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
observation, record review, staff interview and policy review, the facility failed to ensure medications were
administered to the residents without a significant medication error. This affected one (Resident #31) of
three residents reviewed for medication administration. The facility census was 110.
Residents Affected - Few
Findings include:
Review of Resident #31's medical record revealed the resident was admitted to the facility on [DATE].
Diagnoses included Alzheimer's disease and anxiety disorder.
Review of Resident #31's physician orders dated 03/04/24 revealed an order for the resident to receive
pureed foods with nectar thickened liquids. An order dated 06/14/23 for Divalproex Sodium oral tablet
delayed release 250 milligrams (mg) (Divalproex Sodium), administer three tablets by mouth one time a day
for convulsion. This order was discontinued on 04/30/24. A new order dated 04/30/24 for Divalproex Sodium
oral capsule delayed release sprinkle 125 mg (Divalproex Sodium), administer four capsules by mouth one
time a day.
Interview and observation of medication administration on 04/30/24 at 7:30 A.M. revealed Registered Nurse
(RN) #259 on 04/30/24 at 7:30 A.M. stated Resident #31 took her medications crushed in applesauce. RN
#259 was observed to crush the Divalproex Sodium 250 mg three tablets and include them with the
resident's other crushed morning medications and place all the crushed medications in applesauce. At 7:45
A.M., RN #259 was in Resident #31's room with the crushed morning medication explaining to the resident
that it was time to take her medications. The Director of Nursing (DON) came to the door and told RN #259
to come out of the room with the medications. The DON asked if the Divalproex Sodium delayed release
tablets were in the crushed medications and when the nurse replied yes, the DON instructed RN #259 that
the medication could not be administered to the resident, as Divalproex Sodium delayed release tablets
cannot be crushed. The DON was observed to open a binder on the medication cart and turn to the do not
crush list provided by the pharmacy and showed the list to RN #259. RN #259 was observed to discard the
medications and obtained Resident #31's morning medication again without the Divalproex Sodium delayed
release tablets 250 mg, three tablets, in it as the DON stated they would need to get the order clarified.
Interview with the DON on 04/30/24 at 12:55 P.M. confirmed any resident who had a pureed diet order
should have their medications provided to them crushed. The DON verified the facility obtained an order for
Divalproex Sodium oral capsule delayed release sprinkles 125 mg, give four capsules by mouth one time a
day for Resident #31 on 04/30/24 as the capsules could be opened and sprinkled on food to give to
residents, and Resident #31 took her medications crushed. The DON verified the Resident #31 had an
order for pureed diet on 03/04/24 and until 04/30/24 the resident's Divalproex Sodium was
(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:
366494
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
366494
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/07/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Landings of Westerville Health and Rehab The
350 County Line Road West
Westerville, OH 43082
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
Residents Affected - Few
ordered and provided to the resident as three 250 mg tablets that were not to be crushed, but crushed was
the way the resident took her medications. The DON verified the facility staff had documented on the
medication administration record every day during the month of April 2024 that the Divalproex Sodium
delayed release 250 mg, three tablets had been administered to the resident.
Review of the facility policy titled Medication Administration General Guidelines for Administering
Medications dated 06/21/17 revealed medications will be administered by legally-authorized and trained
persons in accordance to applicable State, Local and Federal laws and consistent with accepted standards
of practice. The noted included to refer to medication reference text for administration of any medication
when added to or mixed with any substance to facilitate administration, (e.g. applesauce, juice, milk, etc.).
This deficiency represents non-compliance investigated under Complaint Number OH00153179.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366494
If continuation sheet
Page 2 of 2
