Health inspection·April 9, 2025

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, staff interviews, review of a Medication Error form, and review of facility policy, the facility failed to ensure residents medications were administered as ordered. This affected four (#42, #50, #63 and #71) out of the seven residents reviewed for medication administration. The facility census was 70. Residents Affected - Some Findings include: 1. Record review for Resident #42 revealed the resident was admitted to the facility on [DATE]. Diagnoses included acute respiratory failure with hypoxia, cerebral infarction, and anoxic brain damage. Review of the physicians order, dated [DATE], revealed the resident was to be administered the anticoagulant Lovenox 15 milligrams (mg) once a day to prevent deep vein thrombosis (blood clot). Review of the physicians order, dated [DATE], revealed the resident was to be administered the anticonvulsant levetiracetam 7.5 mg twice a day for seizures. Review of the Medication Administration Record (MAR) for 02/2025 revealed scheduled doses of Lovenox were documented to have not been administered on [DATE] or [DATE]. The scheduled doses of levetiracetam were documented to have not been administered in the evening on [DATE] or the morning on [DATE]. Review of the progress note, dated [DATE] and timed 8:50 P.M., revealed levetiracetam was not available for administration, waiting on pharmacy to supply. Review of the progress note, dated [DATE] and timed 2:13 P.M. revealed levetiracetam was not available for administration, waiting on pharmacy to deliver. Review of the nurses progress note, dated [DATE], revealed the nurse notified the physician the resident did not receive levetiracetam on [DATE] or [DATE] as ordered due to the pharmacy not delivering the medication. Review of the progress note, dated [DATE] and timed 10:28 A.M., revealed the Lovenox was not available, reordered from pharmacy. Review of the progress note, dated [DATE] and timed 10:30 A.M., revealed the physician and resident's spouse were notified of the missed dose of Lovenox. The medication was reordered from pharmacy. (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 6 Event ID: 365673 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 365673 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Embassy of Woodview 2770 Clime Road Columbus, OH 43223 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)