32
Inspections on file
44
Deficiencies cited
19
Visits with none
0
Substandard care
0
Immediate jeopardy

The most recent inspection on file for Buckeye Forest at Fairfield Assisted Living took place on April 22, 2026. Across the 32 inspections published by the Ohio Department of Health, surveyors cited 44 deficiencies.

A deficiency is a rule the surveyor found the facility was not meeting. Ohio inspects against two rule books at once, so most findings carry a federal code and an Ohio code for the same problem; each is counted once here, the way the state counts it. Correction dates are the state's confirmation that the issue was fixed.

This report reproduces what Ohio publishes and nothing else. Of the 32 inspections listed, the state publishes the surveyor's written findings for 13; for the other 19 it publishes only the date, the type of visit and the number of deficiencies - 19 of which found none.

Facility Details

Ohio license number
#1809R
County
Butler
Administrator
Felicia Pierson
Director of nursing
Zach Vandt
Phone
(513) 874-2390
Ownership
For Profit - Limited Liability Company

Inspections

32 on file · 44 deficiencies
April 22, 2026Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
March 26, 2026Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
February 18, 2026Complaint survey4 deficiencies
R-0311Initial assessment time frameOhio citation · correction confirmed 03/26/2026
What the surveyor found

Based on medical record review and staff interview, the facility failed to ensure initial assessment was completed at the time of admission. This affected one (#116) of three residents reviewed for admission process. The facility census was 115.

Findings include

Review of the medical record for Resident #116 revealed an admission on 10/28/25 with diagnoses including generalized edema, chronic obstructive pulmonary disease, asthma, bipolar disorder with behaviors and viral hepatitis C.

Review of the initial assessment tab in the electronic health record revealed an initial assessment was not completed on admission.

Interview on 02/04/25 at 10:10 A.M. with Assisted Living Director #01 confirmed Resident #116's initial admission assessment was not completed and should have been.

This violation is based on incidental findings discovered during the course of this complaint investigation.

Rule
Ohio Administrative Code - residential care rules
R-0338Administered meds - MD ordersOhio citation · correction confirmed 03/26/2026
What the surveyor found

Based on medical record review and staff interview, the facility failed to ensure prescribed medications were available for administration. This affected one (#47) of five residents reviewed for narcotic pain medications availability. The facility census was 115.

Findings include:

Medical record review for Resident #47 revealed an admission on 11/12/21 with diagnoses including but not limited to low back pain and disc degeneration.

Review of the self administration of medication assessments for Resident #47 revealed the facility staff provided the monitoring and administration of narcotic medications.

Review of the physician orders for Resident #47 revealed an order dated oxycodone 5 milligram tablet every four hours as needed for pain dated 01/18/23.

Review of the medication administration record for Resident #47 for the month of September 2025 revealed the resident did not receive any oxycodone 5 mg tablets on 09/01/25 to 09/02/25.

Review of the progress notes for Resident #47 dated 08/29/25 at 4:01 P.M. that nurse faxed oxycodone prescription to the physician. Resident #47 and case manager were notified.

Review of the electronic medication administration record revealed Resident #47 received oxycodone 5 mg tablet on 08/31/25 at 5:49 P.M. and the next dose was not recorded until 09/04/25 at 2:00 A.M.

Interview on 02/04/26 at 12:37 P.M. with Director of Nursing (DON) verified the facility did not have the medication available for Resident #47 if requested.

Interview on 02/05/26 at 1:16 P.M. with Physician #12 verified he did not have any documentation related to the lack of medication (oxycodone) for Resident #47. Additionally, Physician #12 confirmed that he was not contacted for any additional prescription for Resident #47.

This violation represents non-compliance investigated under Complaint Numbers OH00169446 and OH00169214.

Rule
Ohio Administrative Code - residential care rules
R-0339Administered meds - given only to and as prescribedOhio citation · correction confirmed 03/26/2026
What the surveyor found

Based on medical record review, observation, staff interview and policy review, the facility failed to document all narcotic medications at the time of administration. This affected three (#100, #107 and #47) of five residents reviewed for medication administration documentation. The facility census was 115.

Findings included.

1. Review of the medical record for Resident #47 revealed an admission on 11/12/21 with diagnoses including but not limited to low back pain and disc degeneration.

Review of the self administration of medication assessments for Resident #47 revealed the facility staff provided the monitoring and administration of narcotic medications.

Review of the physician orders for Resident #47 revealed an order dated oxycodone 5 milligram tablet every four hours as needed for pain dated 01/18/23.

Review of the medication administration record for Resident #47 for the month of January 2025 revealed the resident received 73 tablets.

Review of the controlled drug administration report for the month of January 2026 revealed Resident #47 received 211 tablets.

Interview on 02/04/26 at 12:37 P.M. with the Director of Nursing (DON) verified the facility did not accurately document the administration of all oxycodone medication on the medication administration record for Resident #47 and they should have.

2. Review of the medical record for Resident #107 revealed an admission on 4/14/25 with diagnoses including heart failure, hypertension, arthropathy and cellulitis.

Review of the self administration of medication assessments for Resident #107 dated 07/24/25 revealed the facility staff provided the monitoring and administration of narcotic medications.

Review of the physician orders for Resident #107 revealed an order dated 11/15/25 for hydrocodone- acetaminophen oral tablet 5-325 mg give two tablets every six hours as needed for pain.

Review of the medication administration record for Resident #107 for the month of January 2025 revealed the resident received 51 tablets.

Review of the controlled drug administration report for the month of January 2026 revealed Resident #47 received 55 tablets.

Interview on 02/04/26 at 12:37 P.M. with the DON verified the facility did not accurately document the administration of all hydrocodone- acetaminophen oral tablet medication on the medication administration record for Resident #107 and they should have.

3. Medical record review for Resident #100 revealed an admission on 07/08/22 with diagnoses including but not limited to chronic obstructive pulmonary disease and type two diabetes without complications.

Review of the physicians order for Resident #100 revealed an order dated 07/27/23 for Pregabalin (controlled substance) Oral Capsule 50 mg give 1 capsule by mouth three times a day for neuropathy.

Observation on 02/04/26 at 11:45 A.M. of Licensed Practical Nurse (LPN) #21 removed one tablet of Pregabalin (controlled substance) Oral Capsule 50 mg from the medication cart locked narcotic drawer. LPN #21 knocked and entered the room for Resident #100 and determined the resident was not in the room. LPN #21 placed the medication in the top drawer of the medication cart and pushed the cart to the next room. LPN #21 located Resident #100, retrieved the cup of medication from the top drawer of the medication cart and administered the Pregabalin (controlled substance) Oral Capsule 50 mg) but did not sign off the narcotic sheet and placed the empty narcotic card in the narcotic binder and closed the binder.

Interview on 02/04/26 at 12:00 P.M. with LPN #21 and DON verified the LPN did not sign off the narcotic medication when administered. Further interview with DON stated the LPN should have signed the medication off on the controlled drug administration record at the time of the administration. The DON verified LPN #21 should not store medication that has been prepared for administration in the top drawer of the medication cart and should be destroyed if not used.

Review of the facility policy titled Administration Procedures for all Medications dated 08/2020 revealed the facility failed to implement the policy. The policy states all medication should be document administration and document the administration on the controlled substance sheet.

This violation is based on incidental findings discovered during the course of this complaint investigation.

Rule
Ohio Administrative Code - residential care rules
R-0397Hand hygiene; hand washing and use of alcohol-based productsOhio citation · correction confirmed 03/26/2026
What the surveyor found

Based on medical record review, observations, staff interview and policy review the facility failed to ensure facility staff used appropriate infection control measures when preparing and administering medications. This affected four (#100, #94, #54 and #78) out of five residents reviewed for medication and infection control. The facility census was 115.

Findings include:

1. Medical record review for Resident #100 revealed an admission on 07/08/22 with diagnoses including but not limited to chronic obstructive pulmonary disease and type two diabetes without complications.

Review of the physicians' order for Resident #100 revealed an order dated 07/27/23 for Pregabalin (controlled substance) oral capsule 50 milligrams (mg), give one capsule by mouth three times a day for neuropathy.

Observation on 02/04/26 at 11:45 A.M. of Licensed Practical Nurse (LPN) #21 retrieve medication cart keys from uniform pocket and unlock the medication cart. LPN #21 turned keys over in her hands to retrieve a different key and unlock the narcotic compartment. LPN #21 located the medication card and pushed the tablet thru the back of the medication card using her finger and placing the oral pregabalin tablet into her hand. LPN #21 dropped the tablet into a plastic administration cup. LPN #21 locked the medication cart and knocked on Resident #100's door. LPN #21 entered the room after turning the door handle for Resident #100's room and determined the resident was not in the room. LPN #21 unlocked the medication cart and placed the medication in the top drawer, closed the drawer and pushed the cart to the next room.

2. Medical record review for Resident #94 revealed an admission on 12/21/23 with diagnoses including but not limited to hemiplegia and hemiparesis following a stroke.

Review of the physicians' order for Resident #94 revealed an order dated 11/18/25 for Loratadine oral tablet 10 mg, give 10 mg by mouth in the afternoon for allergies and an order dated 12/23/23 for Gabapentin oral capsule 400 mg, give 800 mg by mouth four times a day for neuropathy.

Observation on 02/04/26 at 11:52 A.M. of LPN #21 retrieved medication cart keys from uniform pocket and unlocked the medication cart. LPN #21 located the gabapentin medication card after touching all the cards in the section for Resident #94. LPN #21 then pushed the tablets through the back of the medication card with the tablet landing into her bare hand. LPN #21 then slid the gabapentin tablet into a medication administration cup from the palm of her hand. LPN #21 then opened the top drawer of the medication cart and retrieved a multidose bottle of loratadine 10 mg, unscrewing the lid and shaking the bottle until one tablet fell into her open bare palm of her hand. LPN #21 then tilted her hand pouring the loratadine tablet into the plastic administration cup. LPN #21 then handled the water pitcher handle and poured water into a plastic drinking cup. LPN #21 knocked and entered the room for Resident #100 and administered the medication to the resident. LPN #21 pushed the medication cart to the next room.

3. Medical record review for Resident #54 revealed an admission on 06/06/25 with diagnoses including but not limited to hemiplegia and hemiparesis following a stroke, alcohol dependence, depression and opioid dependency.

Review of the physician's order for Resident #54 revealed an order dated 09/02/25 for baclofen tablet 10 mg one tablet by mouth three times a day for pain.

Observation on 02/04/25 at 11:54 A.M. of LPN #21 revealed LPN #21 retrieved medication cart keys from uniform pocket and unlocked the medication cart. LPN #21 located the baclofen medication card after touching all the cards for the resident in the specified section. LPN #21 pushed the tablet through the back of the medication card with the tablet landing into her bare hand. LPN #21 then slid the baclofen tablet into a medication administration cup. LPN #21 then knocked on Resident #54 room door. Resident #54 did not answer, and LPN #21 unlocked the room door using the keypad and called out to the resident. Resident #54 was not in his room. LPN #21 returned to the medication cart and opened the top drawer of the medication cart using keys from her pocket. LPN #21 sat the medication cup in the top drawer and shut the drawer and pushed the medication cart to the next room.

4. Medical record review for Resident #78 revealed an admission on 09/30/18 with diagnoses of Parkinson's disease, anemia, and chronic pain.

Review of the physicians' orders for Resident #78 revealed an order for Tylenol Extra Strength oral tablet 500 mg, give 2 tablet by mouth every six hours as needed for pain dated 01/30/26.

Observation on 02/04/26 at 11:57 A.M. of LPN #21 retrieved medication cart keys from uniform pocket and unlocked the medication cart. LPN #21 located the multidose bottle of Tylenol and shook the bottle until two tablets landed into her bare hand. LPN #21 then slid the Tylenol tablets into a medication administration cup. LPN #21 then placed a plastic cup on the medication cart and picked up the pitcher containing the water pouring it into the glass. LPN #21 then locked the medication cart and knocked on Resident #78's room door. Resident #78 answered and LPN #21 handed the medication to the resident for consumption.

Interview on 02/04/26 at 12:04 P.M. with LPN #21 verified she did not perform hand hygiene prior to administering the medications. LPN #21 verified she handled the medications prior to administration for Resident #100, #94, #78, and #54. LPN #21 verified she touched objects between the preparation of medication and the administration of the medication and did not follow infection control policy.

Interview on 02/04/26 at 12:08 P.M. with the Director of Nursing (DON) verified the staff should not touch the medication prior to administering it to the resident's.

Review of the facility policy titled Administration Procedures for all Medications dated 08/2020 revealed the facility failed to implement the policy. The policy states to cleanse hands using Antimicrobial soap and water or facility provided hand sanitizer before beginning a med pass, before handling medication and before contact with a resident.

This violation is based on incidental findings discovered during the course of this complaint investigation.

Rule
Ohio Administrative Code - residential care rules
September 11, 2025Licensure survey16 deficiencies
R-0092Time frame for criminal records check, terminationOhio citation · correction confirmed 11/18/2025
What the surveyor found

Based on record review and staff interview, the facility failed to ensure background checks were received for all new employees. This had the potential to affect all of the residents residing in the facility. The facility census was 104 residents.

Findings include:

Review of the personnel file for Licensed Practical Nurse (LPN) #96 revealed a hire date of 07/29/25. There was no evidence that a completed background check had been received for LPN #96.

Interview on 09/10/25 at 2:41 P.M. with Human Resources Director (HRD) #220 verified the background check had not yet been received for LPN #96.

Rule
Ohio Administrative Code - residential care rules
R-0305Policy provision, including advanced directives/DNR, skilled nursing, special care unitOhio citation · correction confirmed 02/18/2026
What the surveyor found

Based on review of the facility policy and documents and staff interview, the facility failed to have a special care unit policy which contained the required elements. This had the potential to affect nine residents (#3, #4, #5, #6, #7, #8, #9, #10, and #11) that resided on the memory care unit. The facility census was 104 residents.

Findings include:

Review of the facility policy titled Assisted Living Memory Care Unit dated February 2024 revealed the policy did not include information regarding transfer and discharge and the cost of services.

Review of the facility policy titled Enhancing Independence undated revealed the policy did not include information regarding transfer and discharge and the cost of services.

Review of hte facility document titled Memory Care Checklist undated revealed the policy did not include information regarding transfer and discharge and the cost of services.

Interview on 09/09/25 at 5:33 P.M. with the Director of Nursing (DON) verified the facility lacked a memory care policy with all the required elements.

Rule
Ohio Administrative Code - residential care rules
R-0313Annual health assessment contentOhio citation · correction confirmed 11/18/2025
What the surveyor found

Based on medical record review and staff interview, the facility failed to ensure annual functional assessments were completed. This affected two (Residents #3 and #56) out of eight residents reviewed for assessments. The facility census was 104.

Findings include:

1. Review of the medical record for Resident #3 revealed an admission date of 06/11/24 with diagnoses including angina pectoris, anxiety disorder, hypertensive heart disease, delusional disorders, and mild cognitive impairment of uncertain or unknown etiology. Resident #3's record did not include a recent annual functional assessment.

2. Review of the medical record for Resident #56 revealed an admission date of 11/07/19 with diagnoses including atrial fibrillation, anemia, central pain syndrome, hyperlipidemia, and hypertension. Resident #56's record did not include a recent annual functional assessment

Interview on 09/11/25 at 10:54 A.M. with the Director of Nursing (DON) verified Residents #3 and #56's records did not include recent up-to-date annual functional assessments.

