Health inspection·March 27, 2025

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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. Based on observation, record review, resident interview, staff interview, and review of facility policies the facility failed to ensure medications were secured properly. This affected one (Resident #10) of four residents observed for medication administration. Findings include: Review of medical record noted Resident #10 had an admission date of 10/02/24. Diagnoses included chronic obstructive pulmonary disease, unspecified, pain unspecified, post-traumatic stress disorder, depression, type two diabetes mellitus with diabetic neuropathy, and anxiety disorder. Review of the quarterly Minimum Data Set (MDS) assessment 03/25/25 noted Resident #10 had intact cognition. Review of the medical record revealed Resident #10 had no assessment for the self-administration of medication. Observation on 03/24/25 at 9:49 A.M. noted Resident #10 lying in bed with a cup of medications at bedside. Resident #10 verified the cup of medications at bedside and stated staff left the medications for her to take when she was ready. Interview 03/24/25 at 9:52 A.M., Licensed Practical Nurse (LPN) #501 stated she left the medications at the bedside because the resident is alert and will take them when she is ready. LPN #501 stated she would check on Resident #10 in a little bit to see if she took her medications. Interview on 03/24/25 at 10:00 A.M., the Director of Nursing (DON) stated no medications are to be left with residents at bedside, no matter how alert the resident is. The DON stated all staff would receive education immediately. Interview on 03/25/25 at 5:40 P.M. with the DON #645 verified there was no assessment completed indicating Resident #10 could self-administer medications. Review of the facility policy titled, Medication Administration, dated 08/22/22 stated medications are administered by licensed nurses as ordered by the physician and in accordance with professional standards of practice. Nurses are to observe residents consume medications. Review of the facility policy titled Bedside Storage of Medication, dated 2017 noted residents who (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 3 Event ID: 365825 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 365825 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grande Oaks 24579 Broadway Ave Oakwood Village, OH 44146 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)