Health inspection·February 24, 2026

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 record review, interviews and observations, the facility failed to ensure proper hand hygiene for two Residents #245 and Resident #290. This affected two Residents (#245 and #290) of the six residents reviewed. The facility census was 71.Findings include:1.Review of the medical record for Resident #245 revealed an admission date of 02/03/23 with diagnosis to include but not limited to cerebral infarction, depression, hypertension, hypercholesterolemia, gout, atherosclerotic heart disease, hemiplegia, presence of prosthetic heart valve, thoracic aortic aneurysm, atrial fibrillation, heart failure, obstructive sleep apnea, morbid obesity, shortness of breath, hyperlipidemia, anxiety disorder, and type two diabetes mellitus. Review of the quarterly Minimum Data Set (MDS) dated [DATE] for Resident #245 revealed a Brief Interview for Mental Status (BIMS) score of 13 which indicated no cognitive impairment. Review of the care plan dated 08/31/24 for Resident #245 revealed a care plan for activities of daily living (ADL) functional which stated Resident #245 had impaired musculoskeletal status related to osteoarthritis, gout, lack of coordination, hemiplegia, dependence on wheelchair, muscle weakness, and difficulty in walking. The interventions included administer medications as ordered.Review of the physician order for Resident #245 revealed thiamine mononitrate (vitamin B1) tablet 100 milligrams (mg), amount to administer one tablet, oral.Observation on 02/24/26 at 8:03 A.M. of Licensed Practical Nurse (LPN) #250 who removed the medications for Resident #245. LPN #250 shook out two thiamine pills into the container lid, then used her bare finger to hold one thiamine pill in the lid and shook the other thiamine pill back into the container. Interview on 02/24/26 at 8:21 A.M. with LPN #250 who confirmed she had not been wearing gloves and used her finger to hold the thiamine tablet in the pill lid. LPN #250 stated she should have thrown them out and started over.2.Review of the medical record for Resident #290 revealed an admission date of 06/04/25 with diagnoses to include but not limited to epilepsy, acute and chronic respiratory failure with hypoxia, stenosis of larynx, iron deficiency anemia, depression, obesity, anxiety disorder, dependence on respirator, unspecified lack of expected normal physiological development in childhood, borderline personality disorder, congestive heart failure, asthma, dysphagia, oropharyngeal phase, tracheostomy, difficulty in walking, gastro-esophageal reflux disease, lack of coordination, hypotension, cognitive communication deficit, and need for assistance with personal care.Review of the quarterly MDS dated [DATE] revealed a BIMS of 09 which indicated moderate cognitive impairment.Observation on 02/24/26 at 8:57 A.M. of Registered Nurse (RN) #820 who prepared medications for administration to Resident #290. RN #820 had three medication pill cups on the medication cart and put the medications into the different cups per Resident #290's preference for taking her medications. RN #820 stated Resident #290 prefers some medications crushed, takes some medications whole, and had two liquid medications. There were medications in a medication cup with two capsules, RN #820 picked up one small white pill with her bare hands and moved it to a different medication cup. Then RN #820 put on gloves, opened the two capsules and put the powder into a medication cup, Residents Affected - Few (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 2 Event ID: 366299 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 366299 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Centerburg Pointe 4531 Columbus Road Centerburg, OH 43011 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)