This violation represents noncompliance investigated under Complaint Number OH00168136.

Rule
Ohio Administrative Code - residential care rules
R-0392Establish/implement written infection control P/P; infection prevention and control program and designee requirementsOhio citation · correction confirmed 11/18/2025
What the surveyor found

Based on medical record review, observation, staff interview, and review of the facility policy, the facility failed to ensure staff implemented appropriate infection control techniques during resident care. This affected two (Residents #10 and #14) of three residents reviewed for infection control. The facility census was 104 residents.

Findings include:

1. Review of the medical record for Resident #10 revealed an admission date of 05/30/25 with diagnoses including type two diabetes mellitus, alcoholic cirrhosis of liver, bipolar disorder, major depressive disorder, congestive heart failure, anxiety disorder, and dementia.

Review of the active physician's orders for Resident #10 revealed an order for a wound treatment to the left lateral posterior foot to clean the wound with normal saline, pat dry, apply Santyl to wound bed, cover with bordered gauze and wrap with gauze daily.

Observation on 09/10/25 at 9:56 A.M. of wound care for Resident #10 per Licensed Practical Nurse (LPN) #24 revealed the nurse donned clean gloves and then removed the gloves and put them in a basket with the wound care supplies. LPN #24 then washed her hands threw away the gloves that were in the basket and put on clean gloves. LPN #24 removed the old dressing from Resident #10's foot, moved the trashcan closer, measured the wound, cleansed the wound, applied Santyl to wound bed, covered the wound with bordered gauze, and then wrapped Resident #10's foot with gauze without changing gloves or performing hand hygiene.

Interview on 09/10/25 at 10:10 A.M. with LPN #24 confirmed she had not changed gloves after removing the old wound dressing.

Review of the facility policy titled Wound Care dated August 2024 revealed staff were to remove a wound dressing and then discard it before practicing hand hygiene and putting on clean gloves.

2. Review of the medical record for Resident #14 revealed an admission date of 08/16/23 with diagnoses including chronic obstructive pulmonary disease, cognitive communication deficit, schizophrenia, anemia, chronic kidney disease, and chronic atrial fibrillation.

Observation on 09/10/25 at 8:23 A.M. of medication adminstration for Resident #14 per LPN #96 revealed the nurse administered medications to the resident #14 while wearing gloves. While wearing gloves, LPN #96 touched the laptop on the medication cart, silenced a phone, and then punched out medications while wearing the same gloves.

Interview on 09/10/25 at 8:26 A.M. with LPN #96 verified she had been wearing gloves and touched multiple objects during medication administration for Resident #14.

Review of the facility policy titled Administering Medications dated 04/28/25 revealed staff should follow established facility infection control procedures for the administration of medications.

Rule
Ohio Administrative Code - residential care rules
R-0393Tuberculosis control plan and risk assessmentOhio citation · correction confirmed 02/18/2026
What the surveyor found

Based on record review, staff interview, review of Tuberculosis (TB) policy and TB risk assessment, the facility failed to adhere to the policy related to staff TB screenings. This had the potential to affect all residents residing in the facility. The facility census was 104 residents.

Findings include:

1. Review of the personnel file for Hospitality Aide (HA) #76 revealed a hire date of 02/21/24. Further review of the personnel file for HA #76 revealed no evidence of annual TB screening.

2. Review of the personnel file for HA #44 revealed a hire date of 05/16/24. Further review of the personnel file for HA #44 revealed no evidence of annual TB screening.

Interview on 09/10/25 at 2:41 P.M. with Human Resources Director (HRD) #220 confirmed the facility did not have evidence of TB screenings for HA #44 and HA #76.

Review of the TB risk assessment worksheet completed for 2025 revealed staff would be screened yearly for TB.

Review of the facility policy titled Tuberculosis Infection Control Program dated January 2012 revealed the program included an annual risk assessment to provide TB risk classification, controls established in accordance with the current risk classification, and screening and surveillance of residents and employees as appropriate for the current TB risk classification.

Rule
Ohio Administrative Code - residential care rules
R-0559Procure, store, prepare, distribute and serve foodsOhio citation · correction confirmed 03/26/2026
What the surveyor found

Based on observation, staff interview, and review of the facility policy, the facility failed to ensure food was properly stored, prepared, and served in a manner to prevent food-borne illness. This had the potential to affect all of the residents residing in the facility. The facility census was 104 residents.

Findings include:

1. Observation on 09/08/25 at 9:41 A.M. of the kitchen revealed the dishwasher was operating as a chemical sanitizing dishwasher. The sticker on the dishwasher indicated the final rinse temperature should be 120 degrees Fahrenheit (F). The dishwasher was used several times and the gauges on top of the dishwasher never moved to indicate what the temperature was.

Interview on 09/08/25 at 9:44 A.M. with Dietary Aide (DA) #136 verified the gauges to the dishwasher were not working at the time of the observation.

Review of the facility policy titled General Guidelines for Food Safety dated 2021 revealed staff should be sure the wash and rinse temperatures were appropriate for the dishwasher.

2. Observation on 09/08/25 at 9:45 A.M. in the kitchen revealed multiple packages of frozen chicken were being thawed in a sink with no water running.

Interview on 09/08/25 at 9:46 A.M. with Cook #110 verified the frozen chicken was being thawed in the sink without water running on it.

Review of the facility policy titled General Guidelines for Food Safety dated 2021 revealed safe thawing practices included completely submerging the item in clean running water that was running fast enough to agitate and cause loose ice particles to float off.

3. Observation on 09/08/25 at 10:16 A.M. of the walk-in refrigerator revealed it contained the following opened and undated items: a plastic bag of parmesan cheese, wrapped sliced American cheese, a package of Swiss cheese slices, a container of barbecue sauce, a jar of tartar sauce, a tub of ricotta cheese.

Interview on 09/08/25 at 10:16 A.M. with Dietary Director (DD) #146 confirmed the items in the refrigerator were not marked with a date.

Review of the facility policy titled General Food Preparation and Handling undated revealed staff should label and date foods and put them away promptly.

4. Observation on 09/10/25 at 11:30 A.M. revealed Cook #110 had several thermometers and attempted to obtain meal temperatures prior to lunch being served.

Observation on 09/10/25 at 11:50 A.M. revealed DD #146 also attempted to obtain food temperatures. DD #146 tried several thermometers without success but was eventually able to get a digital thermometer to function. However, the thermometer was stuck around 30 degrees F, which required staff to subtract from the temperatures obtained.

Interview on 09/10/25 at 11:51 A.M. with DD #146 confirmed the facility should have a working digital thermometer in order to check food temperatures at each meal.

Review of the facility policy titled General Guidelines for Food Safety dated 2021 revealed staff should check food temperatures correctly.

This violation is a recite to the complaint survey completed 08/28/25.

Rule
Ohio Administrative Code - residential care rules
R-0564Kitchen and dining areas clean and sanitary; transporting meals; garbageOhio citation · correction confirmed 02/18/2026
What the surveyor found

Based on observations and staff interview, the facility failed to maintain a clean and sanitary kitchen. This had the potential to affect all of the residents residing in the facility. The facility census was 104 residents.

Findings include:

1. Observation on 09/08/25 at 9:57 A.M. of the three-compartment sink revealed there was food and trash in the sanitizing compartment of the sink.

Interview on 09/08/25 at 9:59 A.M. with Dietary Director (DD) #146 verified there was food and trash in the sink at the time of the observation. DD #146 stated there had been an issue with the sink backing up which caused the food and trash to flow into the sanitizing compartment.

2. Observation on 09/08/25 at 10:11 A.M. of the kitchen revealed there were four trash cans without lids.

Interview on 09/08/25 at 10:11 A.M. with DD #146 verified the garbage cans did not have lids/

3. Observation on 09/08/25 at 10:13 A.M. of the kitchen revealed the wall near the garbage cans and garbage disposal had multiple black spots on the wall as well as gnats flying around the area.

Interview on 09/08/25 at 10:13 A.M. with DD #146 confirmed the presence of the black spots and gnats near the garbage cans.

4. Observation on 09/08/25 at 10:16 A.M. of the walk-in refrigerator revealed there was a wet sludgelike substance with a black tint on the floor of the refrigerator.

Interview on 09/08/25 at 10:17 A.M. with DD #146 verfiied the presence of a wet sludgelike substance on the floor of the walk in refrigerator. .

This violation is a recite to the complaint survey completed 08/28/25.

Rule
Ohio Administrative Code - residential care rules
R-0608Clear and unobstructed paths of egress; propping open of doorsOhio citation · correction confirmed 03/26/2026
What the surveyor found

Based on observation and staff interview, the facility failed to ensure doors were not propped open and failed to ensure doors were equipped with appropriate hardware to allow for proper and safe functioning of the doors. This had the potential to affect all of the residents residing in the facility. The facility census was 104 residents.

Findings include:

1.Observation on 09/08/25 at 9:32 A.M. revealed the doors from kitchen to the dining room were propped open. Additionally, it was found that the doors were missing the latching hardware as designed. Further observation found that the kitchen door to the service hall was also propped open and had no latching hardware as designed.

Interview on 09/09/25 at 3:30 P.M. with the Administrator confirmed the findings.

2.Observation on 09/08/25 at 11:28 A.M. revealed the cross-corridor doors by the dining room on the memory care unit did not have the self-closer installed on the door one of the door leaves. The door closest to a resident room did not have the self-closing device attached. Further observation found the doors were integrated with the fire alarm system. This would not allow for the doors to operate as designed and required by code.

Interview on 09/09/25 at 3:30 P.M. with the Administrator confirmed the findings.

3.Observation on 09/08/25 at 11:38 A.M. revealed the door to a resident's room on the memory care unit was not closing and latching as designed. Observation noted cloth materials around the door that would not allow the door to close and latch. Additionally, it was noted that there were corridor doors throughout the facility that were missing doorknobs and latching hardware. This would not resist the passage of smoke in the event of an emergency.

Interview on 09/09/25 at 3:30 P.M. with the Administrator confirmed the findings.

4.Observation on 09/10/25 at 8:26 A.M. on the second floor revealed the door to the laundry room was propped open.

Interview on 09/10/25 at 8:26 A.M. with Hospitality Aide (HA) #50 verified the door was propped open.

5.Observation on 09/10/25 at 8:46 A.M. on the third floor revealed the door to the laundry room was propped open.

Interview on 09/10/25 at 8:46 A.M. with Activities Director (AD) #108 verified the laundry room door was propped open.

6.Observation on 09/10/25 at 8:57 A.M. on the fourth floor revealed the door to the laundry room was propped open,.

Interview on 09/10/25 at 8:57 A.M. with AD #108 verified the laundry room door was propped open.

This violation represents noncompliance investigated under Complaint Number OH00168136.

Rule
Ohio Administrative Code - residential care rules
R-0615Fire drill requirementsOhio citation · correction confirmed 11/18/2025
What the surveyor found

Based on record review, staff interview, and policy review, the facility failed to ensure residents capable of self-evacuation were evacuated to safe areas in at least two fire drills per year on each shift. This had the potential to affect all of the residents residing in the facility. The facility census was 104 residents.

Findings include:

Review of the fire drills completed from 09/01/24 to 09/09/25 revealed no evidence of evacuations of residents capable of self-evacuation.

Interview on 09/09/25 at 3:26 P.M. with Maintenance Director (MD) #184 verified the facility had not ensured residents capable of self-evacuation were evacuated during fire drills.

Review of the facility policy titled Fire Drill Policy dated March 2019 revealed fire drills would include practice in building evacuation procedures.

Rule
Ohio Administrative Code - residential care rules
R-0616Disaster drill requirementsOhio citation · correction confirmed 11/18/2025
What the surveyor found

Based on record review, staff interview, and policy review, the facility failed to conduct at least two disaster drills. This had the potential to affect all of the residents residing in the facility. The facility census was 104 residents.

Findings include:

Review of the disaster drills from 09/01/24 to 09/09/25 revealed only one disaster drill, a tornado drill, was completed.

Interview on 09/09/25 at 3:26 P.M. with Maintenance Director (MD) #184 verified the facility only completed one disaster drill.

Review of the facility policy titled Emergency Drills and Exercises reviewed September 2019 revealed the facility would conduct drills throughout the year testing the emergency preparedness plans and procedures.

Rule
Ohio Administrative Code - residential care rules
R-0619Written record of drills and evaluationOhio citation · correction confirmed 11/18/2025
What the surveyor found

Based on record review and staff interview, the facility failed to maintain documentation related to drills that included all required elements. This had the potential to affect all of the residents residing in the facility. The facility census was 104 residents.

Findings include:

Review of the fire drills completed from 09/01/24 to 09/09/25 revealed the drill reports lacked information related to the number of individuals evacuated, the total time for evacuation, and the weather conditions during the evacuation.

Interview on 09/09/25 at 3:26 P.M. with Maintenance Director (MD) #184 verified the drill reports lacked information related to evacuations.

Rule
Ohio Administrative Code - residential care rules
R-0623Annual staff training on fire preventionOhio citation · correction confirmed 11/18/2025
What the surveyor found

Based on record review and staff interview, the facility failed to ensure all staff completed annual fire prevention training. This had the potential to affect all of the residents residing in the facility. The facility census was 104 residents .

Findings include:

Review of the fire safety documentation revealed no evidence staff had completed annual fire prevention training from an approved source.

Interview on 09/10/25 at 12:16 P.M. with the Administrator verified the facility had no evidence that staff completed annual fire prevention training.

Rule
Ohio Administrative Code - residential care rules
R-0627Smoking requirements, including electronic smoking device, and vapor productsOhio citation · correction confirmed 03/26/2026
What the surveyor found

Based on observation, staff interview, and review of facility Self-Reported Incidents (SRIs), the facility failed to ensure signs were posted near oxygen storage, failed to ensure cigarette butts were disposed of in proper receptacles, and failed to ensure residents did not smoke in nondesignated areas. This had the potential to affect all of the residents residing in the facility. The facility census was 104 residents.

Findings include:

1. Observation on 09/08/25 at 11:49 A.M. revealed the storage room on C Hall of the third floor had multiple oxygen tanks being stored without a sign on the door indicating no-smoking was permitted.

Observation on 09/08/25 at 11:59 A.M. revealed the storage room on the A Hall of the third floor had multiple oxygen tanks being stored without a sign on the door indicating no smoking was permitted.

Interviews on 09/08/25 at 3:48 P.M. and 3:49 P.M. with Maintenance Director (MD) #184 verified there were no signs on the doors where the oxygen tanks were being stored that indicated no smoking was permitted.

2.Observation on 09/08/25 at 12:30 P.M. of the smoking area revealed there was a red metal self-closing trash can with a plastic bag liner and there was combustible trash inside the can and liner.

Interview on 09/08/25 at 12:31 P.M with the Administrator confirmed the metal trash can in the smoking area had a plastic liner which contained combustible trash.

3.Observation on 09/08/25 at 3:55 P.M. revealed there was an odor of cigarette smoke on the fourth floor in D Hall and MD #184 knocked on the door. Resident #84 was smoking inside the room and the resident stated she did not want to go outside to smoke at the time.

Interview 09/08/25 at 3:55 P.M with MD #184 confirmed Resident #184 was smoking inside her room which was not permitted. MD #184 confirmed residents were only permitted to smoke in the designated smoking area.

4. Observation on 09/08/25 at 4:03 P.M. revealed there were plastic receptables for cigarette butts in the smoking area.

Interview on 09/08/25 at 4:04 P.M. with MD #184 confirmed the receptacles for cigarette butts in the smoking area were made of plastic.

