Inspection·September 12, 2023

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 interview and record review the facility failed to ensure Resident #50 was free from significant medication errors. This affected one resident (#50) of three residents medication administration. The facility census was 87. Residents Affected - Few Findings include: Review of the medical record for Resident #50 revealed an admission date of 12/08/22. Diagnoses included hypertensive heart disease with heart failure, anemia, history of other venous thrombosis and embolism, acute diastolic (congestive heart failure), depression, hemiplegia and hemiparesis following cerebral infarction affecting right dominant side, supraventricular tachycardia, unspecified fall, muscle weakness, difficulty in walking, weakness, repeated falls, unspecified protein-calorie malnutrition, and other lack of coordination. Review of the Minimum Data Set (MDS) assessment, dated 06/16/23, revealed the resident had intact cognition. Resident #50 required limited assistance of two for bed mobility, total with two assists for transfers and toileting, dressing and hygiene extensive with one assist, and eating supervision with one assist. Resident #50 was incontinent of bowel and bladder. Review of the care plan dated 06/16/23 revealed Resident #50 has acute/chronic pain related to depression, right femur fracture, status post-surgery, and bilateral foot drop. Interventions included monitor and record pain characteristics every shift and as needed (PRN), monitor, record, and report and signs and symptoms of verbal pain, monitor, record complaints of pain or requests for pain treatment. Review of physician orders dated for 07/27/23, revealed Resident #50 was ordered Oxycodone, narcotic pain medication, 5 milligrams (mg) three times a day (TID) straight. Review of Resident #50's medication administration records (MAR) for August 2023 revealed resident did not receive Oxycodone on 08/27/23 at 1400 hours (2:00 P.M.), 08/27/23 at 2200 hours (10:00 P.M.), and on 08/28/23 at 0600 hours (6:00 A.M.). Review of Resident #50's narcotic sign out sheet for August 2023 revealed no Oxycodone 5 mg was signed out for on 08/27/23 at 1400 hours (2:00 P.M.), 08/27/23 at 2200 hours (10:00 P.M.), and on 08/28/23 at 0600 hours (6:00 A.M.). Review of the Medicine Dispense document for August 2023 revealed no Oxycodone 5 mg was dispensed for Resident #50 on 08/27/23 at 1400 hours (2:00 P.M.), 08/27/23 at 2200 hours (10:00 P.M.), and on (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: 366491 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 366491 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Strongsville Healthcare and Rehabilitation 18936 Pearl Road Strongsville, OH 44136 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)