Laurels Of West Columbus, The

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

11:15 A.M. because the staff gave her a calcium medication last night. Interview with LPN #200 on 09/02/25 at 10:15 A.M. confirmed Resident #81's appointment had to be rescheduled for 09/04/25 because there wasn't an order to hold the Calcitriol before the appointment and the resident was given medication

on 09/01/25. Review of policy entitled Resident Rights dated 09/13/25 revealed the facility must protect and promote the rights of each resident. The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility. This deficiency represents non-compliance investigated under Complaint Number 2599291.

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

09/08/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Laurels of West Columbus, The

441 Norton Road Columbus, OH 43228

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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

Resident #83 in the halls, confused; however, she could not recall what time she had last seen him. CNA #400 denied telling the Administrator she last saw the resident at 4:30 A.M. and further denied being interviewed by the Administrator regarding the incident at all. Interview on 08/21/25 at 11:52 A.M. with LPN #326 revealed at the beginning of her shift on 08/02/25 and into the morning hours of 08/03/25, Resident #83 was pacing in the halls. LPN #326 stated the resident had a history of exit seeking behavior. LPN #326 stated she told the Administrator that she had last seen Resident #83 sometime between 4:00 A.M. and 5:30 A.M. Further interview revealed LPN #326 did not know how the resident left the facility and denied the door alarm sounded. LPN #326 confirmed the facility was unaware the resident was missing until the hospital called at 5:30 A.M. LPN #326 stated the Administrator interviewed her regarding the elopement and she told the Administrator the resident eloped around 4:00 A.M. Interview on 08/25/25 at 3:01 P.M. with

the Administrator revealed Resident #83 had previously attempted to leave the facility, which was when the Wanderguard was implemented, and the facility began exploring alternative placement for the resident. The Administrator confirmed the facility was unable to determine exactly how Resident #83 was able to exit the facility on 08/03/25 or verify the time Resident #83 eloped, but CNA #403 documented care was provided to the resident at 3:30 A.M. The Administrator stated CNA #403 had a language barrier and may not have understood what the surveyor was asking her when she stated she did not provide care for Resident #83

on the morning of 08/03/25. Upon the resident's return to the facility, he was placed on 1:1 staff supervision until a secured memory care placement could be found for him. The resident discharged to a more appropriate placement on 08/13/25. Review of the facility policy titled, Elopement Policy, dated 09/01/10, revealed it was the policy of the facility to prevent, to the extent reasonably possible, the elopement of guests/residents from the facility. This deficiency represents noncompliance investigated under Complaint Number 2586350.

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

09/08/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Laurels of West Columbus, The

441 Norton Road Columbus, OH 43228

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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure tube feeding was provided as physician ordered. This affected one (#14) of two residents reviewed for tube feeding. The census was 79.Findings include: Medical record review for Resident #14 revealed an admission date of 04/26/25.

Medical diagnoses included malignant neoplasm of part of right bronchus lung, cancer, malnutrition, depression, and history of falling. Review of the care plan dated 04/26/25 revealed Resident #14 was unable to nutritionally consume adequate food or fluids by mouth. He required a tube feeding related to malnutrition and weight loss. Intervention was to administer tube feeding as ordered. Review of the quarterly Minimum Data Set (MDS) dated [DATE REDACTED] revealed Resident #14 was cognitively intact. His functional status was partial/moderate assistance for eating, dependent for toileting, substantial/maximal assistance for bed mobility, and transfers were non-applicable. He was occasionally incontinent of bladder and frequently incontinent for bowel. He was coded for a feeding tube. Review of the admission orders dated 07/29/25 revealed Resident #14 was to be on an Enteral Feed Order one time a day Jevity 1.5 at 70 milliliters per hour (mL/hrs), at night (nocturnally) from 8:00 P.M. to 6:00 A.M. via PEG, via pump. Further

review of Resident #14's medical record revealed on 07/31/25 the Jevity 1.2 was initiated for the resident, rather than the ordered Jevity 1.5. Interview with Licensed Practical Nurse (LPN) #250 on 08/28/25 at 12:56 P.M. revealed Resident #14 was admitted on [DATE REDACTED] at 2:30 P.M. with orders for enteral feed for nighttime.

LPN #250 stated the facility was out of the Jevity 1.5, so she asked if he could get the Jevity 1.2 until the Jevity 1.5 came in. LPN #250 confirmed he went without the Jevity 1.5 for two nights and the Jevity 1.2 was started on 07/31/25. This deficiency represents non-compliance investigated under Complaint Number

1. 2599291. 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

09/08/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Laurels of West Columbus, The

441 Norton Road Columbus, OH 43228

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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observations and staff and resident interviews, the facility failed to ensure medications were available from the pharmacy for administration. This affected one (#81) out of three residents reviewed for medication administration. The facility census was 79. Findings included: Review of

the medical record for Resident #81 revealed the resident had a recent admission date 07/23/25.

Diagnoses included chronic diastolic heart failure, hypertension, chronic kidney disease stage two, irritable bowel syndrome, non-pressure chronic ulcer right calf with fat layer exposed, anxiety disorder, and overactive bladder. Review of plan of care dated 09/22/22 revealed that Resident #81 was at risk for discomfort or adverse side effects related to receiving diuretics therapy related to congestive heart failure.

