Inspection·May 2, 2024

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 Based on observation, medical record review, staff interview and policy review the facility failed to ensure peripherally inserted central catheters (PICC) were flushed appropriately and as ordered by the physician. This affected one (Resident #113) of five residents reviewed for medications. The facility identified three residents (102, 103 and 113) with current PICC line or intravenous (IV) lines for medication administration. The facility census was 52. Residents Affected - Few Findings include: Observation on 04/30/24 at 12:05 P.M. revealed Licensed Practical Nurse (LPN) #372 administering ceftriaxone (antibiotic) 2000 milligram (mg) through a PICC line for Resident #113. LPN #372 had the medication solution, two 10 milliliter (ml) syringes of 0.9% normal saline (NS) and one 5 ml syringe of heparin (blood thinner) 100 units (u) per ml. LPN prepared the PICC line tubing by cleaning the caps with alcohol and then flushed with 10 ml of NS, then flushed with 3 ml of the heparin and then another flush with 10 ml of NS. At this time LPN #372 connected the ceftriaxone to the PICC line and began the medication infusion. Review of Resident #113's medical record revealed an admission date of 04/25/24 with admission diagnoses that included chronic non-pressure ulcer to the left foot, left foot abscess, diabetes mellitus and hypertension. Physician's orders upon admission revealed the resident was prescribed ceftriaxone 2000mg daily via PICC line. An additional physician's order on 04/29/24 indicated to flush the PICC line with 10ml NS every shift. No evidence of an order from the physician for use of the SASH method (S-Saline 0.9% 5ml via 10cc syringe prior to administering the dose, A-Administration of IV medication, S-Saline 0.9% 5ml via 10cc syringe upon completion of the infusion and H-Heparin 3ml (100u/ml) after previous saline flush) was found within the medical record. Interview with LPN #372 on 04/30/24 at 1:59 P.M. regarding the flushing method to which she responded that the facility followed the SASH flush method, indicating that staff are to flush with NS, and heparin then administer the medication and flush again with NS after the medication has been infused. Interview with the Director of Nursing on 04/30/24 at 2:20 P.M. revealed staff are to flush PICC lines using the facility procedure of the SASH method - NS flush, medication administration, NS flush and finally a heparin flush. Follow up interview with LPN #372 on 04/30/24 at 3:15 P.M. verified she did not flush the PICC line for Resident #113 as per physician order and facility protocol. She verified she flushed with NS, followed by heparin, then NS and finally adminsitered the medication. After the infusion she flushed with NS and then finally heparin. (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 5 Event ID: 366485 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 366485 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Briarfield Place 8400 Market Street Boardman, OH 44512 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)