Health inspection·September 23, 2024

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NONCOMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Residents Affected - Some Based on medical record review, review of a facility self-reported incident (SRI), review of the facility investigation, facility policy review, and interview, the facility failed to ensure residents were free from misappropriation of medications. This affected 13 (Resident #1, #3, #4, #8, #12, #15, #16, #17, #18, #19, #20, #21, and #22) of 13 residents reviewed for misappropriation. The facility census was 99. Findings include: Review of the Self-Reported Incident (SRI) Tracking Number 251396, dated 08/31/24, revealed on 08/31/24, a concern was reported related to missing medications from Licensed Practical Nurse (LPN) #400's medication cart. On 08/31/24 at approximately 1:00 P.M. the Administrator was watching video cameras and noticed suspicious activity by LPN #400 while she was administering medications. LPN #400 was observed going through the narcotics drawer but not having the medication administration record (MAR) pulled up or documenting on the narcotic count sheets. LPN #400 was immediately suspended pending investigation. An immediate investigation was initiated. During a medication audit on 08/31/24 at 4:30 P.M., completed by the Director of Nursing (DON) and the Assistant Director of Nursing (ADON), it was determined that medications in the cart were unaccounted for, and several routine medications were found in the top drawer of the medication cart. These medications were identified by their imprint code on the medication and compared with resident medication profiles to establish who the medications belonged to. Routine medications in Paxits (a secure bag containing medications scheduled at a specific time of the day with clearly labeled medication information printed on the bag) were found discarded in the trash. Controlled substances were unaccounted for and not documented on MARS or on narcotic count sheets. 1. Review of the medical record for the Resident #1 revealed an admission date of 09/24/23. Diagnoses included dementia, psychotic disorder with hallucinations, adult failure to thrive, acute respiratory failure, and myasthenia gravis. Review of the quarterly Minimum Data Set (MDS) assessment, dated 07/24/24, revealed the resident had severe cognitive impairment. Review of the facility's SRI investigation revealed Resident #1 was not administered risperidone 0.5 milligrams (mg) on 08/31/24 at 12:00 P.M. or buspirone 15 mg on 08/31/24 at 2:00 P.M. as ordered by the physician. (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 6 Event ID: 365271 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 365271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carriage Inn of Steubenville 3102 St Charles Drive Steubenville, OH 43952 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)