Inspection·April 25, 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** THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NONCOMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on medical record review, staff interview and policy review, the facility failed to ensure an accurate reconciliation and accounting of all controlled substances. This affected one (#122) out of three reviewed for medication reconciliation. The facility census was 123. Findings include: Review of the medical record for Resident #122 revealed an admission date of 02/13/25 and a discharge date of 03/15/25. Diagnoses include non-pressure chronic ulcer of right heel and midfoot with unspecified severity, type 2 diabetes mellitus with foot ulcer, rheumatoid arthritis without rheumatoid factor, and spondylolisthesis. Review of the Discharge Return Not Anticipated Minimum Data Set (MDS) dated [DATE] revealed Resident #122 was independent with eating, required supervision assistance with oral hygiene, personal hygiene, and wheelchair mobility, required partial assistance with bed mobility, required substantial assistance with bathing, dressing, and transfers, and was dependent on staff assistance with toileting hygiene. Review of the physician order dated 02/13/25 revealed an order for Oxycontin Oral Tablet Extended Release (ER) 12 Hour Abuse-Deterrent 10 mg tab, give 1 tablet by mouth two times a day for chronic pain syndrome. Further review of the physician orders revealed an order dated 03/14/25 that resident may discharge home with Home Health for physical therapy, occupational therapy and nursing (PT/OT/NSG) services. Review of the care plan dated 02/13/25 revealed Resident #122 required assistance with all activities of daily living. Review of the pharmacy packing slip dated 03/05/25 revealed Oxycontin Oral Tablet Extended Release (ER) 12 Hour Abuse-Deterrent 10 mg tablets, 30 tablets were delivered to the facility on [DATE] for Resident #122. Further record review revealed Resident #122's Oxycontin 30 tablets delivered on 03/05/25 could not be accounted for. Review of Resident #122's progress noted dated 03/15/25 at 10:00 A.M. revealed resident discharged to home with his wife today at 10:00 A.M., resident sent with his medications for the rest of the weekend. (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 3 Event ID: 366301 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 366301 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritagespring Healthcare Center of West Chester 7235 Heritagespring Drive West Chester, OH 45069 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)