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 (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 4 Event ID: 365743 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 365743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324 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)