Inspection·March 20, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the medical record, staff interview, and review of facility policies, the facility failed to ensure a physician was notified when the facility was unable to administer a resident's enteral nutrition as ordered. This affected one (#38) of two residents reviewed for tube feeding. The facility census was 28. Findings include: Review of the medical record revealed Resident #38 had an admission date of 02/12/24 and a discharge date of 02/20/24. Diagnoses included end stage renal disease, liver disease, autoimmune hepatitis, depression, generalized anxiety disorder, dysphagia, gastrostomy status, and liver transplant status. Review of the Minimum Data Set (MDS) five-day assessment dated [DATE] revealed Resident #38 had intact cognition. The resident required set-up assistance for meals and had a feeding tube. Review of hospital discharge orders dated 02/12/24 revealed Resident #38 had orders for Jevity 1.5 (nutritional formula) at 20 milliliters (ml) per hour by percutaneous endoscopic gastrostomy (PEG) tube. Review of a physician order dated 02/12/24 revealed Resident #38 had orders for enteral feed continuous Jevity 1.5 at 20 milliliters (ml) per hour. Review of Resident #38's medication administration record from 02/12/24 through 02/15/24 revealed there was no documentation that the resident received the Jevity 1.5 enteral feed. Review of Resident #38's nursing notes from 02/12/24 through 02/15/24 revealed no documentation the physician was notified the enteral feed was not administered. Review of a medication note dated 02/14/24 at 4:01 A.M. revealed the facility was awaiting delivery of feed and pump. Interview on 03/20/24 at 10:44 A.M., with Registered Nurse (RN) #124 revealed Resident #38 was admitted with orders for continuous PEG tube feeding. RN #124 revealed the resident's family brought in the nutritional formula for the tube feeding. RN #124 revealed the pump required to administer the tube feeding was not working and a new one was ordered. RN #124 was not sure when the new pump arrived. RN #124 further revealed she believed by the time the new pump arrived the resident had already been changed to bolus PEG tube feedings. Interview on 03/20/24 at 10:55 A.M., with the Director of Nursing (DON) verified Resident #38 had (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: 366081 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 366081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Care Center 1406 Oak Harbor Rd Fremont, OH 43420 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)