5. Observation on 09/08/25 at 4:04 P.M. revealed there were multiple cigarette butts in the mulch in the smoking area.

Interview on 09/08/25 at 4:05 P.M. with MD#184 verified there were cigarette butts in the mulch in the smoking area.

Interview on 09/11/25 at 2:21 P.M. with the Administrator confirmed the facility had a fire which had occurred in the early morning in the smoking area on 08/25/25. The Administrator confirmed the facility found a cigarette butt which had been disposed of in a flower bed in the smoking area which the facility's investigation determined was the source of the fire.

Review of the facility SRI created on 08/25/25 revealed a cigarette butt was disposed of in a flower bed in the smoking area, which caused a piece of wood to catch on fire. The SRI indicated the fire was immediately doused. Per the SRI, there were no witnesses.

This violation represents noncompliance investigated under Complaint Number OH00168225 and Complaint Number OH00168182 and Complaint Number 168136.

Rule
Ohio Administrative Code - residential care rules
R-0645Resident-activated call systemOhio citation · correction confirmed 11/18/2025
What the surveyor found

Based on medical record review, observation, and staff interview, the facility failed to ensure residents had functioning call lights that could not be deactivated from any location except from where the call was initiated, unless the staff was able to communicate with the resident. This affected two (Residents #63 and #88) and had the potential to affect all of the other residents residing in the facility. The facility census was 104 residents.

Findings include:

1. Review of the medical record for Resident #63 revealed an admission date of 08/24/23 with a diagnosis of multiple sclerosis.

Observation on 09/10/25 at 10:59 A.M. with Hospitality Aide (HA) #86 revealed the aide activated the call pendant for Resident #63 and was able to turn off the call light at the monitoring station without interacting with Resident #63.

Interview on 09/10/25 at 11:00 A.M. with HA #86 verified Resident #63's call light could be deactivated without going to the resident's room or communicating with the residents.

2. Review of the medical record for Resident #88 revealed an admission date of 01/23/24 with diagnoses including hypertension, muscular dystrophy, hyperlipidemia, and depression.

Observation on 09/10/25 at 10:23 A.M. revealed the call pendant in Resident #88's room was activated.

Interview on 09/10/25 at 10:57 A.M. with HA #86 confirmed an alert was sent to a tablet when Resident #88's call light was pressed. HA #86 stated the tablet needed to be charged and she had not received an alert that Resident #88's call light had been activated.

Interview on 09/10/25 at 1:53 P.M. with HA #86 confirmed the tablet was functioning properly and an alert indicated Resident #88's call light had been activated three hours and 39 minutes prior to the interview.

This violation represents noncompliance investigated under Complaint Number OH00168155.

Rule
Ohio Administrative Code - residential care rules
R-0674Floors in good repairOhio citation · correction confirmed 02/18/2026
What the surveyor found

Based on observation, staff interview, and policy review, the facility failed to ensure all floors were in good repair. This had the potential to affect all of the residents residing in the facility. The facility census was 104 residents.

Findings include:

Observation on 09/08/25 at 12:02 P.M. revealed the carpet on the A Hall of the third floor was wrinkled, which caused the carpet to be uneven. There was also duct tape between the transition of the carpet between the A Hall and the carpet in the common area.

Interview on 09/08/25 at 3:49 P.M. with Maintenance Director (MD) #184 verified the wrinkled carpet and duct tape.

Review of the facility policy titled Quality of Life - Homelike Environment dated May 2017 revealed residents were to be provided with a safe, clean, comfortable and homelike environment.

This violation represents noncompliance investigated under Complaint Number OH00168136.

Rule
Ohio Administrative Code - residential care rules
R-0710Safe and clean environmentOhio citation · correction confirmed 11/18/2025
What the surveyor found

Based on observation, staff interview, and review of the facility policy, the facility failed to provide a safe and clean-living environment. This had the potential to affect all of the residents residing in the facility. The facility census was 104 residents

Findings include:

1. Observation on 09/08/25 at 11:21 A.M. of the second floor B Hall revealed the heating/cooling unit had multiple areas of black spots on the vent.

Interview on 09/08/25 at 3:33 P.M. with Maintenance Director (MD) #184 verified the black spots on the vent.

2. Observation on 09/08/25 at 11:29 A.M. of the dining room in the memory care unit revealed a piece of drywall missing and an electrical box with wires exposed.

Interview on 09/08/25 at 3:37 P.M. with MD #184 verified the piece of missing drywall and the exposed wires.

3. Observation on 09/08/25 at 11:40 A.M. of the memory care unit revealed a room at the end of the hall near the stairwell that was unlocked and being used to store various furniture, trash, and broken items. The room was missing a cooling/heating unit on the wall, which left a large vent to the outside exposed.

Interview on 09/08/25 at 3:42 P.M. with MD #184 verified the door was unlocked with trash, broken items, and the large vent to the outside exposed.

4. Observation on 09/10/25 at 2:13 P.M. of Resident #56's room revealed there were faded black spots on the wall.

Interview on 09/10/25 at 2:13 P.M. with MD #184 confimred he believed the spots on Resident #56's wall were from moisture and were related to mildew.

Review of the facility policy titled Quality of Life - Homelike Environment dated May 2017, revealed residents would be provided with a safe, clean, comfortable and homelike environment.

This violation represents noncompliance investigated under Complaint Number OH00168136 and Complaint Number OH00168141.

Rule
Ohio Administrative Code - residential care rules
August 28, 2025Complaint survey2 deficiencies
R-0559Procure, store, prepare, distribute and serve foodsOhio citation · correction confirmed 03/26/2026
What the surveyor found

Based on observation, staff interview, and review of facility policy, the facility failed to store food in a sanitary manner. This had the potential to affect all of the residents residing in the facility. The facility census was 108 residents.

Findings include:

Observation on 08/28/25 at 11:36 A.M. with Dietary Manager (DM) #3 of the dry storage area revealed the following items: a one gallon container of vanilla flavoring opened 03/09/24 with an expiration date of 02/10/24, one bag of opened undated mini marshmallows with an expiration date of June 2025, a bag of open undated salad croutons, a bag of open undated turkey gravy mix, a bag of open undated frosting mix, a bag of open to air undated dry spaghetti noodles, a container of uncovered mashed potato granules, a bag of open undated chicken soup mix.

Interview on 08/28/25 at 11:38 A.M. with DM #3 confirmed the items observed in the dry storage area should have been dated upon opening and stored in an airtight container. DM #3 further confirmed expired foods should be discarded.

Review of facility policy titled Food Safety and Sanitation undated revealed perishable foods with expiration dates should be used prior to the use by date on the package. When a food package was opened, the food item should be marked to indicate the opendate and this date should be used to determine when to discard the food.

This violation represents noncompliance investigated under Complaint Number OH00167424.

Rule
Ohio Administrative Code - residential care rules
R-0564Kitchen and dining areas clean and sanitary; transporting meals; garbageOhio citation · correction confirmed 02/18/2026
What the surveyor found

Based on observation and staff interview, the facility failed to maintain kitchen trash in garbage cans with tight-fitting lids. This had the potential to affect all of the residents residing in the facility. The facility census was 108 residents.

Findings include:

Observation on 08/28/25 at 11:36 A.M. of the facility kitchen revealed there were four large trash cans filled with kitchen waste with no lids.

Interview on 08/28/25 at 11:40 A.M. with Dietary Manager (DM) #3 confirmed the four kitchen trash cans did not have lids covering them, and the facility did not have lids for those trash cans.

This violation represents noncompliance investigated under Complaint Number OH00167424.

Rule
Ohio Administrative Code - residential care rules
April 25, 2025Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
January 9, 2025Complaint survey1 deficiency
R-0339Administered meds - given only to and as prescribedOhio citation · correction confirmed 09/11/2025
What the surveyor found

Based on record reviews, interview, and policy review, the facility failed to ensure medications were documented as administered per physician orders. This affected three (#7, #89, and #95) of three residents reviewed for medication administration. The facility census was 97. Findings include: 1. Review of the medical record for Resident #7 revealed an admission date of 11/30/22. Diagnoses included chronic kidney disease stage three, vitamin D deficiency, basal cell carcinoma of skin, major depressive disorder, hyperlipidemia, calculus of kidney, overactive bladder, obesity, and localized edema. Review of the Medication Administration Record (MAR) for Resident #7 from 11/01/24 to 11/30/24 revealed missing documentation for: a) Atorvastatin (treats high cholesterol) 20 milligrams (mg.) for a dose of one tablet at bedtime on 11/14/24 and 11/16/24. b) Depakote (anticonvulsant) 125 mg. for a dose of one tablet at bedtime on 11/14/24 and 11/16/24. c) Fish Oil (vitamin) 500 mg. for a dose of two capsules at bedtime on 11/14/24 and 11/16/24.) Furosemide (diuretic) 20 mg. for a dose of two tablets daily on 11/14/24. e) Levofloxacin (antibiotic) 500 mg. for a dose of one tablet daily on 11/14/24. f) Losartan Potassium (lowers blood pressure) 50 mg. for a dose of one tablet daily on 11/14/24. g) Venlafaxine (antidepressant) 150 mg. for a dose of one tablet at bedtime on 11/14/24 and 11/16/24. h) Vitamin D3 (vitamin) 25 micrograms (mcg.) for a dose of one tablet at bedtime on 11/14/24 and 11/16/24. Interview on 01/09/25 at 5:50 P.M. with the Director of Nursing (DON) verified the missing medication administration documentation for Atorvastatin, Depakote, Fish Oil, Furosemide, Levofloxaxin, Losartan Potassium, Venlafaxine, and Vitamin D3 for Resident #7. 2. Review of the medical record for Resident #89 revealed an admission date of 10/10/24. Diagnoses included type two diabetes mellitus with stable proliferative diabetic retinopathy, congestive heart failure, chronic pain, bipolar disorder, anxiety disorder, spinal stenosis, vitamin d deficiency, and insomnia. Review of the MAR for Resident #89 from 11/01/24 to 12/31/24 revealed missing documentation for: a) Atorvastatin 40 mg. for a dose of one tablet at bedtime on 11/14/24. b) Basaglar KwikPen Subcutaneous Solution Pen-injector (insulin) 100 unit/milliliter (ml.) for a dose of seven units daily on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24. c) Duloxetine (antidepressant) 30 mg for a dose of three capsules daily on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24.) Flomax (treats urinary retention) 0.4 mg. for a dose of one capsule daily on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24. e) Furosemide 40 mg. for a dose of one tablet daily on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24 f) Hydroxyzine (antihistamine) 50 mg. for a dose of one tablet in the evening on 11/14/24. g) Losartan Potassium 50 mg. for a dose of one tablet daily on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24. h) Meloxicam (treats pain) 7.5 mg. for a dose of one tablet daily on 11/14/24. i) Protonix (treats acid reflux) 40 mg. for a dose of one tablet daily on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24. j) Remeron (antidepressant) 15 mg. for a dose of half a tablet at bedtime on 11/14/24. k) Seroquel (antipsychotic) 25 mg. for a dose of three tablets at bedtime on 11/14/24. l) Trazodone (antidepressant) 100 mg. for a dose of one tablet at bedtime on 11/14/24. m) Depakote 125 mg. for a dose of one tablet for the morning and evening dose on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24.. n) Ipratopium-Albuteral Inhalation Solution (treats lung diseases) 0.5-2.5 (3) mg./ 3.0 ml. for a dose of three ML for the morning and evening dose on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24. o) Keppra (anticonvulsant) 1,000 mg. for a dose of one tablet for the morning and evening dose on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24. p) Novolog FlexPen Subcutaneous Solution Pen-injector (insulin) 100 unit/ml. sliding scale for the morning dose on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24, and the evening doses on 11/14/24, 11/25/24, 12/10/24, 12/16/24, 12/19/24, 12/23/24, 12/27/24, 12/30/24, and 12/31/24. q) Hydroxyzine 25 mg. for a dose of one tablet daily on 12/16/24, 12/23/24, 12/27/24, and 12/31/24. r) Mirtazapine (Remeron) 7.5 mg for a dose of one tablet daily on 12/26/24. s) Gabapentin (treats nerve pain) 600 mg for a dose of one tablet for the morning dose on 12/16/24, 12/23/24, 12/27/24, and 12/31/24, and the afternoon dose on 12/16/24, 12/19/24, 12/23/24, 12/27/24, and 12/31/24. Interview on 01/09/25 at 5:50 P.M. with the Director of Nursing (DON) verified the missing medication administration documentation for the above medications for Resident #89. 3. Review of the medical record for Resident #95 revealed an admission date of 12/06/23. Diagnoses included type two diabetes mellitus without complications, major depressive disorder, hypertension, and drug induced subacute dyskinesia. Review of the MAR for Resident #95 from 11/01/24 to 12/31/24 revealed missing documentation for: a) Amlodipine Besylate (treats high blood pressure) 10 mg for a dose of one tablet daily on 11/14/24 and 12/31/24. b) Aspirin 81 mg for a dose of one tablet daily on 11/14/24 and 12/31/24. c) Ingrezza (treats tardive dyskinesia) 80 mg for a dose of one tablet daily on 11/14/24 and 12/31/24.) Magnesium (vitamin) 400 mg for a dose of one tablet daily on 11/14/24 and 12/31/24. e) Propranolol (treats high blood pressure) 20 mg for a dose of one tablet daily on 11/14/24 and 12/31/24. f) Thiamine (vitamin) 100 mg for a dose of one tablet daily on 11/14/24 and 12/31/24. g) Metformin (treats high blood sugar) 500 mg for a dose of one tablet for the morning dose on 11/14/24 and 12/31/24, and the evening doses on 11/14/24, 11/25/24, 12/19/24, 12/27/24, and 12/31/24. h) Carbidopa-Levodopa (treats Parkinson's disease) 25-100 mg for a dose of half a tablet for the morning tablet on 11/14/24 and 12/31/24, the afternoon dose on 11/14/24, 12/19/24, 12/27/24, and 12/31/24, and evening dose on 11/14/24, 11/25/24, 12/19/24, 12/27/24, and 12/31/24. Interview on 01/09/25 at 5:50 P.M. with the Director of Nursing (DON) verified the missing medication administration documentation for the above medications for Resident #95. Review of the policy titled Administration Procedures for All MedicationsBased on record reviews, interview, and policy review, the facility failed to ensure medications were documented as administered per physician orders. This affected three (#7, #89, and #95) of three residents reviewed for medication administration. The facility census was 97.

Findings include:

1. Review of the medical record for Resident #7 revealed an admission date of 11/30/22. Diagnoses included chronic kidney disease stage three, vitamin D deficiency, basal cell carcinoma of skin, major depressive disorder, hyperlipidemia, calculus of kidney, overactive bladder, obesity, and localized edema.

Review of the Medication Administration Record (MAR) for Resident #7 from 11/01/24 to 11/30/24 revealed missing documentation for:

a) Atorvastatin (treats high cholesterol) 20 milligrams (mg.) for a dose of one tablet at bedtime on 11/14/24 and 11/16/24.

b) Depakote (anticonvulsant) 125 mg. for a dose of one tablet at bedtime on 11/14/24 and 11/16/24.

c) Fish Oil (vitamin) 500 mg. for a dose of two capsules at bedtime on 11/14/24 and 11/16/24.) Furosemide (diuretic) 20 mg. for a dose of two tablets daily on 11/14/24.

e) Levofloxacin (antibiotic) 500 mg. for a dose of one tablet daily on 11/14/24.

f) Losartan Potassium (lowers blood pressure) 50 mg. for a dose of one tablet daily on 11/14/24.

g) Venlafaxine (antidepressant) 150 mg. for a dose of one tablet at bedtime on 11/14/24 and 11/16/24.

h) Vitamin D3 (vitamin) 25 micrograms (mcg.) for a dose of one tablet at bedtime on 11/14/24 and 11/16/24.

