Health inspection·January 18, 2024

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview the facility failed to ensure resident assessments were accurately completed. This affected two (#15 and #31) of two residents reviewed for accurate resident assessments. The facility census was 43. Residents Affected - Few Findings include: 1. Review of the medical record revealed Resident #15 was admitted on [DATE]. Diagnoses included chronic obstructive pulmonary disease, acute and chronic respiratory failure, hemiplegia affecting left nondominant side, essential hypertension, Alzheimer's disease, major depressive disorder, and acute respiratory failure with hypoxia. Review of the Minimum Data Set assessment dated [DATE] revealed Resident #15 was cognitively intact. The assessment documented Resident #15 was taking an anticoagulant. Review of current physician orders revealed an order dated 09/15/22 for aspirin chewable tablet 81 milligram (mg) with directions to give one tablet by mouth one time a day. 2. Review of the medical record revealed Resident #31 was admitted on [DATE]. Diagnoses included poly-osteoarthritis, unspecified dementia, unspecified osteoarthritis, essential hypertension, type two diabetes mellitus without complications, muscle weakness, fibromyalgia, unspecified dementia, hyperlipidemia, anxiety disorder, and depression. Review of the MDS assessment dated [DATE] revealed Resident #31 was severely cognitively impaired. The assessment documented Resident #31 was taking an anticoagulant. Review of physician orders dated 01/26/23 revealed an order for aspirin tablet delayed release 81 milligram (mg) with directions to give one tablet by mouth at bedtime. Review of physician orders from 01/25/23 to 01/18/24 revealed no medications classified as a anticoagulant were prescribed for Resident #31. Interview on 01/18/24 at 8:33 A.M. with MDS Coordinator #150 verified Resident #15 and #31's physician order for aspirin were miscoded as an anticoagulant. Page 1 of 2 365680 365680 01/18/2024 Vancrest of Hicksville 601 Defiance Avenue Hicksville, OH 43526

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and policy review, the facility failed to ensure medications stored in the medication room were not expired. This had the potential to affect all residents who resided in facility. The facility census was 43. Findings include: Observation on [DATE] at 11:09 A.M. of medication storage room revealed 17 bottles of Milk of Magnesia with expiration date of 09/2023, and two bottles of polyethylene glycol with expiration date of 06/2023 in a cupboard hanging on the wall. Observation on [DATE] at 11:15 A.M. and 11:38 A.M. of both medication carts revealed no outdated Milk of Magnesia or polyethylene glycol. Medication cart on the C hall had no Milk of Magnesia. Interview on [DATE] at 11:11 A.M. with Licensed Practical Nurse (LPN #167) verified 17 bottles of Milk of Magnesia were expired as of [DATE], and two bottles of polyethylene glycol were expired as of 06/2023. Interview on [DATE] at 11:57 A.M. with Registered Nurse (RN #166) verified if the cart did not have Milk of Magnesia they would get it from the medication storage room if available or call the pharmacy if none available in the medication storage room. Interview on [DATE] at approximately 3:45 P.M. with Director of Nursing (DON) verified that every resident had an order for bowel protocol which included if no bowel movement in three days administer Milk of Magnesia per order. Review of policy titled, Storage of Medications revised [DATE] revealed the facility shall not use outdated, discontinued, or deteriorated drugs or biologicals. All such drugs shall be returned to the dispensing pharmacy or destroyed. 365680 Page 2 of 2