Inspection·April 10, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, medical record review, and staff interviews, the facility failed to monitor bruising and bleeding risk for a resident on an anticoagulant. This affected one resident (Resident #45) out of three residents reviewed for anticoagulant medications, and had the potential to affect 48 residents that the facility identified as being on anticoagulant medication. The facility census was 205 residents. Residents Affected - Few Findings include: Review of the medical record revealed Resident #45 was admitted to the facility on [DATE] with diagnoses that included end stage renal disease, dependence on renal dialysis, mood disorder, anemia, anxiety disorder and heart failure. Review of Resident #45's Minimum Data Set (MDS) assessment dated [DATE] revealed that her Brief Interview for Mental Status (BIMS) was 15, indicative of intact cognition. Review of her MDS also revealed that she was receiving anticoagulant medication. Review of Resident #45's physician orders revealed that effective 01/18/25, she had physician orders for Apixaban (an anticoagulant medication) 5 milligrams (mg) one tablet by mouth twice daily. Review of Resident #45's care plan dated 01/27/25 revealed that she was at risk for alteration in hematological status related to anemia and anticoagulant side effects. Interventions, effective 01/27/25, were to administer medications as ordered and observe for side effects of the medication, and to observe for signs of increased bleeding such as bruising. Observation on 04/10/25 at 8:40 A.M. of Resident #45's skin revealed that she had maroon, gray-brown and yellow bruising on her bilateral forearms and gray-brown and yellow bruising on her lower right extremity. Interview on 04/10/25 at 11:04 A.M. with Registered Nurse (RN) #264, who was Resident #45's assigned nurse for the day, revealed that he was unaware of bruising to Resident #45's bilateral forearms and lower right ankle. Further interview confirmed the presence of bruising on Resident #45's lower right ankle and bilateral forearms, and that the resident was receiving anticoagulant medication as ordered. He stated that bruising should be monitored for residents on anticoagulant medication. Interview with the Director of Nursing (DON) on 04/10/25 at 11:06 A.M. confirmed there was no documented evidence of an order to monitor Resident #45's bruising in the medical record, nor did the wound nurse, consulted by the DON, have any evidence of monitoring Resident #45 for bruising. (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: 365379 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 365379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Laurels of Walden Park 5700 Karl Road Columbus, OH 43229 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)