Inspection visit
Health inspection
1 citation recorded
Inspector’s narrative
What the inspector wrote
This survey cited 1 deficiency. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
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
record review, staff interviews, and policy review, the facility failed to ensure medications were administered
as physician ordered. This affected two (#40 and #102) out of three residents reviewed for medication
administration. The facility census was 89.
Findings include:
1. Review of the medical record for Resident #40 revealed an admission date of 04/12/18 with diagnoses of
hypertensive heart disease without heart failure, paraplegia, and type 2 diabetes mellitus with diabetic
autonomic (poly) neuropathy.
Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #40 was
cognitively intact. Resident #40 was independent with bed mobility, required set-up assistance with eating,
oral hygiene, and personal hygiene. Resident #40 required supervision with bathing, dressing, transfers,
and wheelchair mobility, and required substantial assistance with toileting hygiene.
Review of Resident #40's physician orders revealed an order dated 02/23/24 for Pregabalin Capsule 300
MG, give 300 milligrams (mg) by mouth two times a day for neuropathic pain.
Review of Resident #40's progress notes revealed a progress note dated 12/25/24 at 8:50 A.M.
documented Pregabalin capsule 300 mg by mouth two times a day for neuropathic pain, medication not
available, resident and physician notified. A progress note dated 12/25/24 at 10:53 P.M. documented
Pregabalin Capsule 300 mg by mouth two times a day for neuropathic pain, medication not available. A
progress note dated 12/26/24 at 10:38 A.M. documented Pregabalin Capsule 300 mg by mouth two times a
day for neuropathic pain, medication unavailable. A progress note dated 12/27/24 at 1:20 A.M. documented
Pregabalin Capsule 300 mg by mouth two times a day for neuropathic pain, medication not available,
pharmacy contacted.
Review of Resident #40's medication administration record (MAR) for 12/2024 revealed on 12/25/24 the
7:00 A.M. dose and 7:00 PM. dose were not administered and on 12/26/24 the 7:00 A.M. dose and 7:00
PM. dose were not administered.
2. Review of the medical record for Resident #102 revealed an admission date of 01/03/25 and a discharge
date of 01/17/25 with diagnoses of esophagitis, unspecified with bleeding, type 2 diabetes mellitus with
diabetic chronic kidney disease and hypertensive chronic kidney disease.
Review of the physician orders for Resident #102 revealed an order dated 01/06/25 for Pregabalin
(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:
365374
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
365374
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/23/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beavercreek Post Acute
1974 North Fairfield Road
Dayton, OH 45432
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)
F 0755
Oral Capsule 200 mg give one capsule by mouth three times a day for nerve pain.
Level of Harm - Minimal harm
or potential for actual harm
Review of the MAR for Resident #102 for 01/2025 revealed Pregabalin Oral Capsule 200 mg
(Pregabalin)-give one capsule by mouth three times a day for nerve pain was not administered on 01/03/25
at 2:00 P.M. and 8:00 P.M.; on 01/04/25 at 8:30 A.M.; on 01/09/25 at 1:00 P.M.; on 01/10/25 at 6:00 A.M.,
1:00 P.M., and 7:00 P.M.; on 01/11/25 at 6:00 A.M., 1:00 P.M., and 7:00 P.M.; on 01/12/25 at 6:00 A.M., 1:00
P.M., and 7:00 P.M.; and on 01/13/25 at 6:00 A.M. and 1:00 P.M.
Residents Affected - Few
Review of the progress notes for Resident #102 revealed a note date 01/09/25 at 1:48 P.M. revealed
Pregabalin Oral Capsule 200 mg, give one capsule by mouth three times a day for nerve pain, pharmacy
aware to send, physician aware. A progress note dated 01/10/25 at 5:52 A.M. revealed Pregabalin Oral
Capsule 200 mg, give one capsule by mouth three times a day for nerve pain, waiting on pharmacy,
physician aware. A progress note dated 01/10/25 at 4:54 P.M. revealed Pregabalin Oral Capsule 200 mg,
give one capsule by mouth three times a day for nerve pain, on order. A progress note dated 01/10/25 at
11:11 P.M. revealed Pregabalin Oral Capsule 200 mg, give one capsule by mouth three times a day for
nerve pain, waiting for pharmacy, physician aware. A progress noted 01/11/25 at 5:56 A.M. revealed
Pregabalin Oral Capsule 200 mg, give one capsule by mouth three times a day for nerve pain, medication
not available. A progress noted dated 01/11/25 at 12:10 P.M. revealed Pregabalin Oral Capsule 200 mg,
give one capsule by mouth three times a day for nerve pain, medication not available. A progress noted
dated 01/11/25 at 9:18 P.M. revealed Pregabalin Oral Capsule 200 mg, give one capsule by mouth three
times a day for nerve pain, not in stock. A progress noted dated 01/12/25 at 5:52 A.M. revealed Pregabalin
Oral Capsule 200 mg, give one capsule by mouth three times a day for nerve pain, not in stock, pending
pharmacy delivery. A progress note dated 01/12/25 at 4:12 P.M. revealed Pregabalin Oral Capsule 200 mg,
give one capsule by mouth three times a day for nerve pain, pending clarification. A progress noted dated
01/12/25 at 9:47 P.M. revealed Pregabalin Oral Capsule 200 mg, give one capsule by mouth three times a
day for nerve pain, waiting for pharmacy delivery. A progress note dated 01/13/25 at 5:51 A.M. revealed
Pregabalin Oral Capsule 200 mg, give one capsule by mouth three times a day for nerve pain, pending
pharmacy delivery. And a progress note dated 01/13/25 at 1:07 P.M. revealed Pregabalin Oral Capsule 200
mg give one capsule by mouth three times a day for nerve pain, pharmacy aware to send.
