Health inspection·April 21, 2022

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 record review and interview, the facility failed to ensure one resident (Resident #322) received scheduled doses of anticoagulant (blood thinner) medication due to unavailability of the medication. This affected one (Resident #322) out of five (Resident #11, #12, #63, #69 #322) residents reviewed for unnecessary meds. The census was 79. Findings include: Medical record review revealed Resident #322 was admitted to the facility on [DATE] with diagnoses that included cerebral infarction, hypertension, hyperlipidemia, type II diabetes, acute kidney failure, protein-calorie malnutrition and depression. Review of physician's admission orders dated 04/07/22 indicated Resident #322 was prescribed the anticoagulant Heparin Sodium Solution 5,000 unit/ per milliliter (ml), inject one ml (5,000 units) subcutaneously two times a day for anticoagulation therapy. Review of the Medication Administration Record for April 2022 indicated two doses of Heparin 5,000 units was not given as scheduled on 04/15/22 at 8:00 A.M. and on 04/15/22 at 8:00 P.M. Review of nurse progress note dated 04/15/22 at 10:45 P.M. indicated medication was on its way from pharmacy and would be given by third shift. During interview on 04/20/22 at 3:40 P.M., the Director of Nursing (DON) confirmed that the Heparin was not administered to Resident #322 because it was not available from the pharmacy. The DON also indicated that the Pyxis Medstation (an automated medication dispensing machine) did not have Heparin Sodium Solution 5,000 unit/ml available at the time. The DON indicated pharmacy usually drop-ships medications but she was unsure what happened this time. Review of the facility's policy entitled Medication Administration - General Guidelines dated May 2020, indicated if a medication with a current, active order could not be located in the medication cart/drawer, other areas of the medication cart, medication room, and facility (i.e. other units) were to be searched, if possible. If the medication could not be located after further investigation, the pharmacy was to be contacted, or medication removed from the starter box. If a dose of regularly scheduled medication was withheld, refused, not available, or given at a time other than the scheduled time, that dosage administration was to be flagged and documented accordingly. An explanatory note was to be entered on the record. If a dose of a vital medication was withheld, refused, or not available, the prescriber was to be notified unless otherwise instructed by the prescriber. Nursing was (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: 365927 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 365927 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regina Health Center 5232 Broadview Rd Richfield, OH 44286 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)