Inspection·October 12, 2023

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review and interview, the facility failed to maintain a medication error rate of less than five percent (%). Two errors were observed in 27 opportunities resulting in a 7.41% medication error rate. This affected one resident (#14) of four residents observed for medication administration. The census was 59. Residents Affected - Few Finding Include: On 10/11/23 at 8:02 A.M. Licensed Practical Nurse (LPN) #238 was observed administering medications to Resident #14. The LPN prepared multiple medications for the resident, including Novolog (short acting) insulin pen and Toujeo Solo Star (long acting) pen. LPN #238 prepared the Novolog pen by removing the cap of the and wiping the top of the pen with alcohol and applying the needle. She dialed the dosage to 14. LPN #238 prepared the Toujeo pen by removing the cap of the pen, wiping the top of the pen with alcohol, applying the needle and then dialed the dosage to 30 units. The LPN did not prime the pens. LPN #238 administered Resident 14's whole pills and injected the Novolog and Toujeo insulin injections into the resident's left arm. Interview on 10/11/23 at 08:11 A.M. with LPN #238 revealed her process for administering insulin via a pen was to remove the cap and wipe the top of the pen with alcohol, then apply the needle and dial the dosage. The LPN verified she did not prime the pen to remove all of the air and to ensure the resident was administered the correct dose of insulin as ordered. Review of the resident's physician orders for October 2023 revealed two insulin orders, Novolog (pen) 14 units with meals and Toujeo Solo Star (pen) 30 units one time a day. Review of the manufacturer's instruction for the Novolog pen revealed to prime the pen prior to each injection. Priming the pen meant removing the air from the needle and cartridge that may collect during normal use and ensure the pen was working properly. Review of the manufacturer's instruction for the Toujeo Solo Star pen revealed to always do a safety check to ensure pen and needle were working properly. Select three units by dialing the dose selector and press the injection button. If insulin comes out of the needle tip the pen was properly working. Review of the facility policy titled Insulin Administration, revised September 2014, revealed the nursing staff would have access to specific instructions (manufacturer if appropriate) on all forms of insulin delivery systems prior to their use. 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 2 Event ID: 365428 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 365428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sanctuary Wadsworth 365 Johnson Rd Wadsworth, OH 44281 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)