Health inspection·August 10, 2023

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 and staff interview, the facility failed to ensure narcotic pain medication was available in a timely manner following admission to the facility. This affected one resident (Resident #53) of three residents reviewed for admission medication availability. The facility census was 52. Findings include: Review of Resident #53's closed medical record revealed an admission date of 07/27/23 with diagnoses that included left femur fracture with repair and hypertension. Further review of the medical record revealed a physician's order upon admission on [DATE] at 4:17 P.M. which initiated the use of oxycodone (opioid narcotic analgesic) 5 milligrams (mg) every six hours as needed (prn). Review of the 07/27/23 Pain Assessment, listed on the Medication Administration Record, revealed from 7:00 P.M. to 7:00 A.M. the resident had a pain rating of three on a numerical scale of 0-10 (zero being no pain and 10 being the worst pain). There was no evidence of the time the resident was assessed for pain or any documentation related to intervention, if any. Review of the Medication Administration Record (MAR) revealed no evidence of the oxycodone was administered until 07/28/23 at 12:04 P.M., nearly 20 hours after the physician's order was entered. According to the MAR, the resident's pain rating was a 10 on a 0-10 pain scale on 07/28/23 at 12:04 P.M. when she was medicated with the as needed oxycodone dose. Further review of the medical record found no documentation regarding the oxycodone availability or contact of physician and pharmacy to advise of medication not available. Interview with Licensed Practical Nurse (LPN) #65 on 08/10/23 at 8:37 A.M. revealed she was the nurse who admitted Resident #53 to the facility. She indicated Resident #53 was admitted at approximately 3:00 to 4:00 P.M. from her (Resident #53) residence. The resident had a week earlier discharged home from a hospital after surgery and changed her mind about needing skilled nursing care and therapy. Resident #53 did not have a prescription for the oxycodone as the resident had filled the prescription when she discharged from the hospital to home. LPN #65 stated she contacted the nurse practitioner who told her to contact the physician as he wanted to handle all narcotic orders. LPN #65 contacted the physician at approximately 4:15 P.M., advised him of the need for a prescription for Resident #53's oxycodone. He provided her the order for oxycodone at this time. LPN #65 faxed the controlled medication order to the physician and pharmacy at this time. Further interview revealed LPN #65 (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 2 Event ID: 365904 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 365904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Saint Joseph Care Center 2308 Reno Drive NE Louisville, OH 44641 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)