Interview on 01/09/25 at 5:50 P.M. with the Director of Nursing (DON) verified the missing medication administration documentation for Atorvastatin, Depakote, Fish Oil, Furosemide, Levofloxaxin, Losartan Potassium, Venlafaxine, and Vitamin D3 for Resident #7.

2. Review of the medical record for Resident #89 revealed an admission date of 10/10/24. Diagnoses included type two diabetes mellitus with stable proliferative diabetic retinopathy, congestive heart failure, chronic pain, bipolar disorder, anxiety disorder, spinal stenosis, vitamin d deficiency, and insomnia.

Review of the MAR for Resident #89 from 11/01/24 to 12/31/24 revealed missing documentation for:

a) Atorvastatin 40 mg. for a dose of one tablet at bedtime on 11/14/24.

b) Basaglar KwikPen Subcutaneous Solution Pen-injector (insulin) 100 unit/milliliter (ml.) for a dose of seven units daily on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24.

c) Duloxetine (antidepressant) 30 mg for a dose of three capsules daily on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24.) Flomax (treats urinary retention) 0.4 mg. for a dose of one capsule daily on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24.

e) Furosemide 40 mg. for a dose of one tablet daily on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24

f) Hydroxyzine (antihistamine) 50 mg. for a dose of one tablet in the evening on 11/14/24.

g) Losartan Potassium 50 mg. for a dose of one tablet daily on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24.

h) Meloxicam (treats pain) 7.5 mg. for a dose of one tablet daily on 11/14/24.

i) Protonix (treats acid reflux) 40 mg. for a dose of one tablet daily on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24.

j) Remeron (antidepressant) 15 mg. for a dose of half a tablet at bedtime on 11/14/24.

k) Seroquel (antipsychotic) 25 mg. for a dose of three tablets at bedtime on 11/14/24.

l) Trazodone (antidepressant) 100 mg. for a dose of one tablet at bedtime on 11/14/24.

m) Depakote 125 mg. for a dose of one tablet for the morning and evening dose on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24..

n) Ipratopium-Albuteral Inhalation Solution (treats lung diseases) 0.5-2.5 (3) mg./ 3.0 ml. for a dose of three ML for the morning and evening dose on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24.

o) Keppra (anticonvulsant) 1,000 mg. for a dose of one tablet for the morning and evening dose on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24.

p) Novolog FlexPen Subcutaneous Solution Pen-injector (insulin) 100 unit/ml. sliding scale for the morning dose on 11/14/24, 12/16/24, 12/23/24, 12/27/24, and 12/31/24, and the evening doses on 11/14/24, 11/25/24, 12/10/24, 12/16/24, 12/19/24, 12/23/24, 12/27/24, 12/30/24, and 12/31/24.

q) Hydroxyzine 25 mg. for a dose of one tablet daily on 12/16/24, 12/23/24, 12/27/24, and 12/31/24.

r) Mirtazapine (Remeron) 7.5 mg for a dose of one tablet daily on 12/26/24.

s) Gabapentin (treats nerve pain) 600 mg for a dose of one tablet for the morning dose on 12/16/24, 12/23/24, 12/27/24, and 12/31/24, and the afternoon dose on 12/16/24, 12/19/24, 12/23/24, 12/27/24, and 12/31/24.

Interview on 01/09/25 at 5:50 P.M. with the Director of Nursing (DON) verified the missing medication administration documentation for the above medications for Resident #89.

3. Review of the medical record for Resident #95 revealed an admission date of 12/06/23. Diagnoses included type two diabetes mellitus without complications, major depressive disorder, hypertension, and drug induced subacute dyskinesia.

Review of the MAR for Resident #95 from 11/01/24 to 12/31/24 revealed missing documentation for:

a) Amlodipine Besylate (treats high blood pressure) 10 mg for a dose of one tablet daily on 11/14/24 and 12/31/24.

b) Aspirin 81 mg for a dose of one tablet daily on 11/14/24 and 12/31/24.

c) Ingrezza (treats tardive dyskinesia) 80 mg for a dose of one tablet daily on 11/14/24 and 12/31/24.) Magnesium (vitamin) 400 mg for a dose of one tablet daily on 11/14/24 and 12/31/24.

e) Propranolol (treats high blood pressure) 20 mg for a dose of one tablet daily on 11/14/24 and 12/31/24.

f) Thiamine (vitamin) 100 mg for a dose of one tablet daily on 11/14/24 and 12/31/24.

g) Metformin (treats high blood sugar) 500 mg for a dose of one tablet for the morning dose on 11/14/24 and 12/31/24, and the evening doses on 11/14/24, 11/25/24, 12/19/24, 12/27/24, and 12/31/24.

h) Carbidopa-Levodopa (treats Parkinson's disease) 25-100 mg for a dose of half a tablet for the morning tablet on 11/14/24 and 12/31/24, the afternoon dose on 11/14/24, 12/19/24, 12/27/24, and 12/31/24, and evening dose on 11/14/24, 11/25/24, 12/19/24, 12/27/24, and 12/31/24.

Interview on 01/09/25 at 5:50 P.M. with the Director of Nursing (DON) verified the missing medication administration documentation for the above medications for Resident #95.

Review of the policy titled Administration Procedures for All Medications

Rule
Ohio Administrative Code - residential care rules
November 13, 2024Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
September 30, 2024Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
September 9, 2024Complaint survey4 deficiencies
R-0559Procure, store, prepare, distribute and serve foodsOhio citation
What the surveyor found

Based on observation, staff interview, and review of the facility policy, the facility failed to ensure a kitchen vent was maintained in a sanitary manner and food items were held at the proper temperature on the steam table to prevent foodborne illness. This had the potential to affect 104 residents who received food from the kitchen. The facility census was 104.

Findings include:

1. Observation of the kitchen on 09/09/24 at 11:58 A.M. revealed there was a vent in the kitchen above the steam table that had brown and gray debris on it.

Interview with Cook #900 on 09/09/24 at 11:58 A.M. verified there was a vent in the kitchen above the steam table had brown and gray debris on it. Cook #900 identified some of the debris on the vent as rust.

2. Observation of tray line on 09/09/24 at 12:36 P.M. revealed Dietary Manager #950 took the food temperatures of the food items on the tray line. The chicken was 110 degrees Fahrenheit (F), the mashed potatoes were 100 degrees F, and the broccoli was 102 degrees F.

Interview with Dietary Manager #950 on 09/09/24 at 12:36 P.M. verified the chicken was 110 degrees F, the mashed potatoes were 100 degrees F, and the broccoli was 102 degrees F. Dietary Manager #950 confirmed that all items were not held above 135 degrees F on the steam table.

Review of the undated Food Temperature policy dated 2021 revealed all hot foods must be cooked to an appropriate internal temperature and held and served at a temperature of at least 135 degrees F.

This violation represents non-compliance investigated under Complaint Number OH00157345.

Rule
Ohio Administrative Code - residential care rules
R-0564Kitchen and dining areas clean and sanitary; transporting meals; garbageOhio citation
What the surveyor found

Based on observation and resident and staff interview, the facility failed to ensure silverware was available for all residents at meals. This affected 104 out of 104 residents that resided at the facility. The facility census was 104.

Findings include:

Interview with Resident #07 on 09/09/24 at 11:10 A.M. revealed the facility often ran out of silverware during meal service.

Observation of lunch meal on 09/09/24 from 11:44 A.M. to 12:36 P.M. revealed the facility ran out of silverware for lunch meal. The facility then gave plasticware to the remaining residents.

Interview with Dietary Manager #950 on 09/09/24 at 12:36 P.M. verified the facility ran out of silverware and residents were provided with plastic silverware.

This violation represents non-compliance investigated under Complaint Number OH00157345.

Rule
Ohio Administrative Code - residential care rules
R-0602Plumbing is free of leakage and odorsOhio citation
What the surveyor found

Based on observation and staff interview, the facility failed to ensure the kitchen was free from water leaks and water backing up into the kitchen. This had the potential to affect all 104 residents that resided at the facility.

Findings include:

Observation of the kitchen on 09/09/24 at 11:45 A.M. revealed a large pool of water was observed on the floor under the dishwasher. There were also three tiles missing on the kitchen floor near the stove that had water standing in them. Observation of the sink in the kitchen revealed the sink was full of brown water that was filled to the top of the sink.

Interview with Dietary Manager #950 on 09/09/24 at 12:36 P.M. verified there was a large pool of water was observed on the floor under the dishwasher and there were three tiles missing on the kitchen floor near the stove that had water standing in them. Dietary Manager #950 stated the water backed up into the missing tiles and the dishwasher had a leak causing the water under the dishwasher. Dietary Manager #950 also verified the sink did not drain properly.

This violation represents non-compliance investigated under Complaint Number OH00157345.

Rule
Ohio Administrative Code - residential care rules
R-0627Smoking requirements, including electronic smoking device, and vapor productsOhio citation
What the surveyor found

Based on observation, staff interview, and review of the facility policy, the facility failed to ensure oxygen tanks were properly stored. This affected one (Resident #14) of three residents who utilized oxygen at the facility. The facility census was 104.

Findings include:

Review of the Resident #14's chart revealed Resident #14 admitted to the facility on 03/13/21 with diagnoses including chronic obstructive pulmonary disease.

Review of Resident #14's physician order dated 05/22/24 revealed Resident #14 was ordered four liters of continuous oxygen by nasal cannula when stationary and six liters of continuous oxygen by nasal cannula with moving every shift for low oxygen.

Observation of Resident #14's room on 09/09/24 at 10:39 A.M. revealed there were 52 oxygen tanks in Resident #14's room with 28 tanks not being secured in the room. The 28 tanks were standing upright and were not in any type of stand, holder or cart.

Interview with Licensed Practical Nurse (LPN) #54 on 09/09/24 at 10:39 A.M. verified Resident #14 had 52 oxygen tanks in Resident #14's room with 28 tanks not being secured in the room.

Review of the undated Oxygen Storage and Handling policy revealed oxygen tanks should always be stored in a stand or cart to prevent tipping or falling do not allow tanks to stand or lean in an upright position while unsecured.

This violation represents non-compliance investigated under Complaint Number OH00157345.

Rule
Ohio Administrative Code - residential care rules
June 3, 2024Licensure survey1 deficiency
R-0645Resident-activated call systemOhio citation
What the surveyor found

Based on record review, observations, and resident and staff interviews, the facility failed to ensure all residents had access to a functioning call system. This affected four (Residents #97, #101, #109, and #112) of seven residents observed for call light functionality and had the potential to affect all 112 residents residing in the facility.

Findings include:

Observation and interview on 05/22/24 at 11:00 A.M. with Resident #109 stated she did not have an emergency pendant around her neck or a call box in the room. Resident #109 stated her emergency pendant was not working and it was observed sitting on the resident's table and not around the resident's neck. Resident #109's bathroom call light did not work.

Interview on 05/22/24 at 11:00 A.M. with Certified Nursing assistant (CNA) #287 confirmed Resident #109 had no call light working in her bathroom. CNA #287 confirmed Resident #109's emergency pendant was not working, and Resident #109 did not have a call box in the room.

Interview and observation on 05/22/24 at 11:40 A.M. with Resident #112 and CNA #287 confirmed Resident #112's call light was not working in her bathroom.

Interview and observation on 05/22/24 at 11:50 A.M. with Licensed Practical Nurse (LPN) #401 confirmed Resident #101's call light was not working in his bathroom. LPN #401 stated she was unaware the call light in Resident #101's bathroom was broken.

Observations on 05/22/24 at 3:00 P.M. with Maintenance Director (MD) #501 and the Administrator confirmed Resident #97 had no call box in the main living room wall or bathroom wall. MD #501 and the Administrator verified Resident #97 had no call light.

Interview on 05/22/24 at 3:05 P.M. with Resident #97 stated he had never had a call light in his room. Resident #97 stated he had told the management and staff that he did not have a call light in his apartment when he moved in last year. Resident #97 stated no one listened.

Interview on 05/22/24 at 3:59 P.M. with MD #501 stated he did not complete an audit of all the resident rooms and bathrooms to check if they had a call box and if the resident's call lights functioned in the room and bathroom. MD #501 stated he only checks them when they are notified by staff or residents when call lights are not working. MD #501 stated he then fixes them when he knows they are not working.

Review of the facility's call light audit of resident rooms and bathrooms dated 05/23/24 revealed the facility identified 52 call light issues in resident rooms. The issues identified included the resident rooms did not have a call light box in the room, the call light did not function in the room, the resident did not have a call light in the bathroom and/or did not have a functioning call light in the bathroom.

Interview on 05/23/24 at 1:16 P.M. with Executive Director (ED) #393 confirmed there were 52 call lights that were broken. ED #393 stated this was the audit she started last night (05/22/24) and finished today (05/23/24).

Interview with the Administrator, ED #393, and Corporate Director #500 on 05/23/24 at 4:00 P.M. revealed they were unaware of when the new call light system would be installed/replaced. They were waiting for the parts to be delivered to the facility and then the system would be installed.

Observations and Interviews on 05/28/24 from 10:15 A.M. to 4:00 P.M. with Residents #107, #105, #97, Licensed Practical Nurses #578 and #499, MD #501 and the Administrator, revealed the temporary wireless call system with pendants, the facility had purchased on 05/22/24, was in place; however, interview with the Administrator verified the facility has not yet received the equipment and parts for the new permanent call system and confirmed the new call system has not been installed/replaced as of 05/28/24, in accordance with the facility's plan of correction alleging compliance by 05/24/24.

This violation represents non-compliance investigated under Complaint Number OH00153336.

This violation is a recite from the survey dated 03/04/24 and 04/11/24.

Rule
Ohio Administrative Code - residential care rules
April 25, 2024Complaint survey2 deficiencies
R-0070Establish policies and review annuallyOhio citation · correction confirmed 06/03/2024
What the surveyor found

Based on record review, resident and staff interviews, review of witness statements, review of a Self-Reported Incident (SRI), and review of facility policy, the facility failed to implement their abuse policy and timely report an allegation of physical abuse. This affected one (#15) resident of the three residents reviewed for abuse. The census was 49.

Findings include:

Review of the medical record for Resident #15 revealed the resident was admitted on 01/19/23. Diagnoses include, but are not limited to, schizoaffective disorder, diabetes, chronic pain, gastritis, depression, mood disorder, and anxiety.

Review of a progress note dated 04/19/24 at 2:28 P.M. for Resident #15, revealed the pest control company was present to treat the resident's rooms and Resident #15 refused to allow the technicians to enter her room. The nurse went to talk to the Resident #15 and inform her that the technicians must spray since there was bed bug activity in her apartment. Resident #15 began to yell and curse stating that she was not going anywhere and tried to shut her door. The nurse asked Resident #15 to please allow the technicians to enter. Resident #15 continued to yell in the hallway and spat at the nurse. The Executive Director (ED) #33 was present and intervened to try and calm Resident #15 down. While ED #33 was talking with Resident #15, the technicians were able to spray Resident #15's apartment. Resident #15 continued to yell in the hallway and called 911 stating she had a warrant and that she was being mistreated because the technicians were in her room treating it.

