Health inspection·June 20, 2025

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 record review and interview, the facility failed to ensure Resident #27's Gabapentin medication was not administered to Resident #21. This finding affected two (Residents #21 and #27) of six residents reviewed for medication administration. Findings include: Review of Resident #21's medical record revealed the resident was admitted on [DATE] and discharged on [DATE] with diagnoses including encounter for orthopedic aftercare, cerebral palsy and anxiety disorder. Review of Resident #21's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited intact cognition. Review of Resident #21's physician orders revealed an order dated [DATE] for Gabapentin oral tablet 800 mg (milligrams) give one tablet by mouth four times a day for 120 days due at 12:00 A.M., 6:00 A.M., 12:00 P.M. and 6:00 P.M.; and an order dated [DATE] to give Gabapentin 600 mg one time only for nerve pain for one day. Review of Resident #21's progress note dated [DATE] at 3:03 P.M. authored by Licensed Practical Nurse (LPN) #809 revealed it was okay to give a one-time dose of 600 mg of Gabapentin as ordered by the physician. Review of Resident #21's progress note dated [DATE] at 3:13 P.M. authored by LPN #809 revealed the Gabapentin oral tablet 800 mg due at 12:00 P.M. was held and a one-time only dose of 600 mg was administered to the resident. The physician was aware. Review of Resident #21's medication administration records (MARS) from [DATE] to [DATE] revealed the medications were administered as ordered. Review of Resident #27's medical record revealed the resident was admitted on [DATE] and expired in the facility on [DATE] with diagnoses including hemiplegia, chronic obstructive pulmonary disease and bipolar disorder. Review of Resident #27's physician orders revealed an order dated [DATE] (discontinued [DATE]) for Gabapentin 600 mg give one tablet by mouth three times a day; and an order dated [DATE] for Gabapentin 600 mg give one tablet by mouth four times a day. Page 1 of 2 366187 366187 06/20/2025 Minerva Rehabilitation and Nursing Center 1035 East Lincolnway Minerva, OH 44657

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on [DATE] at 9:16 A.M. with Licensed Practical Nurse (LPN) #809 revealed she administered 600 mg of Gabapentin to Resident #21 on [DATE] at 12:00 P.M. and the dose should have been 800 mg. LPN #809 confirmed she called the physician and obtained a one-time order for the 600 mg of Gabapentin for the resident's nerve pain. A second interview on [DATE] at 10:16 A.M. with Director of Nursing (DON) #830 and LPN #809 confirmed LPN #809 administered Resident #27's Gabapentin to Resident #21 on [DATE]. The nurse stated this was done in error. This violation represents non-compliance investigated under Complaint Number OH00164228. 366187 Page 2 of 2