Inspection·March 7, 2024

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 observation, review of late medication reports, staff interview, and policy review, the facility failed to ensure medications administered in a timely manner as ordered. This affected three (Residents #1, #4, and #43) of four residents reviewed for late medications. The facility census was 49. Findings include: 1. Review of the medical record for Resident #1 revealed an admission date of 02/21/21 with diagnoses including but not limited to frontal lobe and executive function deficit following nontraumatic intracerebral hemorrhage, normal pressure hydrocephalus, cognitive communication deficit, cardiac arrhythmia, epilepsy, heart failure, anxiety, and major depressive disorder. Review of The Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #1 was rarely understood. Resident #1 required maximum assistance to total dependence on staff for activities of daily living. Review of the late medication report for 03/05/24 revealed the following medications were due between 7:00 A.M. and 10:00 A.M. losartan potassium (heart) 50 milligrams (mg), multiple vitamin, lactulose 10 grams (gm)/15 milliliter (ml) 10 ml for constipation, escitalopram 10 mg (depression), ferrous sulfate 325 mg, aspirin 81 mg, depakote delayed release (behaviors) 250 mg, vitamin D3 50 micrograms (mcg), and house supplement were administered at 12:58 P.M. Review of the late medication report for 03/06/24 revealed following medications were due between 7:00 A.M. and 10:00 A.M. losartan potassium (heart) 50 milligrams (mg), multiple vitamin, lactulose 10 grams (gm)/15 milliliter (ml) 10 ml for constipation, escitalopram 10 mg (depression), ferrous sulfate 325 mg, aspirin 81 mg, depakote delayed release (behaviors) 250 mg, vitamin D3 50 micrograms (mcg), and house supplement were administered at 12:25 P.M. 2. Review of the medical record for Resident #4 revealed an admission date of 01/06/21 with diagnoses including but not limited to unspecified foreign body in the bronchus causing other injury, dysphagia, depression, personal history of malignant neoplasm of bladder, umbilical hernia, diverticulitis, and hypertension. Review of the MDS assessment dated [DATE] revealed Resident #4 was moderately cognitively impaired. Resident #4 required substantial/maximal assistance for activities of daily living. Review of the late medication report for 03/05/24 revealed the following medications were due (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: 366312 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 366312 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Gardens of St. Francis 930 South Wynn Road Oregon, OH 43616 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)