Health inspection·March 7, 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, staff interview, review of the hospice contract, and review of the facility policy, the facility failed to ensure pain medications were available for a resident experiencing pain and discomfort at the end of life. This affected one (Resident #32) of three residents reviewed for pain management. The facility census was 28. Findings include: Review of the medical record for Resident #32 revealed an admission date of 01/10/18 and a discharge date of 02/12/24. Diagnoses included Parkinson's disease, dementia, and chronic kidney disease (CKD). Review of the significant change Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #32 was admitted to hospice services. Resident #32 was cognitively impaired. Review of the physician orders for Resident #32 revealed an admission date to hospice care on 02/07/24, and morphine sulfate 20 milligram (mg)/milliliter (ml) and give 0.5 ml every two hours for pain and/or shortness of breath (SOB), written on 02/09/24 at 2:50 P.M. Review of the nursing notes dated 02/08/24 untimed, revealed Resident #32 was medicated for pain with Tylenol (treats mild pain), awaiting order at this time, and pain noted with turning/providing care. The nursing note dated 02/09/24 untimed, revealed during morning care, Resident #32 was reluctant to move and moaned and grimacing with each movement. Hospice notified and aware, will address each issue and notify the power of attorney (POA). The nursing note dated 02/10/24, untimed, revealed Resident #32 exhibited increased discomfort still awaiting medications/physician order clarification on call notified. The nursing note dated 02/10/24 at 12:16 A.M. revealed Resident #32's morphine medication did not arrive with delivery from pharmacy, spoke with pharmacy and they informed me that the quantity needed clarified and new e-script in order to fill. Hospice contacted and updated with the clarification needs and updated that Resident #32 was in pain. Hospice followed up confirming they sent the clarification and e-script in. The nurse then called pharmacy and requested an authorization from the pharmacist to pull medication from the starter box, technician confirmed that they did receive it and sent request as urgent. After not hearing back a second request was made, now stating they needed the (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: 366031 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 366031 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mill Manor Care Center 983 Exchange St Vermilion, OH 44089 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)