Inspection visit
Health inspection
7 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 7 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0580
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room,
etc.) that affect the resident.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
medical record review, staff interview, and review of a facility policy, the facility failed to notify the physician
of resident's weight gain as ordered. This affected one (Resident #40) of three residents reviewed for weight
changes. The facility census was 45.
Findings include:
Review of Resident #40's medical record revealed an admission date of 06/29/22. Diagnoses included
hypertensive heart disease, chronic kidney disease, acute respiratory failure, cardiomegaly, diabetes
mellitus type II, gastroesophageal reflux disease, anxiety, cerebral infarction, and heart failure.
Review of the most recently completed Minimum Data Set (MDS) assessment dated [DATE] revealed
Resident #40 was assessed with intact cognition and required supervision only for eating.
Review of a care plan dated 07/06/22 revealed Resident #40 had potential for complications of congestive
heart failure with an intervention to obtain weight as ordered.
Review of a physician order dated 07/28/22 revealed Resident #40 was to be weighed daily for congestive
heart failure. This order was discontinued on 08/09/22 and a new order was written dated 08/09/22 to weigh
Resident #40 daily and notify the physician of weight gain of two pounds (lbs.) a day or three to five pounds
a week.
Review of Resident #40's August 2022 medication administration record and vital signs from August 2022
revealed Resident #40's weights were not obtained on 08/10/22, 08/11/22, 08/14/22, 08/15/22, 08/16/22,
08/18/22, 08/19/22, 08/22/22, 08/24/22, 08/25/22, and 08/26/22. Further review of Resident #40's weights
revealed Resident #40's weight was 184.0 lbs. on 08/23/22 and the next weight obtained was on 08/27/22
and was 196.0 lbs. for a weight gain of 12.0 lbs. in four days. Resident #40's weight was obtained on
08/28/22 and was 201.0 lbs. for a weight gain of five lbs. in one day. Resident #40's weight was obtained on
08/29/22 and was 204.4 lbs. for a weight gain of 3.4 lbs. in one day. There was no evidence in the MAR the
physician was notified of Resident #40's weight gain.
Review of the nursing progress notes dated 08/10/22, 08/11/22, 08/14/22, 08/15/22, 08/16/22, 08/18/22,
08/19/22, 08/22/22, 08/24/22, 08/25/22, and 08/26/22 revealed no documentation of the physician being
notified of Resident #40's weights not being obtained. Further review of nursing progress notes dated
08/27/22, 08/28/22, and 08/29/22 revealed no documentation of the physician being notified of Resident
#40's daily and weekly weight gains as physician ordered.
(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 12
Event ID:
366464
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
366464
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/12/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Springs of Lima The
370 North Eastown Road
Lima, OH 45807
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)
F 0580
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Review of the most recent dietician assessment dated [DATE] revealed Resident #40 displayed significant
weight gain between 06/30/33 and 08/30/22 with her weight initially down from Resident #40's normal and
trending back up over the last month. Resident #40's weight gains were likely attributed to improved intakes
since admission as well as edema to the bilateral lower extremities which Resident #40 recently had
diuretics adjusted to treat the edema. Resident #40's meal intakes were noted between 75 percent (%) and
100 % during the review period.
Interview on 09/08/22 at 11:16 A.M. with Registered Nurse (RN) #239 stated Resident #40 was able to feed
herself and had no recent issues with her weights. RN #239 verified Resident #40's weights were being
monitored daily due to edema associated with congestive heart failure and not for nutritional concerns. RN
#239 verified there was no documentation of Resident #40's weights being obtained on 08/10/22, 08/11/22,
08/14/22, 08/15/22, 08/16/22, 08/18/22, 08/19/22, 08/22/22, 08/24/22, 08/25/22, and 08/26/22, and stated
the facility obtaining daily weights for residents had been a recurring issue. RN #239 also stated notification
of physician notification would be in the nursing progress notes and verified there was no documentation
the physician was notified on the dates in August 2022 when Resident #40's weights were not obtained. RN
#239 also verified the physician was not notified of Resident #40's weight gains on 08/27/22, 08/28/22, and
08/29/22.