Review of a progress note dated 04/19/24 at 5:16 P.M. for Resident #15 by Licensed Practical Nurse (LPN) #38, revealed the resident got angry when two guys from the pest control company walked into her apartment to check and spray for bed bugs. Resident #15 started screaming at the guys saying they planted bed bugs in her apartment and did not want her apartment to be treated.

Review of the progress notes from 04/19/24 through 04/22/24 for Resident #15 revealed no documentation regarding the physical abuse allegations on 04/19/24 involving Wellness Director (WD) #31.

Review of a witness statement dated 04/22/23 and untimed by ED #33 revealed on 04/19/24, ED #33 was notified Resident #15 would not allow the pest control technicians into her apartment for treatment. ED #33 and WD #31 went to speak with Resident #15. The resident was sitting in front of her door yelling expletives at the pest control technicians. ED #33 advised Resident #15 that treating her apartment was mandatory and she would need to let pest control technicians in her apartment. Resident #15 continued yelling, cursing, and throwing her remote control and phone while wheeling out into the hallway. ED #33 opened the resident's door to allow pest control technicians into the apartment and held the door shut to allow pest control to treat. Resident #15 called 911 from her cell phone and indicated she needed the police because she was being held against her will in the facility in Plainsville, West Virginia. ED #33 opened the door and told pest control technicians to put the resident's cat in the bathroom and go ahead and treat the apartment. After closing the door, ED #33 witnessed Resident #15 throwing her remote, kicking, and sputter spitting at WD #31. ED #33 reported she stepped in between WD #31 and Resident #15 when they were going toward each other. ED #33 asked WD #31 to walk away and go to her office as she was visibly upset. Resident #15 continued yelling as ED #33 advised the resident that treating the apartment was mandatory and not optional. Resident #15 said she would make sure that they all would be arrested for this. Resident #15 stated she would call the police department to let them know they threw her out of her room by her head, to let an expletive in her apartment. When pest control technicians finished, Resident #15 went back into her apartment and slammed the door. On 04/2/24, ED #33 spoke with WD #31 and advised her that a statement was needed regarding the incident on 04/19/24 as Resident #15 was still alleging she was slapped and assaulted by various staff. The statement revealed Resident #15 had spit on WD #31, and WD #31 put her hand over Resident #15's mouth to prevent her from spitting again. ED #33 advised WD #31 that she should have just put her hand up. ED #33 noted she did not witness WD #31 putting her hand over the resident's mouth as WD #31 reported to her. WD #31 advised WD #31 to notify the campus administration and the Regional Director of Operations (RDO) with the same thing that she had just reported to her.

Review of the Self-Reported Incident (Tracking #246661) created 04/23/24 at 11:04 A.M. by the Administrator for an allegation of physical abuse on 04/19/24. It was alleged that WD #31 hit Resident #15. The resident showed no areas of concern but said she is sore. Resident #15 appeared to have psychosocial distress but could not be specifically linked to the alleged incident as behaviors were present prior to alleged incident. The SRI had not been completed prior to exiting the survey.

Review of a witness statement dated 04/22/23 and untimed by WD #31 revealed Resident #15 was refusing to allow the pest control technicians to enter her room to spray. WD #31 and ED #33 went to have a conversation with Resident #15 and to allow the pest control technicians to enter her room since it was mandatory due to the bed bug activity noted in her apartment. Resident #15 was sitting in her wheelchair in front of her door yelling, screaming and the resident called 911. Resident #15 was yelling at the 911 operator to send an officer as she was not allowed to enter her room and was being held in the hallway against her will. Resident #15 continued to yell and make threats to the staff. WD #31 asked Resident #15 to lower her voice as she was screaming with every word that came out of her mouth. Resident #15 rolled up to WD #31 and tried to physically harm her with her cell phone and her fist, then spat all over WD #31 landing on her arm, face, and in her mouth. WD #31 tried restraining Resident #15 with one hand on her wrist and the other hand being placed over Resident #15's mouth since she was still spitting. ED #33 came out of Resident #15's room but did not witness the incident, only the spit all over her. ED #33 got in between WD #31 and Resident #15. WD #31 returned to her office to clean up and calm down.

Review of a witness statement dated 04/22/24 and untimed by Housekeeping Supervisor (HKS) #30 revealed she and Housekeeper #32 went to the third floor and witnessed ED #33, WD #31 and Resident #15 in the hallway and ED #33 was holding the resident's door so the Pest control company could spray. The statement indicated as she and Housekeeper #32 got closer to the resident's door, she witnessed Resident #15 screaming and yelling while ED #33 and WD #31 were trying to calm Resident #15 down. HKS #30 witnessed Resident #15 spit on WD #31 then WD #31 hit Resident #15 and ED #33 said to WD #31 stop it, you can't do that.

Review of a witness statement dated 04/22/24 and untimed by Housekeeper #32 revealed on 04/19/24 WD #31 was trying to get Resident #15 out of her apartment so that the bed bug people could spray, and Resident #15 was refusing to move from her apartment. Resident #15 rolled out into the hallway but was trying to go back into her apartment. WD #31 and the resident started arguing when Resident #15 spit in WD #31's face. The statement indicated WD #31 grabbed Resident #15's hair and punched the resident in the face with a closed fist three times and smacked the resident once.

Review of a witness statement dated 04/22/24 and untimed by Activity Director #40 revealed on Friday (04/19/24) around 2:00 P.M., Resident #15 was made to leave her room for pest control. Resident #15 made a big fuss and called the police. As she was leaving the area, she heard the yelling and when she turned around, she thought she saw Resident #15 spit on WD #31

Review of a facility document titled Shower Sheet dated 04/22/24 and untimed for Resident #15 by Licensed Practical Nurse (LPN) #36 revealed the resident had no discoloration, skin was warm to touch, intact without cracks or openings. Both arms had bruises from cat scratches per the resident.

Review of a witness statement dated 04/23/23 and untimed by the Administrator, revealed Resident #15 was interviewed in her room on 04/23/23 around 10:30 A.M. Resident #15 stated she was sore because two girls hit her and when Administrator questioned which two girls, Resident #15 identified the ED #33 and WD #31. The Administrator reported Resident #15 showed her some bruising which were multiple small areas that did not appear suspicious for a person of her age, diagnosis, and the resident's known behaviors. The Administrator asked the Resident #15 why the staff would put their hands on her, and the resident stated that she did not know. Resident #15 stated she felt sick and did not want to leave her apartment for the pest control. The Administrator explained to the resident that the facility must spray her room as they were almost done with the bed bug issue. The administrator asked the resident more questions, but the resident stopped the conversation and said she had to use the restroom.

Interview with Resident #15 on 04/23/24 at approximately 9:00 A.M., revealed WD #31 made her leave her room on 04/19/24 at approximately 2:00 P.M. and then smacked her, pulled her hair, and punched her in the face.

An interview with the Administrator on 04/23/24 at approximately 11:00 A.M., revealed she was unaware of the abuse allegation until a Human Resources (HR) staff reported the abuse allegation to her on 04/22/24 and immediately started the investigation. The Administrator stated HKS #32 reported the abuse allegation to HR on 04/22/24. The Administrator reported the abuse allegations should have been reported to her on 04/19/24.

Interview with ED #33 on 04/23/24 at 11:10 A.M. with the Administrator present revealed Resident #15 barricaded the door to her room by sitting in her wheelchair in front of her door on 04/19/24 while trying to prevent the pest control technicians from entering her room to spray for bed bugs. ED #33 stated they finally got Resident #15 to roll into the hallway to allow the pest control technicians to spray the resident's room. ED #33 stated Resident #15 started yelling and cursing at WD #31 and was trying to hit WD #31 with her cell phone. Resident #15 spit in WD #31's face. ED #33 stated she did not see WD #31 hit Resident #15 nor cover the resident's mouth but did see WD #31 grab the resident's wrist to prevent being hit with the cell phone. ED #33 stated she stepped between Resident #15 and WD #31 and told WD #31 to go to her office and continued to try and calm Resident #15 down. ED #33 stated when the pest control technicians were finished, the resident went back into her apartment and slammed her door.

An interview with Housekeeper #32 on 04/23/24 at 2:33 P.M. revealed on 04/19/24 he and HKS #30 were going up to check on a mattress in a room across the hall from Resident #15 when he witnessed Resident #15 yelling and cursing, then saw Resident #15 spit on WD #31. Housekeeper #32 stated WD #31 smacked Resident #15 and punched her in the face three times.

An interview with HKS #30 on 04/23/24 at 2:43 P.M. revealed on 04/19/24 she and Housekeeper #32 went to the third floor to check on a mattress in a room across the hall from Resident #15. HKS #30 stated Resident #15 was screaming and cursing at WD #31 then the resident spit on WD #31. HKS #30 stated WD #31 smacked the resident but was not sure how hard. HKS #30 stated she saw ED #33 step between WD #31 and Resident #15 and told WD #31 she could not do that.

An interview with WD #31 via telephone on 04/23/24 at 3:14 P.M. revealed on 04/19/24 Resident #15 had her pinned against the wall with her wheelchair and was trying to hit her with a cell phone in her hand. WD #31 stated she grabbed the resident's wrist to stop her from trying to hit her. WD #31 stated Resident #15 spit in her face, so WD #31 placed her hand over the resident's mouth so she could not spit on her again. WD #31 stated ED #33 came over and stepped between them and told her that she could not do that. WD #31 stated she then went to her office to clean off the spit. When asked why the incident was not reported to Administration, WD #31 stated that ED #33 was there so she just assumed that ED #33 would report the incident. WD #31 stated she felt like the physical contact was not abuse and would never smack or hit a resident.

Interview with ED #33 on 04/25/24 at 9:30 A.M. revealed she had met Resident #15 on 04/19/24 and informed her the pest control company was going to spray her apartment and it was not optional due to the bed bug activity. Resident #15 propelled herself into the hallways and ED #33 stayed directly outside of the resident's apartment facing the inside with the door slightly open to keep communication with the pest control technicians. ED #33 indicated that she heard the commotion and when she turned around, she witnessed WD #31 between the resident and the wall, and the resident was trying to hit WD #31 with her cell phone and spitting on her. ED #31 observed WD #33 had a hold of Resident's #15 wrist and there was saliva all over WD #31's uniform and on her face. ED #33 stated WD #31 was visibly very shaken about the incident and instructed her to go to the office while she tried to call Resident #15 down. ED #31 reported she never saw WD #31 slap Resident #15 or have her hand across her mouth. ED #31 indicated she only reported the resident's behaviors to the Administrator on 04/19/24 and never mentioned anything about the physical contact between the WD #33 and the resident. ED #31 indicated WD #33 entered her office on 04/21/24 and wanted to reiterate the events of 04/19/24 and when WD #33 reported she put her hand across the resident's mouth to keep her from spitting on her, ED #31 instructed WD #33 that she needed to report this incident to the Administrator.

Interview with the Administrator on 04/25/24 at 10:00 A.M. revealed she had been informed about Resident #15's behaviors on 04/19/24 but was never told about any physical contact between WD #31 and Resident #15. The Administrator revealed she was aware the PD was in the building on 04/21/24 to interview Resident #15; however, there has not been update from the PD or a report generated.

Interview with Police Officer #65 on 04/25/24 at 11:10 A.M. revealed the Police Department was called to the facility by Resident #15 on 04/19/24 but a police officer never went to the facility. Police Officer #65 stated Resident #15 called again on 04/21/24 and when he responded the facility, Resident #15 informed him of the alleged abuse incident by WD #31. Police Officer #65 reported he was still working on the case; however, when he interviewed some of the other residents' who were in the area, they observed Resident #15 being loud and belligerent with the staff and there were no observations of WD #31 hitting the resident.

Interview with LPN #38 on 04/25/24 at 1:21 P.M. revealed she was the nurse assigned to care for Resident #15 on 04/19/24. LPN #38 reported she was not aware of the incident and the resident never complained of anything and never reported the incident involving WD #31 and ED #33. LPN #38 stated the Police Department showed up on 04/21/24 around 11:00 A.M. to question the resident about the incident. LPN #38 reported Resident #15 told everyone that WD #31 had hit her and pulled her hair. LPN #38 stated she called ED #33 to let her know that the police were in the building and what Resident #15 had reported.

Interview with LPN #36 via telephone on 04/25/24 at 2:14 P.M. revealed she was the nurse assigned to care for Resident #15 on 04/22/23 when ED #33 asked her to complete a skin assessment on the resident. LPN #36 stated she was unaware of any abuse allegations from Resident #15 and the resident never made any statements about the abuse allegation. LPN# 36 stated that there was no bruising or injuries noted during the skin assessment.

Review of personnel files for ED #33 and WD #31 revealed no disciplinary action, coachable moments and licenses were current and unrestricted. ED #33 and WD #31 were on administrative suspension pending the outcome of the investigation.

Review of the Abuse, Mistreatment, Neglect, Exploitation, and Misappropriation of Resident Property Policy (dated 10/2023) revealed Facility staff should immediately report all such allegations to the Administrator and to the Ohio Department of Health (ODH) in accordance with the procedures in this policy.

This violation represents non-compliance investigated under Complaint Number OH000000153172.

Rule
Ohio Administrative Code - residential care rules
R-0711Free from abuseOhio citation · correction confirmed 06/03/2024
What the surveyor found

Based on record review, resident and staff interviews, review of witness statements, review of a Self-Reported Incident (SRI), and review of facility policy, the facility failed to prevent resident abuse. This affected one (#15) resident out of three residents reviewed for abuse. The facility census was 49.

Findings include:

Review of the medical record for Resident #15 revealed the resident was admitted on 01/19/23. Diagnoses include, but are not limited to, schizoaffective disorder, diabetes, chronic pain, gastritis, depression, mood disorder, and anxiety.

Review of a progress note dated 04/19/24 at 2:28 P.M. for Resident #15 by Licensed Practical Nurse (LPN) #38, revealed the pest control company was present to treat the resident's rooms and Resident #15 refused to allow the technicians to enter her room. The nurse went to talk to the Resident #15 and inform her that the technicians must spray since there was bed bug activity in her apartment. Resident #15 began to yell and curse stating that she was not going anywhere and tried to shut her door. The nurse asked Resident #15 to please allow the technicians to enter. Resident #15 continued to yell in the hallway and spat at the nurse. The Executive Director (ED) #33 was present and intervened to try and calm Resident #15 down. While ED #33 was talking with Resident #15, the technicians were able to spray Resident #15's apartment. Resident #15 continued to yell in the hallway and called 911 stating she had a warrant and that she was being mistreated because the technicians were in her room treating it.

Review of the progress notes from 04/19/24 through 04/22/24 for Resident #15 revealed no documentation regarding the physical abuse allegations on 04/19/24 involving Wellness Director (WD) #31.

