Health inspection·February 8, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview, record review, and policy review, the facility failed to notify the physician of medication being unavailable from the pharmacy for administration. This affected one (Resident #76) of three reviewed for medications. The facility census was 70. Findings include: Review of the medical record for Resident #76 revealed an admission date of 12/29/22 with diagnoses including but not limited to chronic kidney disease, hypertensive heart disease, congestive heart failure, type two diabetes, chronic obstructive pulmonary disease (COPD), and asthma. Review of the Minimum Data Set (MDS) assessment dated [DATE] for Resident #76 revealed the resident was cognitively intact and required extensive assistance for activities of daily living. Review of the care plan dated 11/15/22 for Resident #76 revealed the resident had altered respiratory status/difficulty breathing related to COPD. Interventions included administer medications as ordered. Review of physician orders for Resident #76 revealed an order for Dupixent (breathing medication) subcutaneous solution pen-injector 300 milligrams/2 milliliters (ml)- inject 2 ml subcutaneously at bedtime every 14 days. Review of the Medication Administration Record (MAR) for September 2023 revealed Resident #76 did not receive Dupixent on 09/21/23 due to being on order from the pharmacy. Review of the MAR for November 2023 revealed Resident #76 did not receive Dupixent on 11/02/23 and 11/16/23 due to being on order from the pharmacy. Review of progress notes from September 2023 and November 2023 revealed no documentation the physician was notified of medication not being available for administration. Interview on 01/29/24 with the Director of Nursing (DON) and Regional Nurse #710 verified Resident #76 did not receive Dupixent on 09/21/23, 11/02/23, and 11/16/23 and also verified there was no documentation in the resident's medical record regarding physician notification of the medication not being available. Review of policy titled, Medication Administration-General Guidelines, revised December 2019 Page 1 of 3 365535 365535 02/08/2024 Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few revealed medications are administered as prescribed in accordance with good nursing principles and practices as only by persons legally authorized to do so. If a dose of regularly scheduled medication is withheld, refused, not available, or given at a time other than the scheduled time documentation of the unadministered dose is done as instructed by the procedures for use of the eMAR system. If three consecutive doses, or per facility protocol, of a vital medication are withheld, refused, or unavailable the physician is notified. Nursing documents the notification and physician response. This is an incidental finding found during the course of the complaint investigation. 365535 Page 2 of 3 365535 02/08/2024 Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551

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, staff interview, and policy review, the facility failed to ensure medications were administered per physician orders. This affected one Resident (#76) of three residents reviewed for medications. The facility census was 70. Findings include: Review of the medical record for Resident #76 revealed an admission date of 12/29/22 with diagnoses including but not limited to chronic kidney disease, hypertensive heart disease, congestive heart failure, type two diabetes, chronic obstructive pulmonary disease (COPD), and asthma. Review of the Minimum Data Set (MDS) assessment dated [DATE] for Resident #76 revealed the resident was cognitively intact and required extensive assistance for activities of daily living. Review of the care plan dated 11/15/22 for Resident #76 revealed the resident had altered respiratory status/difficulty breathing related to COPD. Interventions included administer medications as ordered. Review of physician orders for Resident #76 revealed an order for Dupixent (breathing medication) subcutaneous solution pen-injector 300 milligrams/2 milliliters (ml)- inject 2 ml subcutaneously at bedtime every 14 days. Review of the Medication Administration Record (MAR) for September 2023 revealed Resident #76 did not receive Dupixent on 09/21/23 due to being on order from the pharmacy. Review of the MAR for November 2023 revealed Resident #76 did not receive Dupixent on 11/02/23 and 11/16/23 due to being on order from the pharmacy. Interview on 01/29/24 with the Director of Nursing (DON) and Regional Nurse #710 verified Resident #76 did not receive Dupixent on 09/21/23, 11/02/23, and 11/16/23. Review of policy titled Medication Administration-General Guidelines revised December 2019 revealed medications are administered as prescribed in accordance with good nursing principles and practices as only by persons legally authorized to do so. If a dose of regularly scheduled medication is withheld, refused, not available, or given at a time other than the scheduled time documentation of the unadministered dose is done as instructed by the procedures for use of the eMAR system. If three consecutive doses, or per facility protocol, of a vital medication are withheld, refused, or unavailable the physician is notified. Nursing documents the notification and physician response. This is an example of non-compliance investigated under Complaint Number OH00150468. 365535 Page 3 of 3