Review of a facility policy titled Notification of Change in Condition, dated 12/01/21, revealed the facility
must inform the resident, consult with the resident's physician and if known notify the resident's legal
representative when there is a significant change in the resident's physical, mental, or psychosocial status,
a need to alter treatment significantly, or an accident involving the resident which results in an injury and
had the potential for requiring physician intervention.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366464
If continuation sheet
Page 2 of 12
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
366464
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/12/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Springs of Lima The
370 North Eastown Road
Lima, OH 45807
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)
F 0677
Provide care and assistance to perform activities of daily living for any resident who is unable.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
medical record review, observations, staff interview, and review of the facility's policy, the facility failed to
ensure Resident #37, who required assistance limited staff assistance for activities of daily living (ADL)
care, received adequate assistance with nail care to promote proper hygiene. This affected one (#37) of
three residents reviewed for activities of daily living. The facility identified all 45 residents residing in the
facility required staff assistance with dressing and bathing.
Residents Affected - Few
Findings include:
Review of Resident #37's medical record revealed Resident #37 was initially admitted to the facility on
[DATE] with re-entry on 08/30/22. Diagnoses included fracture of the left wrist and hand, subsequent
fracture with routine healing, strain of unspecified muscle, muscle weakness, weakness, lack of
coordination, and vascular dementia with behavioral disturbance.
Review of the Minimum Data Set (MDS) assessment, dated 08/04/22, revealed Resident #37 was severely
cognitively impaired. Resident #37 required limited one person assistance with dressing and personal
hygiene.
Observations on 09/06/22 at 11:34 A.M. and on 09/08/22 at 10:28 A.M. revealed Resident #37's toenails
were long.
Interview on 09/08/22 at 10:51 A.M. with Registered Nurse (RN) #261 verified Resident #37's toenails were
too long and did needed to be trimmed.
Observation on 09/12/22 at 9:31 A.M. with RN Regional Support #290 revealed Resident #37's socks
removed and toenails remained approximately the same length as previously observed.
Interview on 09/12/22 at approximately 11:30 A.M. with RN Regional Support #290 revealed Resident #37
refused the last podiatry visit on 04/08/22 and was scheduled for the next visit on 09/21/22. RN Regional
Support #290 verified Resident #37's nails also could be trimmed by nursing staff.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366464
If continuation sheet
Page 3 of 12
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
366464
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/12/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Springs of Lima The
370 North Eastown Road
Lima, OH 45807
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)
F 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
medical record review, resident and staff interview, and review of a facility policy, the facility failed to ensure
resident weights were obtained as physician ordered. This affected one (Resident #40) of three residents
reviewed for weight changes. The census was 45.
Residents Affected - Few
Findings include:
Review of Resident #40's medical record revealed an admission date of 06/29/22. Diagnoses included
hypertensive heart disease, chronic kidney disease, acute respiratory failure, cardiomegaly, diabetes
mellitus type II, gastroesophageal reflux disease, anxiety, cerebral infarction, and heart failure.
Review of the most recently completed Minimum Data Set (MDS) assessment dated [DATE] revealed
Resident #40 was assessed with intact cognition and required supervision only for eating.
Review of a care plan dated 07/06/22 revealed Resident #40 had a potential for complications of congestive
heart failure with an intervention to obtain weight as ordered.
Review of a physician order dated 07/28/22 revealed Resident #40 was to be weighed daily for congestive
heart failure. This order was discontinued on 08/09/22 and a new order was written dated 08/09/22 to weigh
Resident #40 daily and notify the physician of weight gain of two pounds (lbs.) a day or three to five pounds
a week.
Review of Resident #40's August 2022 medication administration record and vital signs from August 2022
revealed Resident #40's weights were not obtained on 08/10/22, 08/11/22, 08/14/22, 08/15/22, 08/16/22,
08/18/22, 08/19/22, 08/22/22, 08/24/22, 08/25/22, and 08/26/22. Resident #40's weights were consistently
obtained in September 2022.
Review of the most recent dietician assessment dated [DATE] revealed Resident #40 displayed significant
weight gain between 06/30/33 and 08/30/22 with her weight initially down from Resident #40's normal and
trending back up over the last month. Resident #40's weight gains were likely attributed to improved intakes
since admission as well as edema to the bilateral lower extremities which Resident #40 recently had
diuretics adjusted to treat the edema. Resident #40's meal intakes were noted between 75 percent (%) and
100% during the review period.
Interview on 09/07/22 at 10:57 A.M. with Resident #40 stated her appetite was good and she was eating
enough for her at each meal. Resident #40 stated the physician started her on diuretic medications to
lessen her edema and it was causing her to urinate more often. Resident #40 stated she felt no distress
and had no issues with her weight.
