Inspection·May 13, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on record review and staff interview, the facility failed to notify the physician of residents not receiving medications as physician ordered. This affected five (Residents #1, #3, #8, #24, and #55) of 13 residents receiving insulin in the facility. The facility census was 63. Findings include: 1. Review of the medical record for Resident #1 revealed an admission dated 04/25/24. Diagnoses included type II diabetes mellitus and end stage renal failure. Review of the medication administration record (MAR) for May 2024 revealed on 05/05/24 at 9:30 P.M., Resident #1 did not have his blood sugar check and did not receive any insulin as physician ordered. At the bottom of the MAR under reasons not administered on 05/05/24 at 9:30 P.M. stated drug/item unavailable. There was no documentation in the medical record that the physician was notified that Resident #1's insulin and blood sugar check were not administered as physician ordered on 05/05/24. Interview on 05/09/24 at 3:00 P.M. with Regional Nurse #310 verified Resident #1 did not receive insulin due to the resident's blood sugar was not taken and was unable to administer insulin per sliding scale. Regional Nurse #310 verified the physician was not notified. 2. Review of the medical record for Resident #3 revealed an admission date of 10/13/23. Diagnosis included type II diabetes mellitus. Review of Resident #3's physician orders for 03/28/24 revealed Humalog KwikPen Insulin (short acting insulin) 100 unit/milliliter (ml) give eight units subcutaneous (SQ) before meals and Lantus Soloster U-100 insulin (long-acting insulin) 100 unit/ml, give 18 units SQ at bedtime. Review of the MAR for May 2024 revealed on 05/05/24 at 9:00 P.M., Lantus 18 unit/ml was not administered, and blood glucose was not checked. On 05/06/24 at 7:30 A.M. glucose sugar was not checked, and insulin was not administered. At the bottom of MAR under reason not administered on 05/06/24 at 7:30 A.M. stated no testing strips available. There was no documentation in the medical record that the physician was notified that Resident #3's insulin and blood sugar check were not administered as physician ordered on 05/05/24 and 05/06/24. Interview on 05/09/24 at 3:00 P.M. with Regional Nurse #310 verified Resident #3 did not receive insulin two times due to the resident's blood sugar was not taken and was unable to administer insulin per sliding scale. Regional Nurse #310 verified the physician was not notified. (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: 365844 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 365844 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aurora Manor Special Care Cent 101 S Bissell Rd Aurora, OH 44202 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)