Health inspection·May 2, 2024

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Based on record review and staff interview the facility failed to ensure nonpharmacological interventions were attempted and/or behaviors were documented prior to the administration of as needed psychotropic medications. This affected one (Resident #37) of five residents reviewed for unnecessary medications. The facility census was 68. Findings include: Review of the medical record for Resident #37 revealed an admission date of 06/02/21 with diagnoses including unspecified dementia, muscle weakness, depression, unspecified mood disorder, anxiety disorder, and cognitive communication deficit. Review of the quarterly Minimum Data Set (MDS) assessment for Resident #37 dated 01/30/24 revealed the resident had severely impaired cognition and was coded for receiving antipsychotic, antianxiety, and antidepressant medications. Review of the care plan for Resident #37 revised 02/07/24 revealed the resident had the potential for adverse or less than effective results from psychoactive medications. The resident was on antidepressants and medication for anxiety. Interventions included the following: consult with the physician about reductions and schedule per regulations, document on mood and behavior as needed, monitor for side effects of medication, report to the physician as needed. Review of the physician's orders for Resident #37 revealed orders dated 02/28/24 to 03/12/24, 03/13/24 to 03/26/24, 03/27/24 to 04/09/24, 04/11/24 to 04/24/24, and 04/24/24 to 05/07/24, for Ativan/Benadryl/Haldol (ABH) gel to be applied topically every six hours as needed. Review of the physician's orders for Resident #37 revealed an orders dated 02/28/24 to 03/12/24, 03/13/24 to 03/26/24, 03/27/24 to 04/09/24, 04/11/24 to 04/24/24, and from 04/24/24 to 05/07/24 for Ativan 0.5 milligrams (mg) one tablet every six hours as needed. Review of the Medication Administration Record (MAR) for Resident #37 dated March 2024 revealed ABH gel was administered on 03/06/24 with no nonpharmacological intervention documented prior to administration. ABH gel was also administered on 03/15/24, 03/19/24, and 03/31/24 with no documentation indicating why the drug was needed and no nonpharmacological interventions. Ativan tablets were administered on 03/12/24, 03/18/24, and 03/26/24 with no nonpharmacological interventions documented. Ativan was also administered on 03/02/24, 03/09/24, and 03/16/24 with no documentation indicating why the drug was needed and no nonpharmacological interventions noted. (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 5 Event ID: 366076 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 366076 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Eastern Star Hlth Care Ctr The 1451 Gambier Road Mount Vernon, OH 43050 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)