Health inspection·April 20, 2023

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to prevent medication errors, which included the dispensing and administration of discontinued medications and the incorrect administration of an antibiotic. This affected three residents (Residents #218, #229, and #274) of five residents sampled for medication errors. The facility census was 74. Residents Affected - Some 1. Review of the physician orders dated 08/17/21 for the Former Specified Resident (FSR) #274, revealed an order for Tramadol tablet, 50 mg (milligrams), four times a day. The physician order for Tramadol, a scheduled IV medication, was discontinued on 08/19/22. Review of the medication error report form dated 08/23/22 revealed the medication was administered in error to FSR #274 on 08/20/22, 08/21/22, and 08/22/22 by specified perpetrator (SP) #391. Review of progress notes for FSR #274 dated 08/24/23 at 8:30 A.M. revealed the family and physician were notified, head to toe assessment was completed, and no new orders were implemented. Review of the controlled narcotic record dated 08/13/22 to 08/22/22, for FSR #274, revealed no discrepancies related to the allegation. Review of the personnel file for Licensed Practical Nurse (LPN) #391 dated 08/31/22, revealed the LPN #391 received education and coaching on the five rights of medication administration. 2. Review of the physician orders dated 03/09/23 for Resident #229, revealed an order for Erythromycin 500 mg tablet, three times a day. Review of the medication error investigation dated 03/09/23 revealed the medication Erythromycin was not administered per the physician order and Azithromycin tablet, 500 mg, was administered once in error to Resident #229 on 03/09/23 LPN #391. Review of progress notes on 03/10/23 for Resident #229, revealed the family and physician were notified, head to toe assessment was completed, and no new orders were implemented. Review of the personnel file for LPN #391 dated 03/17/23, revealed LPN #391 received additional education and coaching on the five rights of medication administration. Interview on 04/17/23 at 10:42 A.M. with Resident #241, revealed no concerns related to medication administration. 3. Review of the physician orders dated 12/15/22 for Resident #218, revealed an order for Xanax, (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: 365268 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 365268 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Wadsworth 147 Garfield St Wadsworth, OH 44281 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)