Inspection·October 3, 2019

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview and facility policy review ,the facility failed to monitor laboratory tests in accordance with physician orders to ensure the adequate use of medications for one resident (#44) of five reviewed for unnecessary medications. The faciltiy census was 60. Residents Affected - Few Findings include: Medical record review revealed Resident #44 was admitted to the facility on [DATE] with diagnoses including cerebral infarction (stroke), epilepsy, diabetes mellitus type II, major depressive disorder severe recurrent with psychotic symptoms, chronic obstructive pulmonary disease, and hypertension. Review of Resident #44's current physician orders revealed the resident was ordered Glucotrol 5 milligrams (mg) twice a day, 15 units of Basaglar insulin twice a day, and Trulicity injection of 0.5 milliliter (0.75 mg) every Tuesday. The resident was also ordered to have laboratory tests every three months which consisted of a complete blood count (CBC-to evaluate overall health), comprehensive metabolic panel (CMP- body's fluid balance), and a Hemoglobin A1c (HBA1c-average of blood glucose levels). Review of Resident #44's medical record revealed the last lab tests completed were 03/01/19 and 09/06/19. There was no evidence the labs had been drawn in June 2019 as ordered. Interview with the Director of Nursing (DON) on 10/02/19 at 2:19 P.M. verified labs ordered for Resident #44 had not been done in June 2019. Review of a facility policy titled Lab and Diagnostic Test Results-Clinical Protocol with a revision date of November 2018 revealed the physician will identify and order diagnostic and lab testing based on the resident's diagnostic and monitoring need. The staff will process test requisitions and arrange for tests. 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: 365483 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 365483 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillwater Skilled Nursing and Rehabilitation 75 Mote Drive Covington, OH 45318 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)