Interview on 01/22/25 at 10:49 A.M. with Licensed Practical Nurse (LPN) #208 confirmed when she arrived
to work on 12/25/24 and Resident #40 did not have any Pregabalin 300 mg available to administer and
there was none available in the emergency box. Interview with LPN #208 also confirmed Resident #40 did
not receive Pregabalin 300 mg tabs on 12/25/24 at 7:00 A.M. and 7:00 P.M. and did not receive his
Pregabalin 300 mg on 12/26/24 at 7:00 A.M. and 7:00 P.M. Interview with LPN #208 confirmed the
pharmacy was called and the physician was notified that Resident #40 needed a refill of Pregabalin 300 mg
due to none being available. Interview with LPN #208 confirmed the refill of Pregabalin 300 mg was
delivered on 12/27/24.
Interview on 01/23/25 at 9:12 A.M. with Pharmacist #213 confirmed the pharmacy received a new
prescription for Resident #40 for Pregabalin Capsule 300 mg, give 300 mg by mouth two times a day for
neuropathic pain on 12/26/25, and it was sent to the facility on [DATE]. The interview with Pharmacist #213
also confirmed that Resident #102 was admitted on [DATE] with a five-day prescription for Pregabalin Oral
Capsule 200 mg (Pregabalin), give one capsule by mouth three times a day for nerve pain which was
delivered on 01/04/25. Interview with Pharmacist #213 also confirmed the pharmacy received a new
prescription for Pregabalin Oral Capsule 200 mg, give one capsule by mouth three times a day for nerve
pain on 01/13/25, and it was dispensed on 01/13/25. Interview with Pharmacist #213 confirmed the
pharmacy did not received a prescription for a refill prior to 01/13/25 from the physician.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365374
If continuation sheet
Page 2 of 3
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
365374
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/23/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Beavercreek Post Acute
1974 North Fairfield Road
Dayton, OH 45432
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)
F 0755
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Interview with Pharmacist #213 also confirmed the facility and the physician had been notified of the need
for a new prescription on 01/06/25.
Interview on 01/23/25 at 2:56 P.M. with the Director of Nursing (DON) and Registered Nurse (RN) Regional
Clinical Support #12 confirmed Resident #40's order for Pregabalin 300 mg on the MAR documented on
12/25/24 7:00 A.M. dose and 7:00 PM. the doses were not administered and on 12/26/24 7:00 A.M. and
7:00 PM. doses were not administered. Interview also confirmed the Pregabalin 300 mg tabs was filled on
12/26/24 and was delivered on 12/27/24. Interview also confirmed Resident #102 did not received
Pregabalin Oral Capsule 200 mg (Pregabalin), give one capsule by mouth three times a day for nerve pain
was not administered on 01/03/25 at 2:00 P.M. and 8:00 P.M., on 01/04/25 at 8:30 A.M., on 01/09/25 at 1:00
P.M., on 01/10/25 at 6:00 A.M., 1:00 P.M., and 7:00 P.M., on 01/11/25 at 6:00 A.M., 1:00 P.M., and 7:00
P.M., on 01/12/25 at 6:00 A.M., 1:00 P.M., and 7:00 P.M., and on 01/13/25 at 6:00 A.M. and 1:00 P.M. due to
awaiting a new prescription from the physician.
Review of the Administering Medication policy, dated April 2019 revealed medications are administered in a
safe and timely manner, and as prescribed.
Review of the Medication and Treatment Orders policy, dated July 2016 revealed drugs and biological's that
are required to be refilled must be reordered from the issuing pharmacy prior to the last dosage being
administered to ensure that refills are readily available.
This deficiency represents non-compliance investigated under Master Complaint Number OH00161492 and
Complaint Number OH00161377.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365374
If continuation sheet
Page 3 of 3
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Back to topCitations
1 citation recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F755 - Pharmacy Services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
FAQ · About this visit
Common questions about this visit
What happened during the January 23, 2025 survey of BEAVERCREEK POST ACUTE?
This was a inspection survey of BEAVERCREEK POST ACUTE on January 23, 2025. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at BEAVERCREEK POST ACUTE on January 23, 2025?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharm..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.