Health inspection·September 12, 2024

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to have parameters for administration of two as needed pain medications for Resident #33. This affected one resident of five reviewed for unnecessary medications. The facility census was 73. Residents Affected - Few Findings include: Review of the medical record for Resident #33 revealed an admission date of 03/15/24. Diagnoses included chronic pain. Review of the significant change Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #33 was cognitively intact. Resident #33 had occasional moderate pain interfering with her activities of daily living. Review of the pain assessments dated 08/28/24 and 09/04/24 revealed Resident #33 had moderate pain described by the resident. Review of the plan of care revealed Resident #33 had pain related to recent re-fracture of right hip and surgery. The interventions included to assess/monitor pain and provide pain medication as ordered. Review of the physician orders dated 09/2024 revealed on 08/09/24, Resident #33 had an order for Ibuprofen (non-narcotic pain medication) 800 milligrams (mg) by mouth every eight hours as needed for mild pain and on 08/12/24, hydrocodone-acetaminophen (narcotic pain medication) 5/325 mg by mouth every six hours as needed for pain. Neither pain medication had description of mild pain, or numerical identification of pain level. Review of the Medication Administration Record for 09/2024 revealed Resident #33 received no doses of Ibuprofen however, received hydrocodone-acetaminophen 5/325 mg by mouth every six hours as needed for pain was administered 20 times for pain ranging from three to six on a pain scale of one to ten along with non-pharmacological interventions. Interview with Licensed Practical Nurse (LPN) #560 on 09/11/24 at 3:42 P.M. confirmed that a resident ordered two pain medications as needed would need parameters to help the nurse decide which medication to administer based on the resident's level of pain. Interview with Director of Nursing (DON) on 09/12/24 at 1:44 P.M. confirmed as needed pain medications required level of pain parameters to ensure the nurse administered the appropriate pain (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: 366381 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 366381 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Concord Health & Rehab Ctr 1242 Crescent Drive Wheelersburg, OH 45694 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)