Health inspection·November 1, 2023

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on medication storage observation, medical record review, staff interview, and review of a facility policy, the facility failed to ensure controlled substances and narcotic medication were disposed of in a timely manner. This affected four (#30, #88, #91, and #92) of four residents reviewed for disposition of controlled substances and narcotics upon discontinuation of orders or discharge. The facility census was 96. Findings include: 1. Observation of the controlled substance drawer of the Whitney Way medication cart on 10/31/23 at 8:12 A.M. with Licensed Practical Nurse (LPN) #200 revealed Resident #88 had 55 pills of the nerve pain medication Lyrica in 25 milligram (mg) doses located in the drawer. Interview with LPN #200 during the observation on 10/31/23 at 8:12 A.M. verified Resident #88's Lyrica in the medication cart, and stated the Director of Nursing (DON) and unit managers are the only staff members permitted to remove a resident's controlled medications from the medication carts when the orders are discontinued or the resident discharges from the facility. 2. Observation of the controlled substances drawer of the Mckinley and Grant medication cart on 10/31/23 at 8:28 A.M. with LPN #23 revealed Resident #91 had six pills of the narcotic pain medication oxycodone instant release in five (5) mg doses; Resident #91 had 61 pills of Lyrica in 50 mg doses and 22 pills of the narcotic pain medication Dilaudid in two (2) mg doses; and Resident #30 had 20 pills of Dilaudid in 2 mg doses, nine (9) pills of the narcotic pain medication Percocet in 5-325 mg doses, and eight (8) pills of Percocet in 7.5-325 mg doses in the controlled substance drawer. Review of Resident #91's medical record revealed the resident was discharged from the facility on 09/25/23. Review of Resident #92's medical record revealed the resident was discharged from the facility on 10/16/23. Review of Resident #30's medical record revealed a physician order dated 09/25/23 discontinuing the ordered Dilaudid, and an ordered dated 10/07/23 discontinuing the Percocet orders. Interview with the DON on 10/31/23 at 8:54 A.M. stated she had been without a unit manager and usually goes through all the narcotic drawers twice a month. The DON confirmed she had no time to review the controlled substance drawers recently to be able to remove narcotics and controlled substance medications for destruction. The DON confirmed Resident #30, Resident #88, Resident #91, and Resident Page 1 of 3 365284 365284 11/01/2023 Crestwood Care Center 225 W Main Street Shelby, OH 44875

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some #92 all had narcotic medications in the controlled substance drawers that should have been removed from storage and destroyed. Further interview with the DON confirmed the most recent date the facility disposed of controlled and narcotic medications was on 08/31/23. Review of the facility's controlled substance policy, dated 08/20, revealed disposition is documented in the facility's drug destruction log or similar form. All controlled substances remaining in the facility after a resident has been discharged or an order discontinued are disposed of in the facility by the DON and consultant pharmacist (or other licensed person). Controlled substances remaining in the facility after the order has been discontinued or the resident has been discharged are retained in the facility in a securely locked area with restricted access until destroyed in accordance with facility policy and state regulations. Accountability records for discontinued controlled substances are maintained with the unused supply until it is destroyed or disposed of, and then stored for five years or as required by applicable law or regulation. The consultant pharmacy or designee routinely monitors controlled substance storage, records, and expiration dates during routine medication storage inspections. This deficiency represents non-compliance investigated under Master Complaint Number OH00147657. 365284 Page 2 of 3 365284 11/01/2023 Crestwood Care Center 225 W Main Street Shelby, OH 44875

F 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. Based on resident interview, staff interview, medical record review, review of food committee minutes, and policy review, the facility failed to ensure snacks were available in the evening and at bed time. This had the potential to affect all 96 residents. The facility census was 96. Findings include: Interview with [NAME] #800 on 10/23/23 at 9:11 A.M. confirmed residents receiving snacks on the second shift was an ongoing issue. [NAME] #800 stated she and the day shift staff pass snacks at 10:00 A.M., and set up the snack cooler for the second shift snack pass at 3:00 P.M. prior to leaving for the day. [NAME] #800 stated more often then not the snack cooler was not touched. [NAME] #800 stated she, the Dietary Manager, and the Administrator have been trying to resolve the issue for months with little success. Interview with the Administrator on 10/23/23 at 9:29 A.M. revealed she was aware of the afternoon snack passing issue. Interview with Registered Dietician (RD) #801 on 10/23/23 at 9:34 A.M. revealed she was aware of the afternoon snack passing issue. Interview with Resident #1 on 10/23/23 at 11:42 A.M. revealed snacks are not available in the afternoon. Interview with Resident #2 on 10/23/23 at 11:44 A.M. revealed she rarely had seen any snacks available. Interview with Resident #3 on 10/23/23 at 11:51 A.M. stated there were never snacks available in the afternoon. Interview with Resident #4 on 10/23/23 at 11:54 A.M. revealed he had not seen any snacks after 3:00 P.M. for a while. Interview with Resident #5 on 10/23/23 at 11:58 A.M. revealed he wished he could have a snack every once in awhile after dinner, and was unaware of any snack availability. Review of the food committee meeting minutes from 08/23/23 revealed the committee indicated they did not get snacks. Review of the policy titled, Snacks, dated 09/01/17, revealed snack and beverages will be provided as identified in the individual plans of care. Bedtime snacks will be provided for all residents. Additional snacks and beverages will be available upon request for all residents who want to eat at non-traditional times. This deficiency represents non-compliance investigated under Complaint Number OH00147617. 365284 Page 3 of 3