080.

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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

09/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Sapphire Rehabilitation and Care Center

1605 Northwest Professional Plaza Columbus, OH 43220

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 - Potential for minimal harm Residents Affected - Many

1. 3. Review of the medical record revealed Resident #3 was admitted on [DATE REDACTED] and readmitted on [DATE REDACTED]

with diagnoses that included osteomyelitis, asthma, type 2 diabetes, and methicillin resistant staphylococcus aureus.

A nursing note dated 04/23/25 at 7:22 P.M. revealed Resident #3 went to an appointment and had not returned. A nursing note dated 05/14/25 at 4:38 P.M. revealed Resident #3 was readmitted to the facility from the hospital.

Review of the census revealed Resident #3 was out to the hospital on [DATE REDACTED] and returned to the facility on [DATE REDACTED].

An interview on 08/28/25 at 2:13 P.M. Director of Nursing (DON) verified Resident #3 had not been provided with a bed hold notification when Resident #3 went to the hospital on [DATE REDACTED] and 05/25/25.

An interview on 09/02/25 at 10:49 A.M. Resident #3 stated she was told once that she had only nine days for her room to be held. Resident #3 verified she was not given a formal bed hold notification.

Review of the policy titled Bed-Holds and Returns, revised March 2017, revealed that prior to transfers residents or resident representatives would be informed in writing of the bed-hold and return policy.

Review of the policy titled Facility Initiated Transfers and Discharge Notice, dated December 2024, revealed that in emergencies the resident and their representative would be notified as soon as possible.

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

Event ID:

Facility ID:

If continuation sheet