Health inspection·May 16, 2023

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 policy review, the facility failed to ensure medications were administered timely and as ordered. This affected one (Resident #100) out of four residents reviewed for change of condition. The facility census was 91. Findings include: Review of Resident #100's medical record revealed Resident #100 was admitted to the facility on [DATE] with diagnoses including cerebral infarction, hemiplegia, hemiparesis (right side), obsessive-compulsive behavior, hypertension, osteoporosis, heart failure, and age-related cataracts. Resident #100 was sent to the hospital on [DATE] and did not return to the facility. Review of Resident #100's Medication Administration Record (MAR) for March 2023 revealed Resident #100 had an order, dated 03/09/22, for Depakote (anticonvulsant medication) tablet delayed release 250 mg, give three tablets by mouth at bedtime for seizures. The Depakote was to be given at 8:00 P.M. Further review of the MAR revealed Resident #100 had an order, dated 02/08/21, for Levetiracetam (anticonvulsant medication) tablet 750 mg, give two tablets by mouth two times a day for seizures. The Levetiracetam was to be given at 8:00 A.M. and 8:00 P.M. The 8:00 P.M. dose of Depakote and Levetiracetam were signed off as administered. Review of the Resident #100's nurses' notes revealed on 03/01/23 at 9:40 P.M. Resident #100 was found in the bathroom, sitting on the toilet, having a mild seizure. Resident #100 was placed in a wheelchair in order to move Resident #100 to bed. Licensed Practical Nurse (LPN) #400 called the on-call and was told to give Resident #100 his oral seizure medication and observe for 15 to 20 minutes. If seizure activity continued, then send Resident #100 to the hospital for evaluation and treatment. Interview on 05/16/23 at 12:40 P.M., with LPN #400 revealed LPN #400 was working on giving Resident #100 his medications when the STNA called her to Resident #100's room to assist with getting Resident #100 back to bed and dealing with his seizure activity. LPN #400 indicated Resident #100's evening dose of antiseizure medication (Levetiracetam and Depakote) was due at 8:00 P.M. on 03/01/23 but LPN #400 had not administered them yet. When LPN #400 called the on-call Certified Nurse Practitioner (CNP) #500 to report his change in condition, the on-call CNP #500 wanted LPN #400 to give Resident #100 his oral seizure medication and observe him for 15 to 20 minutes to see if the seizures stopped. LPN #400 indicated Resident #100 was having a mild seizure that she described as twitching and Resident #100 was alert and able to answer yes/no questions. LPN #400 proceeded to give Resident #100 his 8:00 P.M. dose of anti-seizure medication (Keppra and Depakote) at 9:40 P.M. Resident #100 took the medication with assistance and without difficulty. (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: 366481 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 366481 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of West Columbus, The 441 Norton Road Columbus, OH 43228 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)