Health inspection·April 25, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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, medication administration time review, and policy review, the facility failed to administer physician ordered medications and ensure medications were timely order to have available for administration. This affected four #21, #41, #58 and #63 of eight residents reviewed for medication administration. The facility census was 79. Findings include: 1. Review of medical record for Resident #21 revealed an admission date of 11/23/18, with diagnoses of other seizures, epilepsy, intractable, without status epilepticus, and hemiplegia, chronic obstructive pulmonary disease and unspecified affecting left nondominant side. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #21 was cognitively intact. Review of physician orders dated 11/14/23, to administer Oxcarbazepine tablet, 300 milligrams (mg), give 2 tablets by mouth at bedtime for epilepsy and give 1 tablet by mouth, one time a day for epilepsy; Pepcid tablet (famotidine) 20 mg, give 1 tablet, by mouth two times a day for gastroesophageal reflux disorder; and ferrous sulfate tablet (65 Fe) 325 mg, give 325 mg by mouth two times a day for low hemoglobin and hematocrit. Review of physician orders dated 11/15/23, to administer umeclidinium bromide aerosol powder breath activated 62.5 microgram/inhalation, one puff, inhale orally one time a day for chronic obstructive pulmonary disease (COPD); aspirin low dose tablet chewable, 81 mg, give 1 tablet by mouth one time a day for heart health; Colace capsule, (docusate sodium)100 mg, give 1 capsule by mouth one time a day for constipation; Claritin oral tablet (Loratadine), 10 mg, give 10 mg by mouth one time a day for nasal drainage; doxycycline monohydrate capsule, 100 mg, give 1 capsule by mouth one time a day for recurrent urinary tract infection (UTI); potassium chloride Extended Release (ER) tablet, 10 milliequivalent (mEq), give 10 mEq, by mouth one time a day for hypokalemia; and Multivitamin/Zinc Stress tablet (multiple vitamins-minerals), give 1 tablet by mouth one time a day for supplement. Review of a physician order dated 11/17/23, to administer calcium carbonate-vitamin D tablet, 500-200 mg/unit give 1 tablet by mouth two times a day for supplement. Review of a physician order dated 02/02/24, to administer guaifenesin ER tablet-12 Hour, 600 mg, give 1 tablet by mouth two times a day for cough. Page 1 of 5 365640 365640 04/25/2024 Sycamore Trails Post Acute 450 Oak Ridge Boulevard Miamisburg, OH 45342

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the Medication Administration Record (MAR) dated March 2024 revealed on 03/17/24, morning medication administration the following medications were not signed off as administered: aspirin 81 mg, Claritin 10 mg, Colace 100 mg, doxycycline monohydrate 100 mg, Multivitamin with Zinc tablet, oxcarbazepine 300 mg, potassium chloride ER 90 mg, umeclidinium bromide 62.5 mg, calcium carbonate vitamin D tablet, ferrous sulfate 325 mg, guaifenesin ER 600 mg and Pepcid 20 mg. On 03/31/24, doxycycline monohydrate 100 mg was not administered due to not available. Review of the MAR dated April 2024 revealed on 04/06/24 at 9:16 A.M., the oxcarbazepine 300 mg was not administered due to on order; on 04/07/24 at 10:53 A.M., Pepcid 20 mg was not administered due to awaiting delivery; on 04/24/24 at 10:49 A.M., meclizine MCI 12.5 mg was not administered. 2. Review of medical record for Resident #41 revealed an admission date of 03/13/24, with diagnoses of paraplegia, unspecified, urinary tract infection, absence epileptic syndrome, intractable, and without status epilepticus. Review of the quarterly MDS assessment dated [DATE] revealed Resident #41 was cognitively intact. Review of physician orders dated 03/14/24, to administer buspirone HCl oral tablet 15 mg, give 1 tablet by mouth three times a day; Insulin Lispro (1 Unit Dial) Subcutaneous Solution Pen-injector 100 unit/ml (Insulin Lispro) inject as per sliding scale: if 150 - 200 = 4unit (u); 201 - 250 = 6u; 251 - 300 = 8u; 301 - 350 = 10u; 351 - 400 = 12u; 401 - 500 = 14u, Notify physician (MD) if <70 or >500, subcutaneously before meals and at bedtime; Nucynta oral tablet (tapentadol HCl), 50 mg, give 1 tablet by mouth three times a day for pain management; Pregabalin oral capsule 75 mg, give 75 mg by mouth three times a day for pain - take 1 capsule (75 mg total) by mouth in the morning and 1 capsule (75 mg total) at noon and 1 capsule (75 mg total) in the evening; methocarbamol oral tablet, 500 mg, give 1 tablet by mouth three times a day for muscle spasms; levothyroxine sodium oral tablet 50 mcg, give 50 mcg by mouth in the morning