Inspection·November 13, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on medical record review, resident interview, staff interview, and review of the facility policy, the facility failed to provide medications as ordered by physician. This affected one resident (Resident #11) of three residents reviewed for medication administration. The facility census was 94 residents. Findings include: Review of the medical record for Resident #11 revealed an admission date of 07/10/24 with diagnoses including osteoarthritis and attention deficit hyperactivity disorder (ADHD). Review of the Minimum Data Set (MDS) assessment for Resident #11 dated 10/15/24 revealed the resident was cognitively intact and required assistance with activities of daily living (ADLs.) Review of physician's orders for Resident #11 revealed an order dated 07/15/24 for Adderall five milligrams (mg) two tablets twice daily. Review of controlled drug administration records for Resident #11 revealed Adderall was not administered on the following dates: 08/27/24 to 09/03/24, 09/07/24, 09/08/24, and 9/13/24 to 09/25/24. Review of Medication Administration Records (MAR) for Resident #11 dated August 2024 and September 2024 revealed Adderall was documented as not administered on 08/28/24, 08/29/24, 09/02/24 evening dose only, 09/03/24, 09/07/24, 09/08/24, 09/13/24, 09/14/24, 09/16/24 to 09/23/24, and 09/25/24 morning dose only. Interview on 11/13/24 at 10:25 A.M. with Resident #11 confirmed she did not receive her Adderall for approximately two weeks a couple months ago. Interview on 11/13/24 at 1:45 P.M. with the Director of Nursing (DON) confirmed Resident #11's Adderall was not available to be administered on the following dates: 08/27/24 to 09/03/24, 09/07/24, 09/08/24, and 9/13/24 to 09/25/24. The DON confirmed staff were at times signing off medication as administered in the MAR when the medication was not available. Further interview with the DON confirmed she was unaware Resident #11 had missed numerous doses of Adderall in August and September 2024 until the Surveyor questioned her regarding the medications. Review of the facility policy titled Administering Medications dated December 2012 revealed medications must be administered in accordance with the orders, including any required time frame. (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 3 Event ID: 365186 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 365186 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ayden Healthcare of Madeira 5970 Kenwood Road Cincinnati, OH 45243 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)