Health inspection·February 5, 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 record review and staff and Pharmacist interviews, the facility failed to administer medications as physician ordered. This affected two (#100 and #60) of three residents reviewed for medication administration. Facility census was 101. Findings include: 1. Review of medical record for Resident #100 revealed admission date of 01/17/24. Diagnoses include cellulitis of left toe, type two Diabetes Mellitus, acute osteomyelitis left ankle and foot, Methicillin Susceptible Staphylococcus Areus (MRSA). The admission Minimum Data Set (MDS) dated [DATE] revealed a Brief Interview Mental Status (BIMS) score of 15 indicating intact cognition. The resident remains in the facility. He was independent for eating, toileting, supervision for bed mobility and transfers. Review of the physician orders revealed an order for 12 Grams (gm) Nafcillin (antibiotic) to be given intravenously (IV) every 24 hours with a start date of 01/18/24. Record review of 01/18/24 progress note revealed Nafcillin was not available and was pending pharmacy delivery. Record review of the 01/19/24 progress note revealed the Nafcillin had not been delivered by the pharmacy. The physician was contacted, and orders were received to send Resident #100 to the hospital to receive the needed medication. A joint interview on 02/05/24 at 3:31 P.M. with the Director of Nursing and the Assistant Director of Nursing (ADON) #102 revealed medications cannot be ordered from the pharmacy until after a resident arrives at the facility. The DON acknowledged Resident #100 was admitted to the facility on [DATE]. The DON stated the specific dose for the Nafcillin needed clarification by the pharmacy. The physician was contacted on 01/18/24, and the order was for the Nafcillin to be sent in a one Liter bag to be run continuously over 24 hours. ADON #102 revealed he called the pharmacy on 01/18/24 right before 9:00 P.M. and was told the Nafcillin was being mixed and would be sent on the 11:00 P.M. run and would be at the facility between 2:00 A.M. and 3:00 A.M. on 01/19/24. On the morning of 01/19/24, ADON #102 stated as soon as he got to the facility, he checked with staff to ensure the antibiotic was administered to Resident #100. Once learning it had not, he called he called to inform the physician. ADON #102 received an order to send Resident #100 to the hospital to receive the medication. (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 4 Event ID: 365616 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 365616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kettering Heights Post Acute 3313 Wilmington Pike Kettering, OH 45429 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)