Health inspection·November 6, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and policy review, the facility failed to ensure medications were administered as ordered. This affected one (#93) of three residents reviewed for medications. The facility census was 83. Findings included: Review of Resident #93's medical record revealed an admission ate of 10/02/24. Diagnoses included cellulitis of the left lower extremity, diabetes mellitus, ulcerative colitis, and schizophrenia. The resident was discharged on 10/09/24. Review of Resident #93's Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had an intact cognitive function and was independent of most activities of daily living (ADLs). Review of Resident #93's nursing progress note dated 10/02/24 revealed the resident arrived to the facility at 2:00 P.M. from a local hospital. The resident's medications were reviewed and confirmed with the physician. Review of Resident #93's physician orders while in the facility included orders dated 10/02/24 for atorvastatin calcium tablet 40 milligrams (mg) one table by mouth at bedtime for hyperlipidemia, the antipsychotic medication quetiapine furnarate (Seroquel) oral tablet 150 mg at bedtime for schizophrenia, doxycycline monohydrate (antibiotic) 100 mg to be administered by mouth twice daily for a right toe infection/cellulitis for seven days, Fluticasone-Salmetrerol inhalation aerosol powder breath activated 150-50 micrograms to be administered twice daily for chronic obstructive pulmonary disease, and memantine five (5) mg to be administered twice daily for Alzheimer's disease. Review of Resident #93's medical record revealed a physician order dated 10/03/24 for mesalamine delayed release tablet 1.2 grams to be administered once daily for ulcerative colitis. Review of Resident #93's medical record revealed a physician order dated 10/04/24 for the anticoagulant warfarin sodium 10 mg to be administered every evening on Monday, Wednesday, Friday, Saturday, and Sunday. Review of Resident #93's medication administration record (MAR) for October 2024 revealed on 10/02/24 the resident was not administered atorvastatin calcium and Seroquel as ordered. Further review revealed Resident #93 was not administered Fluticasone-Salmeterol on 10/02/24 at 7:00 P.M. or 10/03/24 for the morning dose as ordered. On 10/03/24 and 10/05/24, mesalamine was not administered as (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: 365279 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 365279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Merit House LLC 4645 Lewis Ave Toledo, OH 43612 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)