Inspection·May 30, 2024

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, interview, and policy review, the facility failed to ensure a medication error rate of less than five percent. Three medication errors out of 30 opportunities for error resulted in a medication error rate of ten percent. This affected two (Residents #38 and #66) of five residents observed for medication administration. The census was 92. Residents Affected - Few Findings include: 1. Review of physician orders revealed Resident #38 had Diclofenac sodium external gel (Non-steroidal anti-inflammatory) one percent topical, apply 0.5 grams to bilateral knees two times a day for pain. During observation of medication pass for Resident #38 on 05/30/24 at 8:10 A.M., Licensed Practical Nurse (LPN) #100 revealed there was no Diclofenac sodium external gel available in the medication cart for Resident #38. During an interview on 05/30/24 at 11:07 A.M., LPN #100 confirmed the resident did not receive his Diclofenac sodium external gel to his knees as the medication was not available. 2. Resident #66 had physician orders for Divalproex sodium tablet delayed release tablets (anti-seizure medication used as a mood stabilizer) 125 milligrams (mg), give three tablets by mouth twice daily for psychosis and enteric coated aspirin, delayed release 81 mg daily for heart health. During observation of medication pass for Resident #66 on 05/30/24 at 8:35 A.M., LPN #100 crushed the Divalproex sodium delayed release tablets, and the Aspirin EC pill and administered the medication to the resident. During an interview on 05/30/24 at 8:48 A.M. LPN #100 stated she crushes medications which are allowed to be crushed. LPN #100 stated she knows what medications can be crushed or it is written on the medication administration record During interview on 05/30/24 at 2:56 P.M., the Director of Nursing (DON) stated the nursing report sheet indicated who in the facility required to have their medications crushed and if a resident required crushed medications the facility would obtain the medications in a form that was able to be crushed. The DON verified Divalproex Sodium tablets and enteric coated Aspirin were medications that were on the do not crush list the facility followed and should not have been crushed. Review of the Common Oral Dosage Forms That Should Not Be Crushed provided by the facility dated (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: 365256 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 365256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Worthington, The 1030 High St Worthington, OH 43085 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)