Health inspection·March 14, 2024

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and policy review, the facility failed to ensure all medications were stored and labeled as required. This affected five (Residents #47, #48, #49, #50, #51) of 10 residents reviewed. Findings include: Observation on 03/14/24 at 7:37 A.M. revealed Licensed Practical Nurse (LPN) #216 had pre-poured medications for Residents #47, #48, #49, #50, #51. A drawer within the medication cart contained five medication cups each containing medications with the resident's name. There was no information regarding the names or strength of the medications in the cups. Interview with LPN #216, at the time of the observation, revealed the medications were pre-poured because he was required to be in the dining room from 7:30 A.M. to 9:00 A.M. to observe residents during breakfast and he had more than 30 residents to administer medications to after breakfast service was finished. Review of the facility's undated policy titled Medication Administration revealed medications were to be poured just prior to administrating to the resident. Page 1 of 2 365633 365633 03/14/2024 The Colony Healthcare Center 563 Colony Park Drive Tallmadge, OH 44278

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and policy and procedure review, the facility failed to ensure staff maintained infection control standards when administering medications. This affected one (Resident #47) of five residents observed for medication administration. Residents Affected - Few Findings include: Observation on 03/14/24 at 8:13 A.M. revealed Licensed Practical Nurse (LPN) #216 preparing medications to administer to Resident #47. LPN #216 popped medications from blister packs into his bare hand and then picked up medications that were dropped and put them into a medication cup to administer to Resident #47. An interview with LPN #216 at the time of the observation confirmed the observations. Review of the facility's undated policy titled Medication Administration revealed medications were not to be touched, either when opening a liquid or dose pack. Dropped medications were to be discarded. 365633 Page 2 of 2