Interview on 09/08/22 at 11:16 A.M. with Registered Nurse (RN) #239 stated Resident #40 was able to feed
herself and had no recent issues with her weights. RN #239 verified Resident #40's weights were being
monitored daily due to edema associated with congestive heart failure and not for nutritional concerns. RN
#239 verified there was no documentation of Resident #40's weights being obtained on 08/10/22, 08/11/22,
08/14/22, 08/15/22, 08/16/22, 08/18/22, 08/19/22, 08/22/22, 08/24/22, 08/25/22, and 08/26/22, and stated
the facility obtaining daily weights for residents had been a recurring issue.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366464
If continuation sheet
Page 4 of 12
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
366464
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/12/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Springs of Lima The
370 North Eastown Road
Lima, OH 45807
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)
F 0684
Level of Harm - Minimal harm
or potential for actual harm
Review of a facility policy titled, Clinical Services-Weight Monitoring, revised 12/21/20, revealed weight
monitoring is essential to the well-being of the residents the facility serves and requires a multidisciplinary
approach. The facility will review for any missing weights weekly as ordered and daily as ordered.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366464
If continuation sheet
Page 5 of 12
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
366464
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/12/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Springs of Lima The
370 North Eastown Road
Lima, OH 45807
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)
F 0689
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to
prevent accidents.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
medical record review, observations, staff interviews, and review of the facility's policy, the facility failed to
ensure a resident's fall interventions were in place as care planned. This affected one (#37) of four
residents reviewed for falls. The facility census was 45.
Findings include:
Review of the medical record revealed Resident #37 was initially admitted to the facility on [DATE] with a
re-entry on 08/30/22. Diagnoses included chronic kidney disease, fracture of left wrist and hand,
subsequent fracture with routine healing, strain of unspecified muscle, muscle weakness, difficulty in
walking, weakness, lack of coordination, hypoglycemia, vascular dementia with behavioral disturbance, or
chronic kidney disease.
Review of the Minimum Data Set (MDS) assessment, dated 08/04/22, revealed Resident #37 was severely
cognitively impaired. Resident #37 required limited one person assistance with bed mobility, transfers,
walking in resident room, dressing, toilet use, and personal hygiene. Resident #37 had a history of falls.
Review of the care plan, last updated on 08/30/22, revealed Resident #37 was at risk for falling with
interventions including to keep the call light in reach.
Observation on 09/07/22 at 8:40 A.M. revealed Resident #37 sitting in her recliner chair in the resident's
room. Resident #37's call light was near the head of the bed and not within reach of Resident #37.
Interview on 09/07/22 at 8:56 A.M. with Dietary Corporate Manager #293 verified the call light was not
within reach of Resident #37.
Observation on 09/08/22 at 10:28 A.M. revealed Resident #37 sitting in a wheelchair in the resident's room
with the breakfast meal in front of her on the bedside table. The adaptive call light was on the bed near the
head of the bed, out of reach of Resident #37.
Interview on 09/08/22 at 10:51 A.M. with Registered Nurse (RN) #261 verified Resident #37's call light was
not accessible to Resident #37. RN #261 verified Resident #37 does utilize the call light at times but was
not always compliant.
Observation on 09/12/22 at 7:53 A.M. revealed Resident #37 sitting in the wheelchair in the resident's room
with the call light observed near the head of the bed and not within reach of Resident #37.
Interview on 09/12/22 at 9:29 A.M. with RN Regional Support #290 revealed Resident #37 often transfers
by herself and falls have occurred when Resident #37 transferred independently.
Observation on 09/12/22 at 9:31 A.M. revealed Resident #37 was sitting in her recliner in the resident's
room with the resident room light on and the breakfast meal tray on the bedside table near the resident. The
call light was observed in the same position as the earlier observation, near the
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366464
If continuation sheet
Page 6 of 12
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
366464
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/12/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Springs of Lima The
370 North Eastown Road
Lima, OH 45807
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)
F 0689
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
head of the bed, inaccessible to Resident #37. Subsequent interview with RN Regional Support #290
verified the call light was out of reach for Resident #37 and the facility staff had recently been in the
resident room to deliver the meal tray.
Review of the facility's policy titled Guidelines for Answering Call Lights, dated 05/11/16, revealed facility
staff are to ensure the call light is plugged in securely to the outlet and in reach of the resident.
Event ID:
Facility ID:
366464
If continuation sheet
Page 7 of 12
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
366464
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/12/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Springs of Lima The
370 North Eastown Road
Lima, OH 45807
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)
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
medical record review, staff interview, and review of a facility policy, the facility failed to ensure medications
were re-ordered correctly and administered as physician ordered. This affected one (Resident #41) of six
residents reviewed for unnecessary medications. The facility census was 45.
