Inspection·July 13, 2023

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 and staff interview the facility failed to ensure the responsible party for Resident #10 was notified of medication changes. This affected one resident (Resident #10) of three reviewed for notification of change. The facility census was 48. Findings included: Review of the medical record revealed Resident #10 was admitted to the facility on [DATE]. Diagnoses included quadriplegia, contractures, dysphagia, COVID-19, vascular dementia, protein-calorie malnutrition, schizophrenia, constipation, cervicalgia, osteoporosis, scoliosis, paralytic syndrome, major depressive disorder, kyphosis, anxiety disorder, intentional harming self with firearm discharge, and allergic rhinitis. Review of the Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #10 had moderately impaired cognition. She required total assistance of two staff for bed mobility, transfers, toilet use and one staff for dressing, eating and personal hygiene. Review of the physician's orders dated 02/01/23 revealed Resident #10 had orders for her Depakote 500 milligrams to be increased from twice daily to three times daily and her Exelon patch increased from 9.5 milligrams in 24 hours to 13.3 milligrams in 24 hours. Review of the progress notes from 01/31/23 to 02/07/23 revealed no documentation the responsible party for Resident #10 was notified of her medication changes. On 07/12/23 at 12:17 P.M. an interview the Director of Nursing revealed the brother of Resident #10 was her responsible party. She indicated he absolutely would not let them change her medication in any way. She stated Resident #10 had increased screaming and behaviors at night so they increased her Depakote and Exelon patch. She stated her brother and sister were both notified when the changes were made by the psychiatrist. She stated the brother came into the facility screaming because her medications were changed and he was not notified. She explained to him he was left a voice message about the medication changes. She stated she sat down with him and the went over all of her medication and they were changed back to what they were prior to the changes and he stated he did not want the psychiatrist to see her anymore. She stated she was not aware of her being lethargic. On 07/12/23 at 1:50 P.M. an interview with the Director of Nursing verified there was no documentation the responsible party for Resident #10 was notified of her medication changes on 02/01/23. (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: 366087 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 366087 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center, The 100 Vista Drive Lisbon, OH 44432 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)