Health inspection·June 24, 2025

F 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and closed medical record review, the facility failed to ensure blood draw orders were obtained for Resident #110 who was receiving Vancomycin (strong antibiotic) intravenously per standards of care. This affected one (Resident #110) of three residents reviewed for intravenous medication administration. The facility census was 97. Residents Affected - Few Findings include: Review of the closed medical record for Resident #110 revealed an admission date of 03/20/25, discharged to hospital on [DATE], returned to facility on 05/07/25 and discharged home on [DATE]. Diagnoses included acute osteomyelitis of right ankle and foot, peripheral vascular disease, diabetes mellitus type two, abscess tendon sheath of right ankle and foot. Upon return from hospital stay resident was diagnosed with metabolic encephalopathy and altered mental status. Review of the physician orders upon admission revealed Resident #110 was ordered Vancomycin hydrochloride intravenous solution 1250 milligrams/250 milliliters, use 250 milliliters (ml) once daily for osteomyelitis. The start date was 03/21/25 and was discontinued on 4/11/25. There were no orders for Vancomycin peak and or trough levels. Review of the nursing progress notes for Resident #110 revealed no documentation related to Vancomycin trough levels being completed. Review of the admissions Minimum Data Set (MDS) dated [DATE] revealed Resident #110 was cognitively intact with no behaviors. Resident #110 required maximum assistance from staff to complete activities of daily living. Resident #110 received intravenous medications, antibiotics, insulin and antiplatelet medications. Review of the 48 hour baseline plan of care and comprehensive plan of care revealed Resident #110 received intravenous antibiotics related to osteomyelitis of right foot and ankle. However, no laboratory interventions related to Vancomycin. Interview on 06/23/25 at 11:46 A.M. with Licensed Practical Nurse (LPN) #170 revealed Vancomycin antibiotic intravenous should have labs drawn often for peak and trough. The results would be called to the physician and pharmacy, as pharmacy helped with dosing. LPN #170 stated Resident #110 did not have any peak or trough levels drawn for three weeks in March 2025. Interview on 06/24/25 at 12:44 P.M. with Physician Assistant (PA) #410, who had provided care for Resident #110, revealed the expectation for residents admitted on the medication Vancomycin would be (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: 365250 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 365250 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Buckeye Care and Rehabilitation 1900 East Main Street Lancaster, OH 43130 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)