Review of a witness statement dated 04/22/23 and untimed by ED #33 revealed on 04/19/24, ED #33 was notified Resident #15 would not allow the pest control technicians into her apartment for treatment. ED #33 and WD #31 went to speak with Resident #15. The resident was sitting in front of her door yelling expletives at the pest control technicians. ED #33 advised Resident #15 that treating her apartment was mandatory and she would need to let pest control technicians in her apartment. Resident #15 continued yelling, cursing, and throwing her remote control and phone while wheeling out into the hallway. ED #33 opened the resident's door to allow pest control technicians into the apartment and held the door shut to allow pest control to treat. Resident #15 called 911 from her cell phone and indicated she needed the police because she was being held against her will in the facility in Plainsville, West Virginia. ED #33 opened the door and told pest control technicians to put the resident's cat in the bathroom and go ahead and treat the apartment. After closing the door, ED #33 witnessed Resident #15 throwing her remote, kicking, and sputter spitting at WD #31. ED #33 reported she stepped in between WD #31 and Resident #15 when they were going toward each other. ED #33 asked WD #31 to walk away and go to her office as she was visibly upset. Resident #15 continued yelling as ED #33 advised the resident that treating the apartment was mandatory and not optional. Resident #15 said she would make sure that they all would be arrested for this. Resident #15 stated she would call the police department to let them know they threw her out of her room by her head, to let an expletive in her apartment. When pest control technicians finished, Resident #15 went back into her apartment and slammed the door. On 04/2/24, ED #33 spoke with WD #31 and advised her that a statement was needed regarding the incident on 04/19/24 as Resident #15 was still alleging she was slapped and assaulted by various staff. The statement revealed Resident #15 had spit on WD #31, and WD #31 put her hand over Resident #15's mouth to prevent her from spitting again. ED #33 advised WD #31 that she should have just put her hand up. ED #33 noted she did not witness WD #31 putting her hand over the resident's mouth as WD #31 reported to her. WD #31 advised WD #31 to notify the campus administration and the Regional Director of Operations (RDO) with the same thing that she had just reported to her.

Review of the Self-Reported Incident (Tracking #246661) created 04/23/24 at 11:04 A.M. by the Administrator for an allegation of physical abuse on 04/19/24. It was alleged that WD #31 hit Resident #15. The resident showed no areas of concern but said she is sore. Resident #15 appeared to have psychosocial distress but could not be specifically linked to the alleged incident as behaviors were present prior to alleged incident. At the time of the survey, the SRI had not been completed by the facility prior to exiting the survey.

Review of a witness statement dated 04/22/23 and untimed by WD #31 revealed Resident #15 was refusing to allow the pest control technicians to enter her room to spray. WD #31 and ED #33 went to have a conversation with Resident #15 and to allow the pest control technicians to enter her room since it was mandatory due to the bed bug activity noted in her apartment. Resident #15 was sitting in her wheelchair in front of her door yelling, screaming and the resident called 911. Resident #15 was yelling at the 911 operator to send an officer as she was not allowed to enter her room and was being held in the hallway against her will. Resident #15 continued to yell and make threats to the staff. WD #31 asked Resident #15 to lower her voice as she was screaming with every word that came out of her mouth. Resident #15 rolled up to WD #31 and tried to physically harm her with her cell phone and her fist, then spat all over WD #31 landing on her arm, face, and in her mouth. WD #31 tried restraining Resident #15 with one hand on her wrist and the other hand being placed over Resident #15's mouth since she was still spitting. ED #33 came out of Resident #15's room but did not witness the incident, only the spit all over her. ED #33 got in between WD #31 and Resident #15. WD #31 returned to her office to clean up and calm down.

Review of a witness statement dated 04/23/23 and untimed by the Administrator, revealed Resident #15 was interviewed in her room on 04/23/23 around 10:30 A.M. Resident #15 stated she was sore because two girls hit her and when Administrator questioned which two girls, Resident #15 identified the ED #33 and WD #31. The Administrator reported Resident #15 showed her some bruising which were multiple small areas that did not appear suspicious for a person of her age, diagnosis, and the resident's known behaviors. The Administrator asked the Resident #15 why the staff would put their hands on her, and the resident stated that she did not know. Resident #15 stated she felt sick and did not want to leave her apartment for the pest control. The Administrator explained to the resident that the facility must spray her room as they were almost done with the bed bug issue. The administrator asked the resident more questions, but the resident stopped the conversation and said she had to use the restroom.

Interview with Resident #15 on 04/23/24 at approximately 9:00 A.M., revealed WD #31 made her leave her room on 04/19/24 at approximately 2:00 P.M. and then smacked her, pulled her hair, and punched her in the face.

An interview with the Administrator on 04/23/24 at approximately 11:00 A.M., revealed she was unaware of the abuse allegation until a Human Resources (HR) staff reported the abuse allegation to her on 04/22/24 and immediately started the investigation. The Administrator stated HKS #32 reported the abuse allegation to HR on 04/22/24. The Administrator reported the abuse allegations should have been reported to her on 04/19/24.

Interview with ED #33 on 04/23/24 at 11:10 A.M. with the Administrator present revealed Resident #15 barricaded the door to her room by sitting in her wheelchair in front of her door on 04/19/24 while trying to prevent the pest control technicians from entering her room to spray for bed bugs. ED #33 stated they finally got Resident #15 to roll into the hallway to allow the pest control technicians to spray the resident's room. ED #33 stated Resident #15 started yelling and cursing at WD #31 and was trying to hit WD #31 with her cell phone then Resident #15 spit in WD #31's face. ED #33 stated she did not see WD #31 hit Resident #15 nor cover the resident's mouth but did see WD #31 grab the resident's wrist to prevent being hit with the cell phone. ED #33 stated she stepped between Resident #15 and WD #31 and told WD #31 to go to her office and continued to try and calm Resident #15 down. ED #33 stated when the pest control technicians were finished, the resident went back into her apartment and slammed her door.

An interview with HKS #30 on 04/23/24 at 2:43 P.M. revealed on 04/19/24 she and Housekeeper #32 went to the third floor to check on a mattress in a room across the hall from Resident #15. HKS #30 stated Resident #15 was screaming and cursing at WD #31 then the resident spit on WD #31. HKS #30 stated WD #31 smacked the resident but was not sure how hard. HKS #30 stated she saw ED #33 step between WD #31 and Resident #15 and told WD #31 she could not do that.

An interview with WD #31 via telephone on 04/23/24 at 3:14 P.M. revealed on 04/19/24 Resident #15 had her pinned against the wall with her wheelchair and was trying to hit her with a cell phone in her hand. WD #31 stated she grabbed the resident's wrist to stop her from trying to hit her. WD #31 stated Resident #15 spit in her face, so WD #31 placed her hand over the resident's mouth so she could not spit on her again. WD #31 stated ED #33 came over and stepped between them and told her that she could not do that. WD #31 stated she then went to her office to clean off the spit. When asked why the incident was not reported to Administration, WD #31 stated that ED #33 was there so she just assumed that ED #33 would report the incident. WD #31 stated she felt like the physical contact was not abuse and would never smack or hit a resident.

A subsequent interview with ED #33 on 04/25/24 at 9:30 A.M. revealed she had met Resident #15 on 04/19/24 and informed her the pest control company was going to spray her apartment and it was not optional due to the bed bug activity. Resident #15 propelled herself into the hallways and ED #33 stayed directly outside of the resident's apartment facing the inside with the door slightly open to keep communication with the pest control technicians. ED #33 indicated that she heard the commotion and when she turned around, she witnessed WD #31 between the resident and the wall, and the resident was trying to hit WD #31 with her cell phone and spitting on her. ED #31 observed WD #33 had a hold of Resident's #15 wrist and there was saliva all over WD #31's uniform and on her face. ED #33 stated WD #31 was visibly very shaken about the incident and instructed her to go to the office while she tried to call Resident #15 down. ED #31 reported she never saw WD #31 slap Resident #15 or have her hand across her mouth. ED #31 indicated she only reported the resident's behaviors to the Administrator on 04/19/24 and never mentioned anything about the physical contact between the WD #33 and the resident. ED #31 indicated WD #33 entered her office on 04/21/24 and wanted to reiterate the events of 04/19/24 and when WD #33 reported she put her hand across the resident's mouth to keep her from spitting on her, ED #31 instructed WD #33 that she needed to report this incident to the Administrator.

A subsequent interview with the Administrator on 04/25/24 at 10:00 A.M. revealed she had been informed about Resident #15's behaviors on 04/19/24 but was never told about any physical contact between WD #31 and Resident #15. The Administrator revealed she was aware the PD was in the building on 04/21/24 to interview Resident #15; however, there has not been update from the PD or a report generated.

Review of the Abuse, Mistreatment, Neglect, Exploitation, and Misappropriation of Resident Property Policy (dated 10/2023) revealed residents have the right to be from abuse.

Review of the Residents' Rights documentation undated, revealed residents had the right to be from physical abuse.

This violation represents non-compliance investigated under Complaint Number OH000000153172.

Rule
Ohio Administrative Code - residential care rules
April 11, 2024Complaint survey1 deficiency
R-0645Resident-activated call systemOhio citation
What the surveyor found

Based on observation, resident interview, and staff interview, the facility failed to ensure all residents had access to a functioning call system. This affected six (Residents #101, #83, #87, #79, #11, and #09) of six residents observed for call light functionality and had the potential to affect all 109 residents residing in the facility. The facility census was 109.

Findings include:

Interview on 04/11/24 at 9:36 A.M., Hospitality Aid (HA) #300 stated some residents have pendants or boxes which they can use to call for help. HA #300 stated there is also a button on the wall at the entrance to the room and a pull cord in the bathroom for the residents to use to call for help. HA #300 stated staff carry walkie talkies, which should alert them if a resident calls for help.

Interview on 04/11/24 at 9:41 A.M., Resident #101 stated she did not have a pendant or box to use to call for help. Resident #101 stated approximately two months ago, she attempted to use the call light in her bathroom and when she pulled the string, it fell out in her hand. Resident #101 stated she told the aide about it and the aide told her to throw it out.

Observation on 04/11/24 at 9:45 A.M. revealed the pull station for the call light in Resident #101's bathroom did not have a pull cord and there was no way to activate the light.

Interview on 04/11/24 at 9:51 A.M., HA #300 verified there was no pull cord in Resident #101's bathroom and there was no way to call for help from the bathroom.

Interview on 04/11/24 at 9:59 A.M., Resident #83 stated she did not have any way of alerting staff of the need for help. Resident #83 stated the pull station for the call light in her room did not have a string. Resident #83 stated her shower chair recently tipped when she was in the shower and she had to scoot to the doorway and got herself up.

Observation on 04/11/24 at 10:00 A.M. revealed the pull station in Resident #83's bathroom had no cord to pull and there was no way to activate the pull station.

Interview on 04/11/24 at 10:04 A.M., Licensed Practical Nurse (LPN) #315 verified Resident #83's pull station in the bathroom did not have a cord and there was no way to activate the call light.

Interview on 04/11/24 at 10:14 A.M., Resident #87 stated she used to have a string in the bathroom that she could pull for help but she used it once and it did not work after that. Resident # 87 stated she used to have a box which contained a call light, however the facility took it away. Resident #87 stated she recently had a fall and crawled from her bedroom to the entrance door of her apartment and used a back scratcher to open the door and call for help. Resident #87 stated she yelled for help approximately 10 times before someone came to help. Resident #87 stated she hated the thought of having to crawl to the door to get help again. Resident #87 further stated she was aware of the button on the wall at the entrance to her room but stated, when you fall, you can't reach that.

Observation on 04/11/24 at 10:17 A.M. revealed the pull station in Resident #87's bathroom had a cord. The cord was pulled in attempt to activate the call light.

Interview on 04/11/24 at 10:19 A.M., HA #310 stated he did not receive any alert of Resident #87's bathroom call light being activated.

Interview on 04/11/24 at 10:31 A.M., Resident #79 stated she did not have access to any call light. Resident #79 stated, if she needs to call for help, she bangs on the wall with her cane or calls the facility, if she has her phone in reach. Resident #79 stated the call light in her bathroom did not work.

Observation on 04/11/24 at 10:32 A.M., Resident #79's pull station in the bathroom was pulled to activate.

Interview on 04/11/24 at 10:36 A.M., HA #325 stated she did not receive any alert for her to know Resident #79's bathroom call light was activated.

Interview on 04/11/24 at 10:39 A.M., Resident #11 stated she had no means of calling for help. Resident #11 stated if she needs help, she hollers.

Observation on 04/11/24 at 10:40 A.M., Resident #11's bathroom call cord was pulled in an attempt to activate it.

Interview on 04/11/24 at 10:46 A.M., HA #325 stated she did not receive any type of alert for Resident #11's call light.

Interview on 04/11/24 at 1:20 P.M., Resident #09 stated she normally wears a medical alert pendant, however she does not wear it in the shower because she did not think it was waterproof. At the time of the interview, Resident #09's medical alert pendant was on the charger and the resident was not wearing it. Resident #09 stated she recently had a fall in her bathroom after she got out of the shower. Resident #09 stated she tried to pull the cord in the bathroom but it didn't work, so she got herself up into a sitting position and tried to scoot out of the bathroom toward the entrance of her room. Resident #09 stated she yelled for help for approximately 90 minutes and eventually two staff came to help her. Resident #09 acknowledged she had a button on the wall at the entrance of her room, however stated, if I'm on the floor, I can't reach that.

Observation on 04/11/24 at 1:20 P.M., HA #300 attempted to test the pull cord in Resident #09's bathroom. Upon pulling the cord, it came out of the wall. No alert was received on HA #300's walkie talkie.

Interview on 04/11/24 at 10:51 A.M., Executive Director (ED) #330 stated the call light system was antiquated, however the pull cords in the bathroom should work. ED #330 stated residents are checked on every two hours as an intervention. ED #330 stated Maintenance Director (MD) #320 resets the system every morning to ensure it is functioning properly.

Interview on 04/11/24 at 11:01 A.M., MD #330 stated the call light system is old and he checks it daily when he comes to work and the other maintenance staff check it in the evening and on weekends. MD #330 stated the call system sometimes gets jammed up, requiring the system to be reset. MD #330 stated the call stations in the bathrooms and the portable call light boxes are battery operated, which need to be replaced periodically. MD #330 stated residents who are high fall risks have pendants and some residents have the portable call light box, however the residents with the portable call light boxes often take the boxes different places and forget them. MD #330 stated he does not know about missing pull cords from the bathroom call stations unless staff or residents tell him about it. MD #330 stated the bathroom pull cords are the main thing that gets missed.

Observation on 04/11/24 at 11:17 A.M. revealed the computer used for the call light system did not display any alerts for the call lights activated prior to that time. MD #330 stated the system had probably gotten jammed up and he had not yet reset it this morning. Observation at 11:18 A.M., MD #330 began the process to reset the system. Continuous observation between 11:18 A.M. and 11:48 A.M. revealed the call light system was still undergoing a reset and calls from the past were showing up.

This violation represents non-compliance investigated under Complaint Number OH00152179. This violation represents ongoing noncompliance from the survey dated 03/04/24.

Rule
Ohio Administrative Code - residential care rules
March 4, 2024Complaint survey3 deficiencies
R-0645Resident-activated call systemOhio citation
What the surveyor found

Based on staff interview observation, and resident interview, the facility failed to ensure each resident had a working call system from the toilet and the living areas. This affected three (Residents #10, #105, and #109) of three resident reviewed for call lights and the had the potential to affect all residents residing in the facility with the exception of two-facility identified residents (#71 and #103) who wore emergency pendants. The facility census was 110.

Findings include:

Interview 03/01/24 at 1:10 P.M. with Assisted Living Administrator (ALA) #167 and Executive Director (ED) #134 confirmed the facility call system was very old and needed to be replaced. The resident rooms had a pull call light in the bathroom and a battery-powered call box in the room for residents to call for assistance. The nursing assistants carried portable devices, walkie-talkies, for aides to carry to notify them when a resident had requested assistance.

Observation on 03/01/24 at 4:00 P.M. of Resident #10's room revealed the resident did not have a call box in her room.

