Health inspection·March 18, 2025

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview and review of facility policy, the facility failed to ensure insulin pens were dated and labeled after opening. This affected three residents (#9, #16, and #40) of four residents observed for insulin pens during medication administration. The facility census was 66. Findings include: 1. Review of Resident #9's medical records revealed an admission date of 12/20/24 with diagnoses including but not limited to diabetes. Review of Resident #9's physician order for March 2025 revealed resident was ordered Glargine insulin (long-acting insulin) 25 units subcutaneous (SQ) twice a day (BID). Observation during medication administration on 03/13/25 at 8:22 A.M. of the insulin pens with Licensed Practical Nurse (LPN) 154 revealed multiple insulin pens were not dated when opened with expiration date. Resident #9's Glargine insulin pen had no date to indicate when it was opened. Interview on 03/13/25 at 9:03 A.M. with LPN #154 confirmed Resident #9's insulin pen was not dated when opened. LPN #154 reported the insulin pen should be dated when opened and stated she was unsure how long insulin pens were good for after opening. Interview on 03/13/25 at 9:10 A.M. with Director of Nursing (DON) confirmed insulin pens are to be dated when opened. DON confirmed there was no date on the Glargine insulin pen for Resident #9. 2. Review of the medical record for Resident #16 revealed an admission date of 02/26/25 with diagnoses including but not limited to diabetes. Review of Resident #16's physician order for March 2025 revealed an order for Basaglar Kwikpen (Glargine insulin, long-acting insulin) give 12 units SQ once a day (QD). Observation during medication administration on 03/13/25 at 8:22 A.M. of the insulin pens with LPN #154 revealed multiple insulin pens were not dated when opened with expiration date. Resident #16's Basaglar KwikPen, (Glargine insulin) had no date to indicate when it was opened. Interview on 03/13/25 at 9:03 A.M. with LPN #154 confirmed Resident #16's insulin pen was not dated when opened. LPN #154 reported the insulin pen should be dated when opened and stated she was unsure how long insulin pens were good for after opening. (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 4 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 03/18/2025 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)