Austinwoods Rehab Health Care

F 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

administered to Resident #85 after reporting severe pain on 11/17/25 at 8:53 A.M. and at 9:01 A.M.

Observation on 11/17/25 from 9:00 A.M. to 9:07 A.M. revealed Licensed Practical Nurse (LPN) #313 obtained vital signs from Resident #85, prepared scheduled morning medications, and administered the prepared medications to Resident #85. At 9:01 A.M., Resident #85 was heard telling LPN #313 that her right leg hurt a lot and she then rated the pain level as an eight on a one to 10 numerical rating scale.

Further observation revealed Tylenol was not included in the medication cup that was prepared and handed to Resident #85, although LPN #313 informed Resident #85 that there was a little something for her leg pain with the medications that were handed to Resident #85. At the time of the medication observation, two staff from the therapy department were in the room and waiting to take Resident #85 for prescribed therapy.Interview on 11/17/25 at 9:07 A.M. with LPN #313 confirmed that when telling Resident #85 that there was something for her leg pain in the medicine cup, LPN #313 was referring to the meloxicam 15 mg that was ordered daily for arthritis. During the interview, LPN #313 also stated that Resident #85 also had

on a patch for pain that was not yet due to be removed (review of the medication orders and the MAR revealed Resident #85 had no orders for, or applications of, topical analgesics or pain patches). Interview

on 11/17/25 at 11:48 A.M. with Resident #85 confirmed she usually took Tylenol to help with her right leg pain. During the interview, Resident #85 was uncertain whether she received the Tylenol with her morning medications because there were so many pills and she did not know what all was in the medicine cup, but

she thought the nurse told her she gave her something extra for pain. At the time of the interview, Resident #85 stated that her pain was worse than earlier and wanted to see if it was time for more Tylenol. During a follow-up interview on 11/17/25 at 12:08 P.M. with LPN #313, LPN #313 was informed that Resident #85 stated the pain in the right leg was worse. During the interview, LPN #85 was observed looking in Resident #85's medical record before stating that all Resident #85 had for pain was a Tylenol order. Follow-up review of the medical record for Resident #85 at 4:57 P.M., including review of the orders, progress notes, pain assessments, and MAR, revealed no additional pain assessment was completed for Resident #85, and no Tylenol was administered to Resident #85 since the last dose given on 11/16/25 at 11:59 P.M. There were no notes to indicate any non-pharmacological interventions were offered, such as ice (as indicated in the Pain Tool assessments), that Resident #85 was offered and declined Tylenol, or that the medical provider was notified that Resident #85's assessment the morning of 11/17/25 revealed an increase in pain since admission to the facility. Review of the undated policy titled Medication Administration revealed medications were to be given timely, as prescribed, as determined by resident need and benefit. This deficiency represents non-compliance investigated under Complaint Number 2663659.

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Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/17/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Austinwoods Rehab Health Care

4780 Kirk Rd Austintown, OH 44515

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Resident #86 confirmed he had already eaten breakfast without having the ordered morning medication and that it had been a while since breakfast was served.Interview with LPN #313 on 11/17/25 at 9:25 A.M. confirmed the sevelamer popped up on the MAR for 8:00 A.M. administration and most medications could be given one hour before or one hour after the time it was timed for on the MAR. Further interview with LPN #313 confirmed that the order specified the sevelamer was to be given before meals, it had been more than 30 minutes since residents on the unit ate breakfast, and that the medication was administered more than one hour after the time that was listed on the MAR. Review of the undated policy titled Medication Administration revealed medications were to be administered according to prescriber orders, including within any required timeframes, and that medications were to be administered within one hour of the prescribed time, or in accordance with the specified time within the order, such as before or after meal orders. The policy further revealed that medications times were to be determined by what was best for resident outcome and not staff convenience, such as times that enhanced the optimum therapeutic benefit of the medications and have the least potential negative consequences or interaction with other medications or foods.This deficiency represents non-compliance investigated under Complaint Number

1. 2663659. Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/17/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Austinwoods Rehab Health Care

4780 Kirk Rd Austintown, OH 44515

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Bleach, and CaviWipes1. The instructions further revealed two of the approved wipes were required, one to clean, and one to disinfect the device. Further review of the manufacturer's instructions revealed the device was to remain wet for the specified amount of time per the wipe manufacturer's instructions in order to be considered properly disinfected. 2. Review of the medical record for Resident #67 revealed an admission date of 04/08/25 and a re-entry date of 09/16/25. Pertinent diagnoses included acute and chronic respiratory failure, spastic quadriplegic cerebral palsy, dysphagia, neuromuscular dysfunction of the bladder, seizures, attention to tracheostomy, dependence on respirator (ventilator) status, tracheostomy status, pressure ulcer of the sacral region, and gastrostomy status. Review of the quarterly MDS 3.0 assessment completed on 10/29/25 revealed Resident #67 had severely impaired cognition. Further review of the MDS revealed Resident #67 had a feeding tube and received more than 51 percent (%) of daily required calories through a feeding tube. Review of the physician's orders revealed an order which specified Resident #67 was to be on EBP per CDC (Centers for Disease Control and Prevention) guidelines.Review of the care plan last reviewed 11/06/25 revealed Resident #67 was on EBP due to having a Foley (an indwelling urinary catheter), a tracheostomy tube (trach), an enteral feeding tube, and wounds.

Interventions included keeping gloves and gowns available and using appropriate personal protective equipment (PPE) during direct personal care, including bathing, dressing, transferring, changing bed linen, changing briefs, and any wound care or device use. Observation on 11/17/25 from 11:58 A.M. to 12:02 P.M. revealed Resident #67 received medication through an enteral feeding tube, which was administered by LPN #387. During the observation, LPN #387 did not wear a gown for the medication administration which required close handling of the feeding tube, such as lifting the gown and readjusting the brief to observe the insertion site, leaning in to auscultate feeding tube placement, closing the port to the enteral formula that was hanging on the feeding pump, opening and closing the medication port to attach and detach a syringe for pre and post medication flushes and medication administration, reopening the enteral feeding line port, and readjusting the residents gown and linen once the medication administration was completed. Interview

on 11/17/25 at 12:05 P.M. with LPN #387 confirmed Resident #67 was in EBP, and a gown was to be worn

during wound care, Foley care, trach care, and probably during administration of medications through Resident #67's feeding tube, but she did not put one on.Interview on 11/17/25 at 3:50 P.M. with the DON confirmed that residents that had enteral feeding tubes were supposed to be in EBP, which required nurses to wear a gown and gloves during medication administration through the feeding tube.Review of the policy titled Enhanced Barrier Precautions (EBP) dated April 2024, revealed EBP was to be implemented for residents with medical devices, including enteral feeding tubes. The facility EBP procedure specified that EBP was to be used consistently throughout the facility and included the use of gowns and gloves during use or care of enteral feeding tubes. This deficiency was an incidental finding identified during the complaint investigation.

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Facility ID:

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