Health inspection·December 27, 2023

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Residents Affected - Few Based on record review, review of Self-Reported Incidents, and staff interviews the facility failed to ensure resident medications were not misappropriated. This affected two (Residents #32, #84) of three reviewed for misappropriation. The facility census was 80. Findings include: 1. Review of the medical record for Resident #32 revealed an admission date of 06/11/22. Medical diagnoses included but were not limited to Chronic Obstructive Pulmonary Disease (COPD), type two diabetes mellitus, anxiety, and rheumatoid arthritis. Review of Resident #32's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview Mental Status (BIMS) score of 15, indicating intact cognition. Resident #32 required maximum assistance with toileting, bed mobility, transfers and supervision for eating. Review of physician orders for Resident #32 revealed an order for Oxycodone (pain medication) 10 milligram (mg) tablet every six hours as needed for pain. Review of the November Medication Administration Record (MAR) for Resident #32 revealed no documentation the medication was given on 11/11/23. Review of the narcotic sign out sheet for Resident #32 revealed 10 mg of Oxycodone was documented as given eight times on 11/11/23 by Licensed Practical Nurse (LPN) #110. Review of the Self-Reported Incident (SRI) completed 11/17/23 revealed a Registered Nurse (RN) reported concerns about a narcotic count sheet for Resident #32. Interview with Resident #32 revealed she only gets pain pills in the morning and night and to the best of her knowledge, she did not receive any extra pain medications. LPN #110 was interviewed and stated, She screwed up and gave residents too much medication. On 11/10/23, LPN #110 had documented eight pills being given on the narcotic sheet, but there was no documentation on the MAR that extra pills were given. It was also discovered that another resident (Resident #84) on the same date was dispensed six pills of Oxycodone 10-325 mg. Interview with the Medical Director revealed if the amounts were given as documented, the residents would have been lethargic, which they were not. LPN #110 was terminated, and the facility substantiated the allegation of misappropriation. 2. Review of the medical record for Resident #84 revealed an admission date of 11/07/23. Medical Page 1 of 4 365743 365743 12/27/2023 Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few diagnoses included but were not limited to lung cancer, chronic obstructive lung cancer, and bipolar disorder. Review of Resident #84's admission MDS assessment dated [DATE] revealed a Brief Interview Mental Status (BIMS) score of 12 indicating impaired cognition. The resident required set up for eating, bed mobility, transfers, and toileting Review of the physician orders for Resident #84 revealed an order for Oxycodone-Acetaminophen (pain medication) 10-325 mg one tablet every four hours as needed. Review of the November MAR revealed Resident #84 was given one Oxycodone-Acetaminophen on 11/11/23 at 12:09 A.M., 2:05 P.M., and 7:00 P.M. Review of the narcotic sign out sheet for Resident #84 revealed Oxycodone was documented as given six times on 11/11/23 by LPN #110. Interview on 12/14/23 at 9:41 A.M. with the Director of Nursing (DON) and the Administrator revealed they were contacted by Assistant Director Of Nursing (ADON) #105 regarding a concern for the amount of narcotics documented as given on the narcotic sheet for Resident #32. The DON shared she interviewed Licensed Practical Nurse (LPN) #110 who informed her she made medication errors by giving too much pain medication. The DON requested LPN #110 have a drug screen done, LPN #110 agreed and the test was negative, she was taken off the schedule as the investigation continued. Initially the error was believed to be a documentation error until during the investigation a second resident's (Resident #84) narcotic concern was identified. LPN #110 was terminated, the Pharmacy, Ohio Board of Nursing and the Police were notified. The facility continued to assist them in their investigations. Plans of Correction were discussed at Quality Assurance and Performance Improvement (QAPI) and implemented. Review of the SRI completed 11/20/23 revealed on 11/10/23, it appeared Resident #84 was given five extra Oxycodone 10/325 mg within a 12-hour period from review of the narcotic sheet and MAR. Interview with LPN #110 revealed, She screwed up and gave the resident too much medication. Interview with the Medical Director and Physician's Assistance revealed they did not receive a call from LPN #110 to administer extra pain medication. The facility substantiated the allegation of misappropriation. The deficient practice was corrected on 11/17/23 when the facility implemented the following corrective actions: • LPN #110 was terminated. • Staff education was provided on medication administration, following physician orders, signing as needed narcotics on the Electronic Medical Record (EMAR) as well as controlled substance log by 11/16/23. • 365743 Page 2 of 4 365743 12/27/2023 Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324

F 0602 30 day look back of controlled substance record for all residents on affected unit by 11/14/23. Level of Harm - Minimal harm or potential for actual harm • Pain assessments were completed for residents on the effected unit by 11/14/23. Residents Affected - Few • Audits of three residents narcotic record and EMAR weekly for four weeks starting week 11/17/23 and ending week 12/11/23. 365743 Page 3 of 4 365743 12/27/2023 Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324

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 interviews, the facility failed to ensure medications were given as ordered. This affected one (Resident #32) of three residents reviewed for medication administration. The facility census was 80. Findings include: Review of the medical record for Resident #32 revealed an admission date of 06/11/22. Medical diagnoses included but were not limited to Chronic Obstructive Pulmonary Disease (COPD), type two diabetes mellitus, anxiety, and rheumatoid arthritis. Review of Resident #32's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview Mental Status (BIMS) score of 15, indicating intact cognition. The resident required maximum assistance with toileting, bed mobility, transfers, and supervision for eating. Review of physician orders for Resident #32 revealed an order for Furosemide (diuretic) 40 milligrams (mg) daily, Levothyroxine (thyroid) 125 micrograms (mcg) daily, Omeprazole (reflux) 20 mg daily, Baclofen (pain) 10 mg every eight hours, Gabapentin (nerve pain) 300 mg every eight hours, Ipratropium-Albuterol 0.5-2.5 mg per (/) 3.0 milliliter (ml) solution, one inhalation every six hours. Review of the November Medication Administration Record (MAR) revealed Furosemide (diuretic) 40 milligrams (mg) daily, Levothyroxine (thyroid) 125 micrograms (mcg) daily, Omeprazole (reflux) 20 mg daily scheduled for 5:45 A.M. was not documented as given on 11/09/23, 11/11/23, 11/13/23, and 11/24/23. Baclofen (pain) 10 mg every eight hours, Gabapentin (nerve pain) 300 mg every eight hours, Ipratropium-Albuterol 0.5-2.5 mg per (/) 3.0 milliliter (ml) solution, one inhalation every six hours scheduled for 6:00 A.M. was not documented as given on 11/09/23, 11/11/23, 11/13/23, and 11/24/23. Interview on 12/27/23 at 4:16 P.M. with Assisted Director of Nursing (ADON) #105 verified missing documentation of medications for Resident #32. ADON #105 shared LPN #105 worked on 11/09/23 and 11/11/23 and LPN #109 worked on 11/13/23 and 11/24/23 and the facility was unable to provide documentation the medications had been given as ordered. This deficiency represents non-compliance investigated under Complaint Number OH00148467. 365743 Page 4 of 4