Findings include:
Review of Resident #41's medical record revealed a re-admission date of 05/08/22. Diagnoses included
diabetes mellitus type II with diabetic chronic kidney disease, sepsis, acute pulmonary edema, atrial
fibrillation, congestive heart failure, and end stage renal disease. Review of the most recently completed
Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #41 was assessed with intact
cognition.
Review of a physician order dated 04/18/21 revealed Resident #41 was ordered Lantus insulin 10 units
subcutaneously at bedtime. Further review of the physician order revealed it was discontinued on 08/01/22.
Review of Resident #41's current physician orders as of 09/08/22 revealed Resident #41's Lantus order
was scheduled to begin again in 2023.
Review of a nursing progress note dated 08/01/22 revealed Resident #41 was out of Lantus insulin, the
physician was notified, and the facility was awaiting delivery of the medication.
Review of additional physician orders revealed Resident #41 was ordered Novolog insulin subcutaneously
via sliding care three times daily and at bedtime on 12/10/20 and Novolog subcutaneously five (5) units
subcutaneously with meals on 04/18/21.
Review of Resident #41's blood glucose levels obtained in August and September 2022 revealed Resident
#41 had no blood glucose levels lower than 80 milligrams per deciliter (mg/dL) or greater than 354 mg/dL.
Review of Resident #41's nursing progress notes dated between 08/10/22 and 09/08/22 revealed Resident
#41 experienced no significant change in condition and the physician did not need to be notified due to
blood glucose levels during this time frame.
Review of a nursing progress note dated 09/08/22 revealed Resident #41 was to receive Lantus 10 units at
night and the re-order was put in the computer system to begin in 2023 instead of 2022. The physician was
notified and gave an order to restart Resident #41's Lantus insulin on 09/08/22.
Interview on 09/12/22 at 10:22 A.M. with Registered Nurse (RN) Regional Clinical Support #290 stated a
nurse attempted to re-order Resident #41's insulin on 08/01/22 and inadvertently discontinued the order
and put in a start date for the new order in 2023. RN Regional Clinical Support #290 verified this was an
error and Resident #41 should have been receiving the Lantus insulin with no discontinuation. RN Regional
Clinical Support #290 verified Resident #41 should have received the Lantus insulin between 08/01/22 and
09/07/22 and did not due to the ordering error. RN Regional Clinical Support #290 verified Resident #41 did
not have any significant changes and Resident #41's blood glucose levels during that time frame did not
require additional interventions.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366464
If continuation sheet
Page 8 of 12
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
366464
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/12/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Springs of Lima The
370 North Eastown Road
Lima, OH 45807
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)
F 0755
Level of Harm - Minimal harm
or potential for actual harm
Review of a facility policy titled, Medication Administration General Guidelines, revised January 2018,
revealed medications as administered in accordance with written orders of the prescriber.
This deficiency substantiates Complaint Number OH00135428.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366464
If continuation sheet
Page 9 of 12
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
366464
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/12/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Springs of Lima The
370 North Eastown Road
Lima, OH 45807
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)
F 0760
Ensure that residents are free from significant medication errors.
Level of Harm - Minimal harm
or potential for actual harm
Based on medical record review, observation, staff interview, policy review, and review of manufacturer's
instructions, the facility failed to administer insulin as physician ordered and per the manufacturer's
instructions which resulted in a significant medication error. This affected one (#25) of three residents
observed during medication administration. The facility identified 14 residents in the facility who receive
insulin. The facility census was 45.
Residents Affected - Few
Findings include:
Review of Resident #25's medical record revealed and admission date of 05/25/19. Diagnoses included
metabolic encephalopathy, diabetes mellitus type II, hyperlipidemia, aphasia, chronic obstructive pulmonary
disease, and cognitive communication deficit.
Review of a physician order dated 05/11/22 revealed Resident #25 was ordered Humalog insulin
subcutaneously via sliding scale three times daily with meals. Resident #25 sliding scale order revealed for
blood glucose levels between 111 milligrams per deciliter (mg/dL) and 150 mg/dL, give one unit of insulin;
between 151 mg/dL and 200 mg/dL, give three units of insulin; between 201 mg/dL and 250 mg/dL, give six
units of insulin; between 251 mg/dL and 300 mg/dL, give nine units of insulin; between 301 mg/dL and 550
mg/dL, give 12 units of insulin; and between 351 mg/dL and 400 mg/dL, give 15 units of insulin.
Review of a physician order dated 05/12/22 revealed Resident #25 was ordered Humalog insulin five units
subcutaneously three times daily and to hold for blood glucose levels 100 mg/dL and below.
