Health inspection·September 27, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interview, medical record review, observation and staff interview, the facility failed to ensure hospital discharge medications were followed and medications provided as ordered. This affected one resident (#37) of three residents reviewed for medications upon discharge from the hospital. The facility census was 74. Residents Affected - Few Findings include: Interview with Resident #37 on 09/26/23 at 9:20 A.M. revealed she had recently returned to the facility after admission to the hospital. She indicated she was prescribed Norco (opioid pain medication) and had an order upon discharge from the hospital that should have been provided upon admission to the facility. Resident #37 indicated she had not received the Norco when requested and staff alerted her she did not have any to administer. Resident #37 stated she was provided other pain relief medications, but the Norco would work better. Review of Resident #37's medical record revealed an admission date of 06/06/23 with admission diagnoses that included diabetes mellitus with diabetic neuropathy, bipolar disorder and cerebrovascular accident. Review of Resident #37's Minimum Data Set (MDS) 3.0 quarterly assessment with a reference date of 09/18/23 indicated Resident #37 had an intact cognition. Further review of the medical record revealed on 09/06/23 Resident #37 was transferred and directly admitted to the hospital due to increasing behaviors. On 09/11/23 Resident #37 was discharged from the hospital back to the facility. Review of the discharge summary and medication list revealed Resident #37 was ordered Norco 5/325 milligrams (mg) one every 12 hours as needed for pain. Review of Resident #37's physician's orders revealed upon readmission on [DATE] an order for Norco 5/325 one every 12 hours as needed for pain. Review of the Medication Administration Record (MAR) revealed Norco orders in place as ordered by the physician. The MAR showed no evidence of any Norco administration for Resident #37 after readmission to the facility. Observation and interview with Licensed Practical Nurse (LPN) #85 on 09/26/23 at 12:10 P.M. revealed Resident #37 does not have any Norco available as nursing staff felt the resident did not need the medication because her pain was adequately controlled with other pain relief medication prior to her hospital admission and readmission to the facility. LPN #85 stated Resident #37 has requested the Norco, but staff advised the resident it is not available. LPN #85 verified staff did not contact physician to clarify the need for Norco upon readmission to the facility. (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 2 Event ID: 365152 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 365152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Schoenbrunn Healthcare 2594 East High Avenue New Philadelphia, OH 44663 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)