Health inspection·June 22, 2023

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 and interview, the facility failed to maintain accurate records for controlled medications for Resident #2 and Resident #202. This affected two residents (#2 and #202) out of five residents reviewed for medication administration. The facility census was 121. Findings include: 1. Review of the medical record revealed Resident #2 was admitted on [DATE] with diagnoses that included but not limited to encephalopathy, acute pancreatitis, abscess of abdominal wall, and chronic pain. Review of the physician orders dated 05/25/23 revealed Resident #2 was ordered Oxycodone/Acetaminophen (opioid for moderate to severe pain) 5-325 milligram (mg) every six hours as needed for pain. Review of the admission Minimum Data Set (MDS) dated [DATE] revealed Resident #2 was cognitively intact. Review of the controlled drug record revealed Oxycodone/Acetaminophen 5-325 mg was signed out as being administered on 06/14/23 at 2:00 P.M., 06/15/23 at 9:48 A.M., and 06/20/23 at 4:39 P.M. and 11:00 P.M. but were not documented on the medication administration record (MAR) as being administered to Resident #2. Interview on 06/22/23 at 3:25 P.M., the Director of Nursing (DON) verified Resident #2's Oxycodone/Acetaminophen 5-325 mg was signed out to be administered on 06/14/23 at 2:00 P.M., 06/15/23 at 9:48 A.M., and 06/20/23 at 4:39 P.M. and 11:00 P.M. but was not documented on the MAR as being administered to Resident #2. 2. Review of the medical record revealed Resident #202 was admitted on [DATE] and discharged on 06/12/23 with diagnoses that included but not limited to malignant neoplasm of bronchus or lung, anxiety disorder, depression, angina pectoris, insomnia, and chronic pain. Review of the physician order dated 05/10/23 revealed Resident #202 was ordered Oxycodone (opioid for moderate to severe pain) five mg every eight hours as needed for pain. Review of the admission MDS dated [DATE] revealed Resident #202 was cognitively intact. Review of the controlled drug record revealed Oxycodone five mg was signed out as being Page 1 of 2 365436 365436 06/22/2023 Mother Angeline McCrory Manor 5199 East Broad Street Columbus, OH 43213

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few administered on 05/17/23 (unknown time), 05/21/23 at 9:20 A.M., 05/23/23 at 6:00 P.M., 05/31/23 at 1:21 P.M. and 06/11/23 at 9:00 P.M. but was not documented on the MAR as administered to Resident #202. Interview on 06/22/23 at 3:25 P.M., the DON verified Resident #202's Oxycodone five mg was signed out 05/17/23 (unknown time), 05/21/23 at 9:20 A.M., 05/23/23 at 6:00 P.M., 05/31/23 at 1:21 P.M. and 06/11/23 at 9:00 P.M. but was not documented on the MAR as being administered to Resident #202. 3. Review of the medical record revealed Resident #202 was admitted on [DATE] and discharged on 06/12/23 with diagnoses that included but not limited to malignant neoplasm of bronchus or lung, anxiety disorder, depression, angina pectoris, insomnia, and chronic pain. Review of the admission MDS dated [DATE] revealed Resident #202 was cognitively intact. Review of the physician order dated 06/02/23 revealed Resident #202 was ordered Alprazolam (benzodiazepine to treat anxiety) 0.25 mg every eight hours. Review of the controlled drug record revealed Alprazolam 0.25 mg was signed out on 06/06/23 at 9:15 A.M. and 06/06/23 at 6:24 P.M. Review of the MAR revealed no documentation of medication being administered on 06/06/23 at 9:15 A.M. or 6:24 P.M. Alprazolam 0.25 mg was scheduled to be administered at 6:00 A.M., 2:00 P.M. and 10:00 P.M. Further review of the MAR revealed documentation of Alprazolam 0.25 mg being administered on 06/07/23 at 2:00 P.M. Review of the controlled drug record revealed Alprazolam 0.25 mg was not dispensed. The MAR and controlled drug record revealed no documentation of Resident #202 being administered Alprazolam 0.25 mg on 06/09/23 at 6:00 A.M. Interview on 06/22/23 at 3:25 P.M., the DON verified Resident #202's Alprazolam 0.25 mg was signed out on 06/06/23 at 9:15 A.M. and 06/06/23 at 6:24 P.M. but the MAR revealed no documentation of Alprazolam being administered on 06/06/23 at 9:15 A.M. or 6:24 P.M. to Resident #202. The DON verified there was documentation on the MAR of Alprazolam 0.25 mg being administered to Resident #202 on 06/07/23 at 2:00 P.M. but the controlled drug record revealed Alprazolam 0.25 mg was not dispensed. The DON also verified there was no documentation on the MAR and controlled drug record of Resident #202 being administered Alprazolam 0.25 mg on 06/09/23 at 6:00 A.M. This deficiency represents non-compliance investigated under Complaint Number OH00143433. 365436 Page 2 of 2