Health inspection·August 15, 2024

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, staff interview, and review of the facility policy, the facility failed ensure proper labeling of insulin vials. This affected one (Resident #33) resident of three reviewed for medication administration. The facility census was 50 residents. Findings include: Review of the medical record for Resident #33 revealed an admission date of [DATE] with medical diagnoses including pancreatitis, diabetes mellitus, disorder of the thyroid, osteoarthritis, and asthma. Review of the admission Minimum Data Set (MDS) assessment for Resident #33 dated [DATE] revealed the resident had moderate cognitive impairment and required supervision and staff assistance with activities of daily living (ADLs.) Review of the physician's orders for Resident #33 revealed an order dated [DATE] for Humalog (insulin) inject 15 units subcutaneously three times per day. Observation on [DATE] at 7:56 A.M. revealed Licensed Practical Nurse (LPN) #209 prepared the Humalog injection for Resident #33. Neither the box containing the vial of insulin nor the vial itself were dated upon opening. LPN #209 drew up 15 units of Humalog and subcutaneously injected the insulin into Resident #33's right upper arm. Interview on [DATE] at 8:04 A.M. with LPN #209 confirmed Resident #33's insulin had not been dated upon opening and she was unsure if it had expired or not. LPN #209 further confirmed insulin should be dated upon opening. Review of the facility policy titled Medication Storage revised [DATE] revealed medications and biologicals should be stored safely, securely, following manufacturer's recommendations or those of the supplier. Multiple dose injectable vials, once opened, need an expiration date shorter than the manufacturer's expiration date to insure medication's purity and potency. When the original seal of a manufacturer's container or vial that requires a shorter expiration is initially broken, the vial should be dated with a dated. A date opened sticker should be placed on these mediations and nurses should check the expiration date of each medication before administering it. No expired mediations should be administered to the resident. 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: 366461 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 366461 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wooded Glen 2900 Bechtle Avenue Springfield, OH 45504 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)