Health inspection·June 18, 2025

F 0605 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to complete a gradual dose reduction (GDR) or documentation of a clinical contraindication for not attempting a GDR for a resident on two antipsychotics. This affected one (Resident #16) of five residents reviewed for unnecessary medications. The facility census was 67. Findings include: Record review of Resident #16 revealed this resident was admitted to the facility on [DATE]. Diagnoses included paranoid schizophrenia. Review of the Minimum Data Set (MDS) assessment completed on 04/02/25 revealed Resident #16 had cognitive impairments. Review of the physician orders revealed Resident #16 was on the following medications: on 02/11/23, Perphenazine (antipsychotic) 8.0 milligrams (mg) one tablet by mouth four times a day for paranoid schizophrenia. On 02/21/24, Ziprasidone (antipsychotic) 80 mg one tablet by mouth twice daily for paranoid schizophrenia, Resident #16's medical record did not have evidence have a GDR attempt for the two antipsychotic medications (Perphenazine and Ziprasidone) nor rationales why a GDR would be contraindicated. Interview with the Director of Nursing (DON) on 06/18/25 at 3:10 P.M. verified there were no attempts a GDR was attempted for the use of the two antipsychotic medications (Perphenazine and Ziprasidone) nor was there rationale why a GDR would be contraindicated for Resident #16 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 3 Event ID: 365932 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 365932 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edgewood Manor of Lucasville II 10098a Bear Creek Road Lucasville, OH 45648 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)