Inspection·April 3, 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. Based on medical record review, staff interview, and review of a facility policy, the facility failed to administer medication as ordered to treat constipation. This affected one (#110) of three residents reviewed for bowel movements. The census was 106. Findings include: Review of Resident #110's medical record revealed an admission date of 02/27/23. Diagnoses included compression fracture of the vertebra, history of hemorrhoid surgery, and moderate protein-calorie malnutrition. Resident #110 was discharged on 03/30/23 to home. Review of Resident #110's bowel movement documents dated from 03/01/23 through 03/11/23 revealed Resident #110 had no bowel movements from 03/02/23 through 03/07/23. Resident #110 had medium sized bowel movements on 03/08/23 at 10:35 A.M., on 03/10/23 at 10:35 A.M., and on 03/11/23 at 1:47 A.M. Review of a history and physical progress note dated 03/10/23 at 6:12 P.M., documented by Physician #500, revealed Resident #110's bowels were assessed with hard stool noted at the rectum that Resident #110 could not push out. Further review of the note revealed Resident #110 was to use a suppository to help soften the hard stool then an enema if the suppository was unsuccessful. Review of a physician order dated on 03/10/23 revealed Resident #110 was ordered the stool softener Dulcolax rectal suppository 10 milligrams (mg) to be inserted rectally stat for constipation. Review of a physician prescriber copy dated on 03/10/23 by Physician #500 revealed Resident #110 had an order for Dulcolax rectal suppository 10 mg to give now. If Resident #110 was unable to pass the stool after the suppository staff were to given an enema. Review of the March 2023 medication administration record revealed no documentation Resident #110 received the Dulcolax rectal suppository on 03/10/23 as ordered. Interview on 03/31/23 at 3:00 P.M. with Director of Nursing (DON) confirmed the Dulcolax rectal suppository should have been give to Resident #110 within four hours. DON stated the pharmacy delivery of medication would have shipped within two to four hours for direct delivery. Interview on 03/31/23 at 3:15 P.M. with Physician #500 verified he saw Resident #110 on 03/10/23 late in the evening about her being constipated. Physician #500 stated Resident #110 had discomfort from her hard stool and stated the Dulcolax rectal suppository was to be administered to Resident #110 right away. (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: 365917 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 365917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Oakwood Village 1500 Villa Road Springfield, OH 45503 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)