for hypothyroidism, polyethylene glycol powder, give 17 gram orally two times a day for constipation, Theragran-M oral tablet (multiple vitamins w/ minerals) give 1 tablet by mouth one time a day for vitamin supplement, Desitin External Paste 40 % (zinc oxide) apply to bilateral buttocks topically, one time a day for skin condition; and Estrogens Conjugated Vaginal Cream, 0.625 mg/gram, insert 0.5 gram vaginally one time a day for vaginal dryness. Review of physician orders dated 03/15/24, to administer midodrine HCl oral tablet 10 mg, give 1 tablet by mouth three times a day for low blood pressure hold for systolic blood pressure (SBP) >120 and chlorhexidine gluconate external liquid 4 %, apply to rash topically one time a day every Tuesday, Friday for Skin condition. Review of a physician order dated 03/19/24, to administer Pyridium oral tablet (phenazopyridine HCl) 100 mg, give 1 tablet by mouth three times a day for dysuria. Review of a physician order dated 03/24/24, to administer Pentosan Polysulfate Sodium oral capsule 100 mg, give 1 capsule by mouth three times a day for behavior problems. Review of a physician order dated 04/01/24, to administer Cephalexin capsule 500 mg, give 1 capsule by mouth three times a day for infection/urinary tract infection (UTI) for 7 days. Review of the MAR for March 2024 revealed on 03/14/24, Pentosan Polysulfate Sodium 100 mg was not documented as not given and documented as OT, and buspirone 15 mg afternoon dose not documented as given. On 03/15/24, Pentosan Polysulfate Sodium 100 mg, afternoon dose was documented as OT and not 365640 Page 2 of 5 365640 04/25/2024 Sycamore Trails Post Acute 450 Oak Ridge Boulevard Miamisburg, OH 45342

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some given; Insulin Lispro 100 unit / ml was not documented as given; and Nucynta 50 mg documented as 2:00 P.M., dose OT and not given. On 03/16/24, Pentosan Polysulfate Sodium 100 mg, evening dose was documented as OT and not given. On 03/19/24, Pregabalin Oral Capsule 75 mg was not documented as given; Nucynta 50 mg was not documented as given; Methocarbamol 500 mg was not documented as given; and Levothyroxine Sodium 50 mcg not documented as given. On 03/24/24, Pentsan Polysulfate Sodium 100 mg morning and afternoon dose documented as drug not available and not given; and on 03/27/24, Pentsan Polysulfate Sodium 100 mg morning and afternoon dose documented as OT and drug not given. Review of the MAR for April 2024 revealed on 04/04/24, Levothyroxine Sodium 50 mcg not documented as given; and Cephalexin 500 mg, 8:00 A.M. dose not documented as given. On 04/12/24, Midodrine HCI 10 mg afternoon dose not documented as given. On 04/20/24, Insulin Lispro 100 units / 1 ml , 7:30 A.M. and 5:30 P.M. dose not documented as given; Pyridium 100 mg, morning dose not documented as given; Midodrine HCI 10 mg, morning and afternoon dose not documented as given; Buspirone 15 mg not documented as given; Polyethylene Glycol 17 gram documented as drug not available and not given; Theragram-M not documented as given; Desitin External Paste 40% not documented as given; and Extrogens Conjugated Vaginal Cream 0.625 mg / gm Insert 0.5 gram not documented as given; and on 04/23/24, Chlorhexidine Gluconate External Liquid 4% was documented as drug not available and not given. 3. Review of medical record for Resident #62 revealed an admission date of 03/22/24, with diagnoses of hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting left non-dominant side, and epilepsy, not intractable, without status epilepticus. Review of the quarterly MDS assessment dated [DATE], revealed Resident #63 with moderate cognitive impairment. Review of physician orders dated 03/23/24, to administer Depakote oral tablet delayed release (divalproex sodium) 250 mg, 3 times daily for seizures and levetiracetams oral tablet 1000 mg, 2 times daily for seizures. Review of the Electronic Medical Record (EMAR) Resident Detail report for April 2024, revealed Resident #58 received the Depakote Oral Tablet Delayed Release 250 mg (Divalprox Sodium) on 04/22/24 at 1:34 A.M., 9:58 A.M. and 11:30 P.M.; on 04/11/24 at 1:18 A.M.; on 04/10/24 at 12:38 A.M.; on 04/08/24 at 4:23 P.M. and 12:54 A.M.; on 04/05/24 at 5:44 A.M.; on 04/04/24 at 1:47 A.M.; on 04/02/24 at 3:24 A.M.; and on 04/01/24 at 1:20 P.M. The times were not consistent, or the medication was not administered 3 times a day or at all. Review of the EMAR Resident Detail report for March and April 2024, revealed Resident #58 received the levetiracetam oral tablet 1000 mg on 03/29/24 at 12:33 P.M.; on 03/30/24 at 2:22 A.M.; on 04/01/24 at 1:20 A.M.; on 04/02/24 at 3:24 A.M. and 1:18 P.M., on 04/04/24 at 1:48 A.M., on 04/05/24 at 