Health inspection·January 5, 2024

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 medical record review, policy review and staff interview, the facility failed to ensure medications were administered per physician orders. This affected one (#2) of 3 residents reviewed for medication administration. The current census is 76. Findings include: Review of Resident #2's medical record revealed an admission date of 12/01/23 and discharged home on [DATE]. Diagnoses for Resident #2 included: aftercare for orthopedic surgery, fracture of femur, hemiplegia, dysphagia, and weakness. Review of the comprehensive Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had impaired cognition, pain, and was a one-person assist for Activities of Daily (ADL). Review of Resident #2's care plans dated 12/04/23 revealed a focus for risk of pain. Interventions include administering medications per physician order, monitoring for pain symptoms, offer non-pharmacological interventions, and therapy as needed. Review of Resident #2's physician orders dated 12/01/23 revealed Resident #2 was prescribed Ferrous Sulfate 325 milligrams (mg) one time a day, Hydrocodone- Acetaminophen 5-325 mg every 6 hours for pain, Spironolactone 25 mg daily for hypertension, Aspirin 81 mg every 12 hours for post op blood thinner, and Docusate Sodium 100 mg twice a day for constipation. Review of Resident #2's Medication Administration Record (MAR) dated December 2023 revealed on 12/02/24, Resident #2 did not receive the ordered Ferrous Sulfate, Spironolactone, Aspirin, and Docusate Sodium for the scheduled morning doses. Further review of Resident #2's MAR revealed the resident received the first dose of Hydrocodone pain medication on 12/02/23 at 8:48 P.M. Review of Resident #2's Narcotic records dated December 2023 revealed one dose of Hydrocodone had been removed from the emergency supply under Resident #2's name. On the narcotic sheet the nurse documented the resident had been given one dose of Hydrocodone on 12/02/23 at 12:20 A.M. No further documentation of the 12/02/23 at 12:20 A.M. administration was noted in the resident's records. Interview on 01/05/24 at 2:45 P.M., with the Administrator verified there was no documentation of Resident #2 receiving her ordered Ferrous Sulfate, Spironolactone, Aspirin, and Docusate Sodium for the scheduled morning doses. Per the Administrator there was one Hydrocodone dose removed from the emergency supply and administered to Resident #2 per the narcotic records. The Administrator verified there was no documentation in the resident's records regarding the administration of the 12/02/24 at Page 1 of 2 365900 365900 01/05/2024 Versailles Rehabilitation and Health Care Center 200 Marker Road Versailles, OH 45380

F 0755 12:20 A.M. dose and its effectiveness. Level of Harm - Minimal harm or potential for actual harm Review of the undated policy titled, Administering Medications, revealed per policy all medications are to be administered in a timely manner as prescribed. Residents Affected - Few This deficiency represents non-compliance discovered during investigation of Master Complaint Number OH00149236 and Complaint Number OH00148941. 365900 Page 2 of 2