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.
Based on medical record review, resident interview, and staff interview, the facility failed to ensure a
resident received ordered medications timely after admission to the facility. This affected (#31) of five
residents reviewed for medications. The census was 21. Findings include:Review of Resident #31's medical
record revealed an admission date of 12/18/25. Diagnoses listed low back pain, chronic obstructive
pulmonary disease, hypertension, anxiety disorder, hypertension, and lumbar disc degeneration.A
Minimum Data Set (MDS) assessment had not yet been completed.Review of physician orders revealed an
order dated 12/18/25 for the antidepressant medication Buproprion hydrochloride (HCL) oral tablet
extended-release (ER) 24-hour 300 milligrams (mg). Give 700 mg by mouth in the morning for depression.
The order was discontinued 12/22/25. An order dated 12/22/25 was for Buproprion HCL oral tablet ER
24-hour 300 mg. Give 700 mg by mouth in the morning for depression. The order was discontinued
12/23/25. Review of medication administration notes dated 12/19/25 at 8:02 A.M. revealed Buproprion HCL
oral tablet ER 24-hour 300 mg. Give 700 mg by mouth in the morning for depression was on order and
needed clarification from the provider.Review of a facsimile (fax) dated 12/18/25 revealed pharmacy
requested for Buproprion HCL oral tablet ER dose and strength to be clarified. A hand-written note on the
fax had the dose clarified by the nurse practitioner to 300 mg daily.Review of medication administration
records (MAR) revealed Buproprion was not administered on 12/19/25, 12/20/25, 12/21/25, 12/22/25, and
12/23/25.Interview with the Director of Nursing (DON) on 12/23/25 at 11:08 A.M. confirmed Resident #31
had not received Buproprion on 12/19/25, 12/20/25, 12/21/25, 12/22/25, and 12/23/25 due to the order not
being clarified timely. The order was clarified on 12/23/25.Interview with Resident #31 on 12/23/25 at 10:03
A.M. revealed he takes an antidepressant medication at home and was unsure of the name and dose.
Resident #31 was unaware that he was not receiving the antidepressant medication at the facility.
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 2
Event ID:
366224
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
366224
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/24/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Gardens at Celina
1301 Myers Road
Celina, OH 45822
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)
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
medical record review, observation, staff interview, and facility policy, the facility failed to implement
Enhanced Barrier Precautions (EBP) for a resident with an open wound. This affected one (Resident #01)
of three residents review for EBP. The facility census was 21.Findings include:Record review revealed
Resident #01 was admitted on [DATE] with diagnoses including pleural effusion, chronic obstructive
pulmonary disease (COPD), and diabetes mellitus type II.Review of the weekly wound assessment dated
[DATE] revealed Resident #01 had a stage III pressure ulcer on the coccyx. Observation of Registered
Nurse (RN) #148 on 12/24/25 at 9:48 AM revealed RN #148 provided wound care to Resident #01's open
coccyx wound without the use of complete personal protective equipment (PPE). RN #148 applied gloves
but did not don (apply) a gown for the wound care treatment. Interview with RN #148 at the time of
observation confirmed she did not wear a gown during the wound care treatment for Resident #01 and she
should have. RN #148 further confirmed there was no signage posted that identified Resident #01 needs
EBP during high-contact care activities.Interview on 12/24/25 at 10:11 AM with the Director of Nursing
(DON) revealed there was no EBP order in place for Resident #01 and acknowledged that EBP should
have been implemented due to her open wound.Review of the facility policy titled, Enhanced Barrier
Precautions (EBP), dated 04/01/24, revealed that Enhanced Barrier Precautions are required for residents
with wounds. The policy further directs that staff must don gowns and gloves during high-contact resident
care activities.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366224
If continuation sheet
Page 2 of 2
