Inspection·July 11, 2024

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, policy review, review of manufacturer instructions, review of Medscape guidance on intermittent insulin injections, and pharmacy and staff interviews, the facility failed to prime an insulin pen per manufacturer instructions prior to administration, resulting in a significant medication error. This affected one (Resident #75) of one resident observed for insulin administration. The facility identified 19 residents who receive insulin. The facility census was 98. Residents Affected - Few Findings include: Review of the medical record for Resident #75 revealed an admission date of 05/16/22. Diagnoses include diabetes mellitus (DM) type two. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #75 was cognitively impaired. Review of the physician orders for Resident #75 revealed an order dated 04/14/24 for Insulin Glargine subcutaneous solution 100 unit/milliliter (ml) inject 26 units subcutaneously one time a day for DM. Observation of medication administration on 07/10/24 at 9:10 A.M. with Licensed Practical Nurse (LPN) #204 and Assistant Director of Nursing (ADON) #231 revealed LPN #204 administered medications to Resident #75. LPN #204 turned the dial to 26 units on the insulin pen. LPN #204 did not expel insulin from pen to prime prior to dialing 26 units. LPN #204 then administered the insulin to Resident #75. Interview on 7/10/24 at 9:18 A.M. with LPN #204 stated she turned the dial on the insulin pen to 28 units then turned the insulin dial to 26 units to prime the insulin pen before administering. LPN #204 confirmed she did not expel any insulin prior to administering the 26 units of insulin to Resident #75. Interview on 7/10/24 at 9:25 A.M. with ADON #231 stated nursing staff were taught to prime insulin pens by turning the dial two to three units past the ordered dose to get rid of the bubbles and then to flip it to the administration dose. Interview on 07/10/24 at 1:10 P.M. with the Director of Nursing (DON) stated when priming an insulin pen, two to three units of insulin should be expelled from the pen to prime it. The DON stated insulin pen can be primed by dialing past two to three units past the prescribed units and pressing the button to expel the additional units, making sure the correct dose was left, or dialing to the two mark and pressing the button. The DON stated that was how they were taught to do it in nursing school. The DON stated the facility received instructions for administration from Pharmacy #500 and did (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: 366457 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 366457 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Laurels of Gahanna 5151 North Hamilton Road Columbus, OH 43230 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)