Health inspection·November 8, 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 resident and staff interview, the facility failed to administer medications to the residents as physician ordered. This affected two (Residents #34 and #61) of three residents reviewed for medication administration. The facility census was 60. Findings include: 1. Review of Resident #34's medical record revealed the resident was admitted to the facility on on 10/13/23. Diagnoses included urinary tract infection (UTI), type II diabetes mellitus, chronic heart failure, wound to left lower leg, and peripheral vascular disease. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #34 was cognitively intact. Review of the progress note dated 10/13/23 at 3:26 P.M. revealed Resident #34 was admitted to the facility. Review of the physician orders dated 10/13/23 revealed Resident #34 had physician orders to receive the following medications: cephalexin (antibiotic) 500 milligrams (mg) four times daily; carvedilol (to treat high blood pressure and heart failure) 25 mg twice daily; glipizide (anti-diabetic) 10 mg twice daily; Lyrica (anticonvulsant also used for diabetic peripheral neuropathy) 100 mg daily; Metformin (Insulin Response Enhancer) 500 mg twice daily; Omeprazole (Proton Pump Inhibitors) 40 mg daily; and Spironolactone (treat high blood pressure) 25 mg daily. Review of the medication administration record (MAR) revealed Resident #34 was not administered the following medications as physician ordered: cephalexin 500 mg on 10/13/23 (one missed dose) and on 10/14/23 (four doses); Coreg 25 mg the evening of 10/13/23 and 10/14/23, and the morning of 10/14/23; glipizide 10 mg the evening of 10/13/23 and the morning of 10/14/23; Lyrica 100 mg on 10/14/23, 10/15/23, 10/16/23, 10/17/23, and 10/18/23; Metformin 500 mg on 10/13/23; Omeprazole 40 mg on 10/14/23; and Spironolactone 25 mg on 10/14/23. The reason marked for each missed dose was drug/item unavailable. Lyrica's reason was marked awaiting pharmacy. Review of the Omnicell (automated medication dispensing unit) inventory log revealed cephalexin, carvedilol, glipizide, metformin, Omeprazole, and spironolactone were available to obtain from the automated medication dispensing unit within the facility. Interview on 11/08/23 at 9:32 A.M. with Resident #34 revealed some of her medications were not administered for several days when she was admitted to the facility. Resident #34 was told they needed orders for the medications. Page 1 of 4 365481 365481 11/08/2023 Altercare Newark North Inc. 151 Price Road Newark, OH 43055

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 11/08/23 at 12:04 P.M. with the Director of Nursing (DON) verified Resident #34 did not receive medications as physician ordered and the medications were available in Omnicell. 2. Review of the medical record revealed Resident #61 was admitted on [DATE] and discharged on 10/26/23. Diagnoses included type II diabetes mellitus. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #61 was cognitively intact and received insulin. Review of the physician orders dated 10/12/23 Resident #61 had an on order for Humalog (insulin) per sliding scale with meals and Humalog 10 units with meals (8:00 A.M., 12:00 P.M. and 5:00 P.M.). Review of the medication administration record (MAR) revealed Humalog 10 units was not administered to Resident #61 on 10/14/23 at 8:00 A.M. due to being too close to the scheduled lunch dosage. Interview on 11/08/23 at 12:04 P.M. with the Director of Nursing (DON) verified Resident 61 did not receive Humalog as physician ordered on 10/14/23. This deficiency represents non-compliance investigated under Complaint Number OH00147564. 365481 Page 2 of 4 365481 11/08/2023 Altercare Newark North Inc. 151 Price Road Newark, OH 43055

F 0807 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration. Based on review of resident council minutes, observations, staff interviews, and resident and family interviews, the facility failed to ensure residents had adequate fluids available per the resident's preferences. This affected seven residents (#14, #18, #22, #26, #28, #35, and #50). The facility census was 60. Findings include: Review of the resident council minutes dated 08/16/23 revealed the residents were helping themselves to ice from the ice chests in the hallways. The ice chest was removed, and residents had to ask for ice. The resident council minutes dated 09/13/23 revealed residents had concerns with ice water not getting passed each shift. Staff education was provided. During the initial tour of the facility on 11/06/23 from 7:19 A.M. to 7:36 A.M. revealed there were several residents who did not have fluids within their reach. Resident #19 was the only resident observed with ice water. Interview on 11/06/23 at 11:15 A.M. with State Tested Nursing Aide (STNA) #22 revealed fresh water was passed twice a shift. Interview on 11/06/23 at 2:47 P.M. with a family member of Resident #14 revealed the residents had to ask for ice water. Resident #14 was recently moved to the memory care unit. Resident #14 was the only resident with a water pitcher on the memory care unit. Interview and observation on 11/06/23 at 2:54 P.M. with Resident #18 revealed they needed fresh water. There was no water pitcher observed in the resident's room. Interview and observation on 11/06/23 at 2:55 P.M. with Resident #26 revealed they had requested ice water and a STNA took the water pitcher but did not bring it back. There was no water pitcher observed in the resident's room. Observation on 11/06/23 at 2:57 P.M. revealed Resident #22 had an empty water pitcher in her room. Interview on 11/06/23 at 3:02 P.M. with Resident #35 revealed they were given fresh water but wanted more. Observations on 11/08/23 from 7:31 A.M. to 9:32 A.M. revealed residents on the front hall did not have fresh water available. Interview on 11/08/23 at 7:35 A.M. with Resident #28 revealed residents had to ask for fresh water. Interview on 11/08/23 at 7:38 A.M. with Resident #50 revealed staff did not provide ice water unless a resident requested it. Interview on 11/08/23 at 7:43 A.M. with STNA #14 revealed fresh water was given to residents first thing in the morning or right after breakfast. 365481 Page 3 of 4 365481 11/08/2023 Altercare Newark North Inc. 151 Price Road Newark, OH 43055

F 0807 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 11/08/23 at 11:37 A.M. with STNA #22 revealed not all residents wanted ice with their water. STNA #22 verified fresh ice water was not passed to residents on the front hall on 11/06/23 between 6:00 A.M. and 2:00 P.M. STNA #22 stated the ice chest had to be kept locked up due to residents getting into the ice chest. Interview on 11:40 A.M. with STNA #50 revealed they usually worked on another hall and residents usually requested water several times a day. The nursing staff provided the water as requested. This deficiency represents non-compliance investigated under Complaint Number OH00147564. 365481 Page 4 of 4