5:44 A.M., on 04/08/24 at 12:54 A.M. and 1:48 P.M.; on 04/10/24 at 12:39 A.M. and 12:46 A.M.; on 04/11/24 at 1:19 A.M.; on 04/15/24 at 11:42 A.M.; on 04/21/22 at 11:22 A.M.; and 04/22/24 at 1:34 A.M. and 11:30 P.M. The times were not consistent, or the medication was not administered 2 times a day or at all. 4. Review of medical record for Resident #63 revealed an admission date of 03/14/24, with diagnoses unspecified convulsions, Crohn's disease, irritable bowel syndrome without diarrhea, and constipation. Review of the physician orders dated 03/15/24, to administer MiraLax Oral Packet (polyethylene 365640 Page 3 of 5 365640 04/25/2024 Sycamore Trails Post Acute 450 Oak Ridge Boulevard Miamisburg, OH 45342

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some glycol 3350) give 17 grams by mouth two times a day for constipation; Nifedipine Extended Release (ER) 90 mg oral tablet 24 hour, give 1 tablet one time a day for hypertension; and Lunesta oral tablet 2mg (eszopiclone) give 1 tablet one time a day for sleep. Review of the physician order dated 03/16/24, to administer Lidocaine External Patch 4 %, apply to lower back topically one time a day for pain. Review of the physician order dated 03/20/24, to administer Hydrocortisone external cream 2.5%, apply to inner thighs and groin for chaffing. Review of the physician order dated 03/23/24, to administer Zofran 4 mg, give 1 tablet by mouth before meals for nausea. Review of the MAR for March 2024 for Resident #63 revealed on 03/23/24, Hydrocortisone external cream 2.5%, apply to inner thighs and groin documented as OT (other and not administered in the morning). On 03/28/24, Zofran 4 mg, documented as OT (other) and not administered for 7:30 A.M. dose. Review of the MAR for April 2024, for Resident #63 revealed on 04/10/24, Lidocaine 4% Patch documented as OT (other) and not administered in the morning. On 04/12/24, Miralax 17 grams documented as OT (other) and not administered in the morning. On 04/14/24, Miralax 17 grams documented as not available and not administered in the morning. On 04/19/24, Nifedipine ER 90 mg documented as not available and not given in the morning. On 04/20/24, Nifedipine ER 90 mg documented as OT (other) and not given in the morning. On 04/21/24 and 04/22/24, Lunesta 2 mg documented as OT (other) and not administered in the evening. Interview on 04/24/24 at 10:35 A.M., with Licensed Practical Nurse (LPN) #325 revealed medications are administered if available, and the facility runs out of stock medications frequently. LPN #325 stated when medications are not available nurses will chart DN for drug not available or OT for other and sometimes the nurses will document in the nurses notes about this. Interview on 04/24/24 at 11:29 A.M., with Registered Nurse (RN) #336 revealed if it is documented on the MAR as DN, it means drug is not available and not given; if OT is documented on the MAR, it also means the drug was not given. RN #336 stated it is just for another reason other than drug not available and should be documented in the notes as to why, but that never happens. RN #336 stated it is the nurses responsibility to reorder drugs and supplies timely, but that does not always happen. RN #336 stated it is a weekly problem that medications are not available and there is not a backup supply of over-the-counter medications available when the supply runs out. Interview on 04/24/24 at 4:25 P.M., with Director of Nursing (DON) revealed there were no concerns reported related to medications not available. DON reported if it is an over-the-counter medication, the facility will go to Walmart or the local pharmacy and pick it up. DON verified the medications were not documented as being administered per physician orders for Resident #21, #41, #58 and #63. Review of the facility provided Medication Pass Times scheduled revealed pass times for 2 times daily are 7:00 A.M. - 11:00 A.M. and 7:00 A.M. - 11:00 P.M. Review of the facility provided Medication Pass Times schedule revealed the pass times for 3 times daily are 7:00 A.M. - 11:00 A.M. and 1:00 P.M. - 2:30 P.M. and 7:00 P.M. - 11:00 P.M. 365640 Page 4 of 5 365640 04/25/2024 Sycamore Trails Post Acute 450 Oak Ridge Boulevard Miamisburg, OH 45342

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the policy titled, Specific Medication Administration Procedures, dated November 2021, revealed it is the policy to administer medications in a safe and effective manner. Review 5 rights 3 times, check Medication Administration Record (MAR) / Treatment Administration Record (TAR) for order. This deficiency represents non-compliance investigated under Master Complaint Number OH00153130 and Complaint Number OH00152823 365640 Page 5 of 5