Observation on 09/07/22 at 11:34 A.M. revealed Registered Nurse (RN) #229 preparing to administer
Resident #25 her scheduled insulin. RN #229 obtained Resident #25's blood glucose level and was
observed to be 261 mg/dL. RN #229 explained Resident #25 would receive a scheduled five units of
Humalog insulin, and based on Resident #25's blood glucose level, an additional nine units of Humalog
insulin for a total of 14 units of Humalog insulin. RN #229 then removed Resident #25's Humalog insulin
pen from the medication cart, turned the dosage dial to 14 units, affixed the needle to the end of the insulin
pen, walked to Resident #25's bedroom and administered the insulin subcutaneously into her abdomen
without priming the insulin pen needle.
Interview on 09/017/22 at 11:42 A.M. with RN #229 verified she did not prime the insulin pen prior to
selecting the dose of insulin to administer to Resident #25. RN #229 stated she was not aware insulin pens
needed to be primed with each administration, but rather thought priming only was needed on the initial
dose of a new insulin pen.
Review of a facility policy titled, Medication Administration General Guidelines, revised January 2018,
revealed medications as administered in accordance with written orders of the prescriber.
Review of a facility policy titled Vials and Ampules of Injectable Medications, revised January 2018,
revealed vials and ampules of injectable medications are used in accordance with the manufacturer's
recommendations of the provider pharmacy's directions for storage, use, and disposal.
Review of Humalog insulin manufacturer's instructions, dated 2004, revealed the pen must be primed
before each injection to make sure the pen is ready to dose. The user should affix a needle to the insulin
pen and turn the dial knob until 2 can be seen in the dose window. The insulin pen should
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366464
If continuation sheet
Page 10 of 12
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
366464
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/12/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Springs of Lima The
370 North Eastown Road
Lima, OH 45807
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)
F 0760
Level of Harm - Minimal harm
or potential for actual harm
then be held with the needle pointed upwards, and when the administration button is pressed, insulin
should be seen at the tip of the needle. The desired dose of insulin should then be selected, and if no
insulin is seen at the tip of the needle, the process should be repeated.
This deficiency substantiates Complaint Number OH00135428.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366464
If continuation sheet
Page 11 of 12
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
366464
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/12/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Springs of Lima The
370 North Eastown Road
Lima, OH 45807
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)
F 0868
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
Level of Harm - Potential for
minimal harm
Based on review of Quality Assessment and Assurance (QAA) Committee/Quality Assurance Improvement
Program (QAPI) meeting sign in sheets and staff interview, the facility failed to ensure the Medical Director
or designee attended QAA Committee/QAPI meetings at least quarterly. This had the potential to affect all
45 residents residing in the facility.
Residents Affected - Many
Findings include:
Review of QAA Committee/QAPI meeting sign in sheets between September 2021 and August 2022
revealed the facility held meetings monthly and the Medical Director or a designee did not attend the
meetings at least quarterly as required. Further review of the QAA Committee/QAPI meeting sign in sheets
revealed the Medical Director attended the meeting on 09/24/21, and did not attend another meeting until
04/27/22. There was no documentation of Medical Director designees present at any of the QAA
Committee/QAPI meetings between September 2021 and August 2022.
Interview on 09/12/22 at 12:27 P.M. with the Administrator verified the facility held QAA Committee/QAPI
meetings monthly between September 2021 and August 2022 and verified the Medical Director or a
designee was not present for any meetings in the fourth quarter of 2021 and the first quarter of 2022 as
required. Each monthly QAA Committee/QAPI meeting sign in sheet between September 2021 and August
2022 was reviewed with the Administrator during the interview, and she verified there were no designees
that attended the QAA Committee/QAPI meetings during that time frame.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366464
If continuation sheet
Page 12 of 12
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
Back to topCitations
7 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F677 - A resident who is unable to carry out activities of daily living receives
Provide care and assistance to perform activities of daily living for any resident who is unable.
F580 - Notification of Changes
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
F755 - Pharmacy Services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
F760 - Residents are free of any significant medication errors
Ensure that residents are free from significant medication errors.
F868 - Quality assessment and assurance
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
FAQ · About this visit
Common questions about this visit
What happened during the September 12, 2022 survey of SPRINGS OF LIMA THE?
This was a inspection survey of SPRINGS OF LIMA THE on September 12, 2022. The surveyor cited 7 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at SPRINGS OF LIMA THE on September 12, 2022?
Yes, 7 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide care and assistance to perform activities of daily living for any resident who is unable."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.