Interview on 03/01/24 at 4:00 P.M. with Resident #10 confirmed she did not have a call box and when she needed something she opened her door and yelled or waited for staff to pass by her room and offer assistance.

Observation on 03/01/24 at 4:02 P.M. of Resident #109's room revealed neither the call box nor the bathroom call cord in the resident's room were functioning properly.

Interview on 03/01/24 at 4:02 P.M. of Resident #109 confirmed the call box and bathroom call cord in her room did not work, and if she needed help, she would call the nurse on her personal cell phone.

Interview 03/01/24 at 4:20 P.M. with Personal Care Assistant (PCA) #135 confirmed Resident #10 did not have a call box in her room and Resident #109's call box and bathroom cord were not working.

Observation on 03/01/24 at 4:35 P.M. of Resident #105's room revealed the resident had activated the call cord in her bathroom but there was no response.

Interview on 03/01/24 at 4:35 P.M. of Resident #109 confirmed the call cord in her bathroom was not working.

Interview on 03/01/24 at 4:37 P.M. of Licensed Practical Nurse (LPN) #168 confirmed Resident #105's call cord in her bathroom was not working and that even though Resident #105 had activated the call cord she did not hear any signals come over the walkie talkie to indicate the resident needed assistance.

This violation represents non-compliance investigated under Complaint Number OH00151266.

Rule
Ohio Administrative Code - residential care rules
R-0661Maintain clean environment; housekeeping, garbage, rodentsOhio citation · correction confirmed 06/03/2024
What the surveyor found

Based on staff interview, record review, observation, and resident interview, the facility failed to maintain an effective pest control management system and provide a clean and sanitary environment. This affected Residents #30, #79 #98, #104, and #105 and had the potential to affect all 110 residents residing in the facility.

Findings include:

Interview 03/01/24 at 1:10 P.M. with Assisted Living Administrator (ALA) #167 confirmed the facility was purchased in January 2023 with a bed bug infestation. The facility started with individual pest control treatments and then signed a one-year contract for pest control services, because the infestation was worse than anticipated.

Review of the facility agreement with the pest control company dated 03/14/23 revealed the facility contracted for bedbug cleanout which came with a six-month guarantee from the initial treatment that should there be bedbug they would re-treat at no cost during that time. The agreement revealed the facility had experienced a high level of bed bug infestation and cleanup of the whole facility was needed with a treatment involving spraying of live spores to target the bed bugs and wipe out the colonies. The bed bug cleanup plan included the facility would need to place all linens, clothing, privacy curtains and window treatments (curtains) into the dryer for one hour on high heat then bag them up until after the treatment. The residents should shower and put on a fresh set of clothing before leaving the room for four hours during the treatment. If the resident had a wheelchair it should remain in the room during treatment because bed bugs were often found in the wheelchairs. If the walls to the resident rooms had cracks or holes they should be repaired because bed bugs could hide in them. If mattresses had tears or cracks in them, they should be replaced, and severely infested furniture should be discarded.

1. Review of a facility work order dated 12/12/23 revealed Room 303A needed to be treated for bed bugs. Further review of the work order revealed Room 303A revealed two live bed bugs were found on the couch and the room was treated on 12/13/23.

Observation on 03/01/24 at 3:35 P.M. of Room 303A revealed there were several plastic bags in the room filled with clothing and bedding from when the room was treated. There were socks, clothing and debris under the bed, clothes hanging in the closet, towels on a shelf in a closet and clothes on the floor of a storage closet. All the clothing and fabric items were not bagged for the dryer as per protocol. The living room carpet had red stains in front of the couch.

Review of the facility policy titled Pest Control-Bed Bugs undated revealed all clothing in resident's closets, drawers should be placed in blue colored bags and taken to the laundry prior to bed bug treatment.

Interview on 03/01/24 at 3:38 P.M. with Housekeeping Supervisor (HS) #166 confirmed the clothing in Room 303A had not been gathered per protocol for the room to be treated for bed bugs. HS #166 confirmed the carpet in Room 303A was soiled.

2. Review of the facility work orders revealed that in the last five weeks 13 resident rooms were observed with active bed bugs. Five resident rooms and the kitchen were treated for roaches.

Review of a facility work order dated 01/23/24 reveled room D505 had bed bug activity but was not ready for treatment. Six rooms on the 500 hall had signs of old activity. Room C305 had bed bug activity and needed treatment. Room D404 had roaches and was treated.

Review of a facility work order dated 01/25/24 revealed Room D505 was treated for bed bugs. Room C305 was treated for light bed bug activity on the chair and main door frame. There was light bed bug activity to two chairs om the lobby which was treated.

Review of a facility work order dated 01/27/24 work order revealed there was a heavy roach infestation throughout the kitchen. The cracks and crevices in the kitchen wall were flushed with a pesticide, all baseboards were sprayed, and bait was used to treat the area.

Review of a facility work order dated 01/30/24 revealed the kitchen was treated for roaches. The dining area was inspected for bed bugs with dead bugs found in 75 percent (%) of all chairs.

Review of a facility work order dated 02/06/24 revealed room A201 had four live bed bugs which were found and treated. Room 204A had light bed bug activity. Room B202 had live bed bugs and was scheduled to be sprayed later in the week. Room A211 was treated for mild roaches with suspicion that there were roaches in a cabinet that was drilled shut. Maintenance would have to remove the cabinet in order to treat the area. Room B208 was treated for light roaches mostly in bathroom, baited cabinets and dusted under the refrigerator.

Review of a facility work order dated 02/08/24 revealed room A204 was treated, and dead bugs were found. Room B204 was treated for light bed bug activity. Room B310 was treated for roaches, and something had spilled under the refrigerator. The kitchen sink was stopped up and there was coffee spilled under the refrigerator that needed to be cleaned up. Room C313 was treated for roaches and was dirty with dirty dishes in the sink. Room B202 was treated for one live bedbug.

Review of a facility work order dated 02/13/24 revealed room B307 had one live bedbug and was scheduled to be treated later in the week. The room was not ready to be treated and needed to be vacuumed. Room B309 had one bed bug which was barely moving, and room was scheduled to be treated later in the week when the room was ready. There were six rooms on the 300 hall that had evidence of dead bedbugs.

Review of a facility work orders dated 02/15/24 revealed Room C305 had light bedbug activity and needed to be treated. Rooms C309 and C311 had light bed bug activity. Rooms B307 and B309 were treated for light bed bug activity. The couch in Room D301 was nearly destroyed and was difficult to check properly. Room D309 needed to be inspected because it had been treated the month before, but staff were unable to enter the room because they did not know the code.

Review of a facility work order dated 02/22/24 revealed Room 507 had a few live bed bugs. Room 506 had a few living bed bugs, but the resident refused treatment. Six rooms on the fifth floor had old evidence of bed bugs. The dining room had seven chairs treated, one with live bed bug activity and six with dead bed bugs. Two chairs in the lobby, one with live bed bugs and one with dead bed bugs were treated.

Review of facility work order dated 02/23/24 revealed Rooms C506 and C507 was treated for light/medium bed bug activity.

Review of the facility work order dated 02/28/24 revealed a live bed bug was found on the mattress in Room B406. Ten rooms on the 400-hall had dead bed bugs and five had feces.

Review of a facility work order dated 02/29/24 revealed Room B406 was treated for three bed bugs found on the mattress. Room B407 had one dead bedbug and was treated.

3. Observation and interview of residents on 03/01/24 between 3:30 P.M. and 4:40 P.M. accompanied by HS #166 revealed there were multiple carpets and walls in resident rooms that were in poor repair with multiple carpet stains, loose debris in the room, no hot water available in one room, and damaged walls.

a. Interview with Resident #105 confirmed her apartment had no hot water. The water in the sink and shower were run and remained cold.

b. Observation of Resident #30's living room revealed there was a three by two-foot soiled area on the carpet entering the room.

c. Observation of Resident #104's apartment revealed there were runs in the carpeting. There were dark stains in the carpet around the refrigerator and recliner.

. Observation of Resident #98's carpet immediately outside her apartment door revealed a one-foot diameter soiled area in the hall. There was a three foot by two-foot soiled area on the carpet in front of the couch. The molding was detached from the wall entering the apartment. The walls were damaged with holes, and the metal corner protector was detached from the wall in places and exposed. The damaged walls were not repaired per the pest control contract's instructions to eliminate bed bugs.

e. Interview 03/01/24 at 4:40 P.M. with Resident #70 confirmed they were supposed to get rid of his couch because of bed bugs and they have not got rid of the couch. He said his couch was eaten up with bed bugs.

HS#166 confirmed all of the findings at the times of the observations.

This violation represents noncompliance investigated under Complaint Number OH00151485.

Rule
Ohio Administrative Code - residential care rules
R-0674Floors in good repairOhio citation · correction confirmed 06/03/2024
What the surveyor found

Based on observation and staff interview, the facility failed to maintain the flooring in resident areas in good repair. This had the potential to affect all 110 residents residing in the facility.

Findings include:

Observation 03/01/24 at 6:32 P.M. revealed the facility had one operating elevator for the five-story building. The floor immediately outside the first-floor elevator door was in disrepair. There was a tile missing in front of the elevator door leaving a divot in the floor. There were six tile squares, approximately one square foot each, that were not secure. One was bubbled up and was loose from the floor. One was repaired with a thick dark cement type adhesive that extended out from under the tile, raising one end. The excess was not removed, leaving it spread on the repaired tile and surrounding tiles leaving elevations in the flooring. Four of the tiles were uneven and sunken as if the floor below was damaged and sagging.

Interview 03/01/24 at 6:32 P.M. with Housekeeping Supervisor (HS) #166 confirmed the floor immediately outside the first-floor elevator door was in disrepair and presented a hazard to residents who had to walk on the floor in order to access the only working elevator in the facility.

Rule
Ohio Administrative Code - residential care rules
February 15, 2024Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
January 16, 2024Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
December 1, 2023Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
October 18, 2023Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
September 18, 2023Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
August 2, 2023Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
July 20, 2023Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
July 5, 2023Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
June 27, 2023Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
May 9, 2023Complaint survey1 deficiency
R-0710Safe and clean environmentOhio citation · correction confirmed 06/03/2024
What the surveyor found

Based on record review, observation and interviews the facility failed to provide a safe, clean comfortable environment that was free of clutter and debris. This affected Resident #61 and #67 and had the potential to affect all 107 residents residing in the facility.

Findings include:

Observation of entire facility on 05/08/23 at 10:30 A.M. revealed multiple carpets, walls and resident rooms in poor repair with multiple carpet stains, loose debris, and evidence of bed bug droppings noted on floors and handrails. Observation of the fourth floor revealed the room of Resident #61 revealed there was a missing air conditioner cover, dirty flooring, visibly soiled bathroom flooring, and evidence of bed bug droppings throughout the room.

Interview with the Administrator on 05/09/23 at 12:45 P.M. verified the building required a complete clean up, and verified the missing air conditioner cover for Resident #61. The Administrator verified multiple areas of visible soiling and debris throughout the facility. The Administrator stated he was in the process of hiring a new Maintenance Director who will address all of the environmental issues throughout the building.

Interview with Resident #61 on 05/09/23 at 1:00 P.M. revealed the facility was always filthy and was never cleaned. Resident #61 stated he cannot remember the last time his room had been cleaned.

Interview with Resident #67 on 05/09/23 at 1:20 P.M. revealed the entire building has been unkept and filthy for over a year, and they have been treating for bed bugs for that long also.

This violation represents non-compliance investigated under Complaint Number OH00142505.

Rule
Ohio Administrative Code - residential care rules
May 2, 2023Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
March 21, 2023Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
February 6, 2023Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
January 5, 2023Licensure survey2 deficiencies
R-0122Physical exams for staffOhio citation · correction confirmed 06/03/2024
What the surveyor found

Based on record review and staff interview, the facility failed to ensure a physician completed staff physical examinations prior to employment. This affected five of six personnel records reviewed and had the potential to affect all residents. The facility census was 98.

Findings include:

Review of the personnel records for Licensed Practical Nurses (LPN) #22 revealed a hire date of 12/07/22; LPN #42 revealed a hire date of 10/26/22; Personal Care Assistant (PCA) #31 revealed a hire date of 11/03/22; Certified Nurse Aide (CNA) #45 revealed a hire date of 04/13/22 and CNA #53 revealed a hire date of 04/11/22. The employee files contained physical forms completed but not by a physician or a other health care professional with in their scope. The forms were just signed by a Registered Nurse or a Licensed Practical Nurse.

Interview on 01/03/23 at 5:38 P.M., with the Director of Nursing verified a physician had not completed the physical examinations for these personnel.

Rule
Ohio Administrative Code - residential care rules
R-0126Evidence of first aid trainingOhio citation · correction confirmed 06/03/2024
What the surveyor found

Based on record review and staff interview, the facility failed to ensure staff completed and maintained first aide training. This affected four of six personnel records reviewed and had the potential to affect all residents. The facility census was 98.

Findings include:

Review of the personnel records for Licensed Practical Nurse (LPN) #22, a Personal Care Assistant (PCA) #31, Certified Nurse Aides (CNA) #45 and #53 revealed no evidence of first aide training.

Interview on 01/03/23 at 5:38 P.M., with the Director of Nursing verified there was no evidence of first aide training completion for these personnel.

Rule
Ohio Administrative Code - residential care rules
November 30, 2022Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.
October 14, 2022Complaint survey6 deficiencies
R-0312Initial health assessment contentOhio citation · correction confirmed 01/05/2023
What the surveyor found

Based on record review and staff interview, the facility failed to ensure initial health assessments were completed. This affected one (#77) of ten residents sampled for health assessments. The census was 87.

Findings include

Review of the medical record for Resident #77 revealed an admission date of 01/12/22 with a diagnosis of intervertebral disc degeneration

Review of the medical record for Resident #77 revealed it did not include an initial health assessment

Interview on 10/14/22 at 4:15 P.M. with Wellness Director, Registered Nurse (RN) #275 confirmed the facility had not completed an initial health assessment for Resident #77.

The violation is based on incidental findings discovered during the course of this complaint investigation.

Rule
Ohio Administrative Code - residential care rules
R-0313Annual health assessment contentOhio citation · correction confirmed 01/05/2023
What the surveyor found

Based on record review and staff interview, the facility failed to ensure annual health assessments were completed.

This affected three (#6, #75, #76) of ten residents sampled for health assessments. The census was 87.

Findings include

1. Review of the medical record for Resident #6 revealed an admission date of 08/30/18 with a diagnosis of dementia with behavioral disturbance.

Review of the medical record for Resident #6 revealed it did not include an annual health assessment completed in the past 12 months.

2. Review of the medical record for Resident #75 revealed an admission date of 05/01/18 with a diagnosis of diabetes mellitus (DM.)

Review of the medical record for Resident #75 revealed it did not include an annual health assessment completed in the past 12 months.

3. Review of the medical record for Resident #76 revealed an admission date of 05/01/18 with a diagnosis of hypertension.

Review of the medical record for Resident #76 revealed it did not include an annual health assessment completed in the past 12 months.

Interview on 10/14/22 at 4:15 P.M. with Wellness Director, Registered Nurse (RN) #275 confirmed the facility had not completed annual health assessments in the past 12 months for Residents #6, #75, and #76.

The violation is based on incidental findings discovered during the course of this complaint investigation.

Rule
Ohio Administrative Code - residential care rules
R-0314Assess for change in conditionOhio citation · correction confirmed 01/05/2023
What the surveyor found

Based on record review, staff interview, and review of the facility policy, the facility failed to ensure resident's back pain was assessed as ordered by the physician. This affected one (#10) of three residents reviewed for change in condition. The census was 87.

