Health inspection·January 20, 2026

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on record review, observation, interview and review of facility policy, the facility failed to ensure medications were accurately documented as administered. This affected one resident (Resident #83) of three residents who were observed for medication administration. The facility census was 96.Findings include:Review of the medical record for Resident #83 revealed an admission date of 08/20/25. Pertinent diagnoses included sepsis with an unspecified organism, urinary tract infection, chronic obstructive pulmonary disease (COPD), metabolic encephalopathy, gastroesophageal reflux disease (GERD), unspecified atrial fibrillation, unspecified heart failure, diastolic congestive heart failure, and anxiety. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment completed on 12/05/25 revealed Resident #83 had intact cognition and no history of behaviors or rejection of care. High risk drugs included medications from the antidepressant, anticoagulant, and opioid categories. Review of the active medication orders revealed Resident #83 had an order for pantoprazole sodium 40 milligrams (mg) delayed release granule tablets, one tablet via PEG-tube (percutaneous endoscopic gastrostomy tube, a tube that is inserted into the abdominal wall into the stomach with the help of a thin, flexible camera, that can be used for tube feeding, medication administration, and/or fluid administration) in the morning for GERD. Orders for scheduled respiratory medication included umeclidinium bromide inhalation aerosol powder breath activated 62.5 micrograms per actuation (mcg/ACT), inhale one puff orally in the morning for COPD and fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcg/ACT, inhale one puff inhale orally two times a day for COPD. Both inhalers included instructions to rinse the mouth with water and spit after each use. Further review of the medications revealed an order for acetaminophen 325 mg oral tablet, give two tablets by mouth or PEG tube every six hours as needed for pain. Review of the care plan dates 08/21/25 through 01/16/26 revealed Resident #83 had COPD. Interventions included giving bronchodilators and aerosols as ordered and documenting the effectiveness of these medications and any noted side effects. Further review of the care plan revealed Resident #83 was on pain management therapy and that analgesics (pain medications) were to be administered as ordered and documented and monitored for effectiveness and for side effects. The care plan also revealed that Resident #83 had GERD. Interventions included giving medications as ordered and observing for side effects and effectiveness. Observation on 01/14/25 between 9:05 A.M. and 9:50 A.M. revealed Licensed Practical Nurse (LPN) #177 prepared and administered Resident #83's morning medications, which consisted of one topical medication, one intravenous medication, and placing tablets or capsules into individual clear medication cups, each consisting of a different medication type that needed crushed or opened and dissolved prior to administration. The total number of medicine cups was 13, which was confirmed by LPN #177 at the time of the observation. During this observation, LPN #177 confirmed that one of the 13 medicine cups contained two tablets of acetaminophen, which Resident #83 had ordered as needed for pain, and the other 12 medicine cups contained the following: one zenpep (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: 366431 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 366431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Aurora 425 South Chillicothe Road Aurora, OH 44202 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)