Health inspection·May 29, 2024

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 medical record review, staff interview, and review of facility policy, the facility failed to ensure medications were available to administer as ordered. This affected one (Resident #80) of five patients reviewed for medication administration. The facility census was 65. Findings include: Review of the medical record revealed Resident #80 was admitted to the facility on [DATE] and expired at the facility on [DATE]. Resident #80 had diagnoses including unspecified neoplasm of digestive organ, essential hypertension, gastroesophageal reflux disease, absence epileptic syndrome, oropharyngeal phase dysphagia, chronic ulcerative pancreatitis, unspecified lymphedema, sciatica, and unspecified anxiety disorder. Review of the most recent quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact, had no behaviors, did not reject care, and did not wander. Review of the care plan dated [DATE] revealed Resident #80 received Hospice services related to a diagnosis of protein calorie malnutrition. Interventions included to collaborate with Hospice to provide care services, to observe for non-verbal symptoms of pain (facial grimacing, crying, increased respirations), to observe for shortness of breath/secretions, to obtain orders as needed as symptoms occurred, to administer comfort medications as ordered, to monitor for effectiveness of medications, to notify Hospice of any change in condition, and to report any changes to Hospice and physician. Review of the medical record revealed Resident #80 had physician orders dated [DATE] for Morphine Sulfate 100 milligrams (mg) per 20 milliliters (ml) solution, 0.25 ml (5 mg) by mouth every four hours as needed for moderate pain or shortness of breath. This order was discontinued on [DATE] and a new order was placed for morphine sulfate 20 mg per 5 ml solution, give 0.5 ml (2 mg) by mouth every two hours for shortness of breath and pain for 14 days. This order was changed on [DATE] from as needed to be administered routinely every hour. Review of the Medication Reconciliation Sheet revealed on [DATE], the facility received a 30 ml bottle of Morphine Sulfate solution 100 mg/5 ml for Resident #80. The last dose from this bottle was administered on [DATE] at 9:00 A.M. Review of the Medication Reconciliation Sheet revealed on [DATE], the facility received a 15 ml bottle of Morphine Sulfate Concentrate, no strength, dosage, or frequency indicated. The first dose was administered on [DATE] at 9:42 A.M. (continued on next page) 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 3 Event ID: 365603 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 365603 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at West Park 2950 West Park Drive Cincinnati, OH 45238 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)