Health inspection·October 28, 2025

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident and staff interviews, review of facility policy, and review of the Ohio Administrative Code, the facility failed to ensure qualified personnel removed a midline intravenous (IV) catheter. This affected two (#22 and #49) of four residents reviewed with midline or peripheral intravenous central catheters (PICC). The facility census was 87. Findings include:Review of the medical record for Resident #22 revealed an admission date of 09/15/25. Diagnoses included urinary tract infection (UTI). Review of the Interim Payment Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #22 was cognitively intact. Resident #22 received intravenous medications within the last fourteen days and had no noted behaviors of refusal of medication. Review of the physician's orders dated 10/10/25 for Resident #22 revealed medication orders including cefazolin sodium injection solution reconstituted (antibiotic) one gram (gm) use one gm intravenously every eight hours for UTI until 10/13/25. Cefazolin was administered from 10/10/25 through 10/13/25. The physician orders noted Resident #22 had a midline IV catheter placed. The midline IV catheter was placed at the facility by an outside specialty nursing services provider on 10/10/25. Review of Resident #22's nursing progress note dated 10/20/25 at 11:08 A.M. written by Licensed Practical Nurse (LPN) #301 revealed an order was received to remove right arm midline. The progress note dated 10/20/25 at 6:14 P.M. written by LPN #301 revealed the midline was removed, tip intact, pressure dressing applied, and there were no signs/symptoms of infection noted. The resident tolerated it well, and daughter was present. Interview on 10/28/25 at 8:40 A.M. with Resident #22 stated the midline IV catheter had been placed at the facility and LPN #301 had removed her midline IV catheter last week. Resident #22 stated she had no right arm discomfort and no issues or concerns at this time. 2. Review of the medical record for Resident #49 revealed an admission date of 06/23/25. Diagnoses included urinary tract infection (UTI). Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #49 was cognitively intact. Review of the physician order dated 10/11/25 through 10/17/25 revealed Meropenem intravenous solution reconstituted (antibiotic) one gram (gm) use one gram intravenously three times a day for UTI for seven days. Review of Resident #49's nursing progress note dated 10/20/25 at 11:07 A.M. written by Licensed Practical Nurse (LPN) #301 revealed an order was received from Doctor #610 to remove right arm midline. However, there was no physician order written. The progress note dated 10/20/25 at 6:18 P.M. and written by LPN #301 revealed the midline IV removed from right upper arm, tip intact, pressure dressing applied. Resident #49 tolerated the removal without issue and there were no signs or symptoms or infection. Review of the personnel file for LPN #301 revealed she had basic IV training certification dated from 2014, and no peripheral inserted central catheter (PICC) or midline IV training noted. Interview on 10/27/25 at 11:31 A.M. with Registered Nurse (RN) #324 stated LPN #301 was directed to remove the midline IV catheters for Residents #22 and #49 on 10/20/25 per LPN #309. RN #324 stated someone came up to the Page 1 of 2 366199 366199 10/28/2025 Country Lane Gardens Rehab & Nursing Ctr 7820 Pleasantville Road Pleasantville, OH 43148

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few second floor where she was working and asked her about removing the midline IV, but then it was revealed to her that someone from corporate had stated that LPNs can remove midline IV catheters. RN #324 stated she did not remove the midline IV catheter for Resident #22 or Resident #49. RN #324 stated she was not aware that LPNs could change the midline IV dressings or remove the midline IV catheter. Interview on 10/27/25 at 2:23 P.M. with Regional Director of Clinical Services (RDCS) #500 stated she received a telephone call on 10/20/25 regarding LPNs and midline IVs. RDCS #500 revealed an email she had sent to LPN #309 which had a frequently asked questions article from the Ohio Board of Nursing Momentum issue dated Spring 2023. The article was titled LPN IV Therapy Updates and FAQs (frequently asked questions)-Updated Accordance with HB 509, effective 04/06/23. RDCS #500 stated she sent them the article so that no one should have any questions about what the LPNs could do with central lines. Subsequent interview on 10/27/25 at 4:34 P.M. with RDCS #500 stated she spoke to LPN #301 on 10/20/25 and LPN #301 had told her she felt comfortable with IVs and she had been working with IVs for years. RDCS #500 stated she had been at the building for only three weeks and that no IV training had been completed by any of the staff prior to her arrival or after her arrival. Interview on 10/28/25 at 8:36 A.M. with Resident #49 stated the midline IV catheter had been placed at the facility and LPN #301 removed her midline IV catheter last week. Resident #49 stated she had no right arm discomfort and no issues or concerns at this time. Interview on 10/28/25 at 12:46 P.M. with RDCS #500 confirmed the article titled LPN IV Therapy Updates and FAQs-Updated Accordance with HB 509 effective 04/06/23 made references to the Ohio Administrative Code. RDCS #500 confirmed the facility policy stated a peripheral IV is defined as a catheter that is less than three inches (seven point five centimeters(cm)) in length. RDCS #500 confirmed the Rules 4723-17-03(A), (B), and (C), Ohio Administrative Code (OAC) effective 02/01/20 revealed except as provided in paragraph (B) of this rule, a LPN shall not perform any of the following intravenous therapy procedures: initiate or discontinue a PICC or any catheter that is longer that three inches. RDCS #500 stated she didn't know the OAC rules regarding the intravenous therapy procedures for the LPN or she would not have directed them to remove the catheter. RDCS #500 verified LPN #301 was not qualified to remove the midline IV catheter for Resident #22 and Resident #49 on 10/20/25. Review of the policy titled Removal of a Peripheral IV (Over the Needle, Peripheral Short) Catheter dated 09/2011 revealed a peripheral IV catheter is defined as a catheter that is less than three inches (seven point five centimeters (cm)) in length. It is also referred to as a peripheral shorth catheter, an over the needle catheter, saline lock, and angiocath. The policy titled Removal of Central Line and Midline Catheters dated 01/17/19 revealed to verify the state nurse practice act for RN/LPN scope of practice and function. Review of the article titled LPN IV Therapy Updates and FAQs-Updated Accordance with HB 509, effective 04/06/23 revealed that LPNs who have the required skills, knowledge and ability are authorized to perform limited adult IV therapy as authorized by Sections 4723.18 and 4723.181, Ohio Revised Code (ORC), and current Rules 4723-17-03(A), (B), and (C), Ohio Administrative Code. Review of Rules 4723-17-03(A), (B), and (C), Ohio Administrative Code effective 02/01/20 revealed except as provided in paragraph (B) of this rule, a LPN shall not perform any of the following intravenous therapy procedures: initiate or discontinue a peripherally inserted central catheter, or any catheter that is longer that three inches. This deficiency represents non-compliance investigated under Complaint Number 2650792. 366199 Page 2 of 2