Review of the medical record for Resident #36 revealed an admission date of 12/08/21 with a diagnosis of chronic obstructive pulmonary disease (COPD.)

Review of annual health assessment for Resident #36 dated 07/18/22 revealed resident was cognitively intact and was independent with activities of daily living (ADL's).

Review of the telephone orders for September 2022 for Resident #36 revealed an order dated 09/27/22 for resident to have an x-ray of her lower back.

Review of the progress note for Resident #36 dated 09/27/22 revealed the resident complained of pain to her lower back. Resident #36 stated that this was a new onset of pain causing her not to be able to stand up straight. Resident #36 stated that if the pain continued she would send herself to the hospital. The nurse reported the concern to the attending physician who gave an order for facility to obtain an x-ray to resident's lower back.

Interview on 10/14/22 at 8:40 A.M. with Resident #36 confirmed an xray technician had come to the facility in September 2022 to take an x-ray of her back but he told her she might exceed the weight limit of the x-ray machine and he did not take the x-ray. Resident #36 confirmed this was a few weeks ago and the facility has still not arranged for her to have the x-ray.

Interview on 10/14/22 at 12:52 P.M. with Wellness Director, Registered Nurse (RN) #275 confirmed the facility had not obtained the x-ray for Resident #36 as ordered on 09/27/22. Wellness Director, RN #275 further confirmed Resident #36 has not been further assessed by the staff and/or physician since she started experiencing the back pain.

Review of the facility policy titled Lab and Diagnostic Test Results undated revealed the facility would obtain labwork and diagnostic tests as ordered by the physician and would ensure the physician was notified of the results.

This deficiency substantiates Complaint Number OH00136310.

Rule
Ohio Administrative Code - residential care rules
R-0333Personal care services provided appropriatelyOhio citation · correction confirmed 01/05/2023
What the surveyor found

Based on record review, staff interview, and review of the facility policy the facility failed to ensure resident's blood sugar was checked according to the physician's orders. This affected one (#10) of three residents reviewed for blood sugar monitoring. The facility also failed to ensure laboratory blood tests ordered by the physician were obtained. This affected one (#36) of three residents reviewed for care and services. The census was 87.

Findings include:

1. Review of the medical record for Resident #10 revealed an admission date of 03/11/21 with a diagnosis of diabetes mellitus (DM.)

Review of annual health assessment for Resident #10 dated 07/18/22 revealed resident was cognitively intact and required assistance with activities of daily living (ADL's).

Review of the October 2022 monthly physician orders for Resident #10 dated 09/15/21 for resident to have blood sugar checked once weekly on Wednesday.

Review of the October 2022 Medication Administration Record (MAR) for Resident #10 revealed Resident #10's blood sugar was not checked during the month of October. Date of survey was 10/14/22. MAR was blocked off for blood sugar checks on 10/05/22 and 10/12/22 but the record was blank.

Review of the September 2022 MAR for Resident #10 revealed resident's blood sugar was 113 on 09/07/22 and 144 on 09/21/22. There was no blood sugar recorded for 09/14/22 and 09/28/22.

Interview on 10/14/22 at 8:20 A.M. with Licensed Practical Nurse (LPN) #200 confirmed the facility had not checked blood sugars as ordered for Resident #10 for the month of October 2022.

Interview on 10/14/22 at 12:52 P.M. with Wellness Director, Registered Nurse (RN) #275 confirmed the facility had not checked blood sugars as ordered for Resident #10 on 09/14/22 and 09/28/22.

2. Review of the medical record for Resident #36 revealed an admission date of 12/08/21 with a diagnosis of chronic obstructive pulmonary disease (COPD.)

Review of annual health assessment for Resident #36 dated 07/18/22 revealed resident was cognitively intact and was independent with ADL's.

Review of the telephone orders for October 2022 for Resident #36 revealed an order dated 10/05/22 for resident to have the following blood tests obtained: complete blood count (CBC) and basic metabolic panel (BMP).

Review of the medical record for Resident #36 revealed there were no recent CBC or BMP results available.

Interview on 10/14/22 at 4:15 P.M. with Wellness Director, RN #275 confirmed the facility had not obtained the CBC or BMP as ordered for Resident #36 on 10/05/22.

Review of the facility policy titled Lab and Diagnostic Test Results undated revealed the facility would obtain labwork and diagnostic tests as ordered by the physician and would ensure the physician was notified of the results.

This deficiency substantiates Complaint Number OH00136310.

Rule
Ohio Administrative Code - residential care rules
R-0338Administered meds - MD ordersOhio citation · correction confirmed 01/05/2023
What the surveyor found

Based on record review, observation, staff interview, and review of the facility policy, the facility failed to ensure staff administered medications as ordered. This affected one (#85) of three residents observed for medication administration. The census was 87.

Findings include:

Review of the medical record for Resident #85 revealed an admission date of 06/26/22 with a diagnosis of chronic kidney disease.

Review of the October 2022 monthly physician orders for Resident #85 revealed resident had orders for carvedilol 12.5 milligram (mg) tablet, ferrous sulfate 325 mg tablet, omeprazole 20 mg capsule, cyclobenzaprine 10 mg tablet.

Review of the October 2022 Medication Administration Record (MAR) for Resident #85 revealed the following medications due at 6:00 A.M. on 10/14/22 were not signed off as given or refused: carvedilol, ferrous sulfate, omeprazole, cyclobenzaprine.

Review of the nurse progress notes for Resident #85 for 10/14/22 revealed the notes did not include information regarding 6:00 A.M. medication for resident.

Observation on 10/14/22 at 6:30 A.M. revealed Licensed Practical Nurse (LPN) #100 prepared morning medications for Resident #85: carvedilol, ferrous sulfate, omeprazole, cyclobenzaprine. Resident #85 was not in her room, and LPN #100 placed the cup with the four pills for Resident #85 inside the top right-hand drawer of the second floor A/B medication cart.

Interview on 10/14/22 at 6:30 A.M. with LPN #100 confirmed he placed the four pills for Resident #85 in the top right-hand drawer of the second floor A/B medication cart and he would try to approach the resident later.

Observation on 10/14/22 at 8:11 A.M. with LPN #250 revealed there was a container of four pills in the top right-hand drawer of second floor A/B medication cart in the same spot where LPN #100 had been observed placing them at 6:30 A.M.

Interview on 10/14/22 at 8:11 A.M. with LPN #250 confirmed she did not know who was supposed to receive the four pills in the top right-hand drawer of the AB medication cart. LPN #250 confirmed she had received report from LPN #100, but he had not mentioned any refusal of medications or any resident unavailable to receive medications. LPN #250 confirmed the following 6:00 A.M. medications for Resident #85 had not been signed off as given or refused or withheld: carvedilol, ferrous sulfate, omeprazole, cyclobenzaprine.

Review of the facility policy titled Storage of Medications dated April 2007 revealed drugs shall be stored in the packaging in which they are received.

Review of the facility policy titled Medication Administration dated 09/2018 revealed medications are to be administered at the time they are prepared. If a dose of regularly scheduled medication is withheld, refused, or given at other than the scheduled time (for example, the resident is not in the nursing care center at scheduled dose time, or a starter dose of antibiotic is needed), the space provided on the front of the MAR for that dosage administration is initialed and circled. An explanatory note is entered on the reverse side of the record.

This deficiency substantiates Complaint Number OH00136310.

Rule
Ohio Administrative Code - residential care rules
R-0345Labeling of medicationsOhio citation · correction confirmed 01/05/2023
What the surveyor found

Based on record review, observations, staff interview, and review of the facility policy, the facility failed to ensure medication was appropriately stored. This affected three (#75, #76, #77) of six residents reviewed for medications. The facility also failed to ensure that resident insulin was labeled upon opening in order to ensure insulin was discarded as appropriate. This affected one (#71) of three residents reviewed for insulin administration. The census was 87.

Findings include:

1. Observation on 10/14/22 at 8:11 A.M. with Licensed Practical Nurse (LPN) #250 revealed there were three plastic cups of pills in the top drawer of the second floor AB medication cart. Cups were full of pills and were labeled with the first names of Residents #75, #76, and #77.

Interview on 10/14/22 at 8:11 A.M. with LPN #250 confirmed she had pulled all the medications for Residents #75, #76, and #77. LPN #250 confirmed it was her usual practice to pull all the medications for the A hall and assemble them in plastic cups in the top drawer of the cart and then administer medications to all the A Hall residents. Then LPN #250 would pull all the medications for the B Hall and would continue in this fashion. LPN #250 confirmed she did not prepare one resident's medication at a time and ensure that resident was completed including documentation of medication administration before moving on to the next one.

Interview on 10/14/22 at 9:00 A.M. with Assisted Living Director (ALD) #300 confirmed nurses should administer one resident's medication at a time before going on to the next resident and that pre-pulling all the medications for multiple residents could result in medication errors and was against the facility policy.

Review of the facility policy titled Storage of Medications dated April 2007 revealed drugs shall be stored in the packaging in which they are received.

Review of the facility policy titled Medication Administration dated 09/2018 revealed medications are administered as prescribed in accordance with manufacturers' specifications, good nursing principles and practices and medications are to be administered at the time they are prepared.

2. Review of the medical record for Resident #71 revealed an admission date of 01/19/16 with a diagnosis of diabetes mellitus (DM.)

Review of the assessment for Resident #71 dated 07/18/22 reveled resident was mildly cognitively impaired and required assistance of staff with activities of daily living (ADL's).

Review of the October 2022 monthly physician orders for Resident #71 revealed an order dated 03/20/22 for insulin glargine, inject 20 units subcutaneously every morning.

Observation on 10/14/22 at 8:06 A.M. with Licensed Practical Nurse (LPN) #225 revealed the insulin glargine vial for Resident #71 was undated.

Interview on 10/14/22 at 8:06 A.M. with LPN #225 confirmed the insulin glargine vial for Resident #71 was not dated upon opening and therefore she was unable to determine if it was expired or not.

Review of the facility policy titled Medication Administration dated 09/2018 revealed staff should check the expiration date on package/container. No expired medication should be administered to a resident.

Review of the facility policy titled Subcutaneous Insulin dated 05/2016 revealed nurse should date insulin vial or device after first use.

This violation is based on incidental findings discovered during the course of this complaint investigation.

Rule
Ohio Administrative Code - residential care rules
September 30, 2022Complaint survey1 deficiency
R-0339Administered meds - given only to and as prescribedOhio citation · correction confirmed 01/05/2023
What the surveyor found

Based on medical record review, observations and resident and staff interviews and policy review, the facility failed to ensure medications were administered as physician ordered. This affected three (#91, #56 and #65) out three residents reviewed for medication administration. The facility census was 89.

Findings include:

1. Review of medical record for Resident #91 revealed admission date of 08/30/18. Diagnoses include dementia with behaviors, anxiety and type one Diabetes Mellitus. Resident #91's last functional assessment on 04/07/22 documented she was alert and oriented to person, place and time.

Review of the September 2022 Medication Administration Record (MAR) for Resident #91 revealed an order for Levimir (long-acting insulin) 50 units in the A.M. Further review revealed Resident #91's Levimir insulin was not documented as given on 09/03/22, 09/15/22, 09/21/22 and 09/22/22.

Review of the September 2022 MAR for Resident #91 revealed an order to check blood sugar three times (8:00 A.M., 12:00 P.M. and 4:00 P.M.) daily with meals and inject Novolog (fast acting insulin) per sliding scale. Less than 200 give zero units, 201 to 250 give one unit, 251 to 300 give two units, 301 to 350 give three units, 351 to 400 give four units, 401 to 450 give five units. There is missing documentation on of blood sugar on for 9:00 A.M. on 09/23/22 and 12:00 P.M. on 09/02/22, on 4:00 P.M.

Review of the September 2022 MAR for Resident #91 revealed an order to give six units of Novolog (short acting insulin) daily with meals (8:00 A.M., 12:00 P.M. and 4:00 P.M.) this was documented as given at 8:00 P.M. 14 times, at 12:00 P.M. six times and 4:00 P.M. 15 times which indicated there were multiple instances the insulin was not administered for the month.

Interview on 09/26/22 at 11:05 A.M. with Resident #91 revealed she did not get her morning insulin until after she had eaten around 10:00 A.M. Resident #91 continued to share she never gets her insulin as she should. Resident #91 stated she had to chase the nurses down because they are never around and then they only give it to her if they feel like it.

Observation on 09/26/22 at 11:23 A.M. of insulin administration for Resident #91 with the Director of Nursing (DON) revealed the DON dialed up one unit of Novolog to administer to Resident #91 based on a sliding scale. The observations revealed the DON did not prime the insulin pen prior to administering Resident #91's Novolog insulin. The DON verified she did not prime the needle for the Novolog insulin pen prior to administering the medication to Resident #91.

On 09/30/22 at 10:27 A.M. an interview with the Administrator and DON confirmed Resident #91's insulin was not administered as physician order according to the documentation in the MAR.

2. Review of medical record for Resident #56 revealed admission date of 10/19/18. Diagnoses including hypertension, heart failure, dementia, and anemia Resident #56's last functional assessment on 07/18/22 documented she was alert to person, place and time.

Review of the September 2022 MAR for Resident #56 revealed an order for Levimir (long-acting insulin) 50 units scheduled for 9:00 A.M. with no documentation as given on 09/03/22, 09/15/22, 09/21/22 and 09/22/22.

Review of the September 2022 MAR for Resident #56 revealed a handwritten entry added for an additional five units of Novolog to be given for a blood sugar of greater than 200. However, further record review for Resident #56 revealed there was no physician order for the five additional units of Novolog.

Review of the September 2022 MAR for Resident #56 revealed an order for Warfarin (anticoagulant) two five milligram tablet four times a week (Tuesday, Thursday, Saturday and Sunday) was not documented as given on 09/06/22 or 09/15/22. Further review of the September 2022 MAR for Resident #59 revealed an order for Warfarin (anticoagulant) five milligram tablet three times a week (Monday, Wednesday and Friday) was not documented as given on 09/09/22 and 09/21/22.

On 09/30/22 at 10:27 A.M. an interview with the Administrator and DON confirmed Resident #56's insulin and Warfarin were not administered as physician ordered. The Administrator and DON also confirmed the handwritten note on Resident #56's MAR indicating staff should administer an additional five units of Novolog; however, they confirmed there was no physician order that corresponds to this entry on the MAR.

3. Review of medical record for Resident #65 revealed admission date of 03/13/20. Diagnoses include Diabetes Mellitus type two, depression and anxiety. Resident #65's last functional assessment dated 07/18/22 documented he was alert and oriented to person, place and time.

Review of the September 2022 MAR for Resident #65 revealed an order for Lantus (long-acting insulin) at bedtime, scheduled for 8:00 P.M. with no documentation as given on 09/01/22, 09/05/22, 09/06/22, 09/11/22, 09/12/22, or 09/25/22.

On 09/30/22 at 10:27 A.M. an interview with the Administrator and DON confirmed Resident #65 did not receive insulin as physician ordered.

Review of the facility policy titled Medication Administration of Subcutaneous Insulin last reviewed 05/16 revealed staff are to perform the safety test before each injection of insulin to ensure to get the accurate dose and ensure the pen and the needle work correctly removing air bubbles.

This violation substantiates Complaint Number OH00135381.

Rule
Ohio Administrative Code - residential care rules
August 22, 2022Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies
No deficiencies cited
Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.