Inventions included administering medication as ordered, encouraging residents to drink fluids, observe possible side effects every shift, and observing and reporting to physician dehydration or no urine. Review of plan of care dated 12/08/22 revealed that Resident #81 had risk for potential complications related to having ileostomy. Interventions included administer medication as ordered, use colostomy bag frequently, observe for diarrhea and report, and observe ostomy functioning every shift and amounts of stool passed.

Review of quarterly Minimum Data Set (MDS) dated [DATE REDACTED] revealed that Resident #81 had Brief Interview of Mental Status (BIMS) of 15 that indicated cognitively intact. Resident #81 required setup or clean-up for meals, and dressing upper body. Resident #81 was substantial to maximum for dressing lower body and putting on and off shoes. Resident #81 was partial to moderate assistance for bathing, personal hygiene, toileting, and oral hygiene. Resident #81 used a wheelchair and ambulating with no assistance at the facility. Review of the physician order dated 08/25/25 at 4:30 P.M. revealed Resident #81 had an order for Lomotil 2.5-0.025 mg to give one tablet by mouth every four hours as needed for diarrhea. Observation on 08/25/25 at 11:01 A.M. with Resident #81 who asked for Lomotil 2.5-0.025 mg tablet from Licensed Practical Nurse (LPN) #284 during medication pass. Resident #81 told LPN #284 she asked last night with

the night nurse and still had diarrhea. Interview on 08/27/25 at 11:03 A.M. with LPN #284 who stated Resident #81's Lomotil 2.5-0.025 mg tablets were not in her medication cart. LPN #284 verified that there was a physician orders active dated 08/25/25 for Lomotil for Resident #81. Interview on 08/27/25 at 11:05 A.M. with Director of Nursing (DON) stated that she expected staff to drop ship order the medication from pharmacy when ordering medication that was necessary. DON stated that the drop ship usually took four hours to receive the medication. Interview on 08/27/25 at 11:10 A.M. with Resident #81 stated she requested the Lomotil 2.5-0.025 mg tablet last night from the nurse, who stated it was not in stock. Resident #81 stated she would like Lomotil medication right now, because she was still having diarrhea. Interview on 08/27/25 at 4:07 P.M. with DON who stated that she called pharmacy about Resident #81 Lomotil 2.5-0.025 mg tablet. DON stated that Resident #81 arrived to the facility returning from the hospital on [DATE REDACTED] at 5:34 P.M. DON stated she called the pharmacy who stated they needed a new prescription for Lomotil 2.5-0.025 mg tablet. DON stated the Lomotil 2.5-0.025 mg had not arrived at the at the facility yet. DON stated that

the nurses were instructed for any resident who had medication that needed dropped shipped. DON stated that when medication was delivered was what the pharmacy was expecting in time frame. DON stated she had no facility policy on when facility had pharmacy delivering medication. This deficiency represents non-compliance investigated under Complaint Numbers 2597140 and 2567001.

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

09/08/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Laurels of West Columbus, The

441 Norton Road Columbus, OH 43228

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 0770

Provide timely, quality laboratory services/tests to meet the needs of residents.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff and resident interviews, the facility failed to ensure laboratory testing was completed as physician ordered. This affected one (#14) of three residents reviewed for laboratory testing.

This census was 79. Findings include: Medical record review for Resident #14 revealed an admission date of 04/26/25. Medical diagnoses included malignant neoplasm of part of right bronchus lung, cancer, malnutrition, depression, and history of falling. Review of fax from the chemotherapy physician dated 07/31/25 revealed to draw these labs on 08/01/25 and every other Friday. The labs were B-12 Folate, Iron study with ferritin, Cortisol random, Thyroid Stimulating Hormone (TSH) with reflex, free T-4, Comprehensive Metabolic Panel (CMP), Complete Blood Count (CBC) with differential, and Adrenocorticotropic Hormone Blood Test (ATCH). Review of the quarterly Minimum Data Set (MDS) dated [DATE REDACTED] revealed Resident #14 was cognitively intact. His functional status was partial/moderate assistance for eating, dependent for toileting, substantial/maximal assistance for bed mobility, and transfers were non-applicable. He was occasionally incontinent of bladder and frequently incontinent for bowel. He was coded for a feeding tube. Review of lab results dated 08/18/25 revealed the above labs were supposed to be collected, but a Prothrombin Time (PT) and International Normalized Ratio (INR) was collected. On 08/19/25 the above lab orders were supposed to be collected but all were collected except for CMP. Further

review of the lab orders revealed to collect a CMP on 08/21/25. Interview with Resident #14 on 08/28/25 at 10:32 A.M. revealed he has missed a chemotherapy treatment due to the labs not being collected correctly but couldn't remember the dates. Interview with Licensed Practical Nurse (LPN) #250 on 08/28/25 at 10:45 A.M. revealed the labs were messed up on 08/18/25 when they came out to draw blood, they got a PT and INR and that was wrong. Then she ordered them to come back on 08/19/25 and she put in a STAT lab so

the facility could get the resident to chemotherapy, but the lab drew everything except the CMP. She reported she had to get the CMP ordered for 08/21/25. She confirmed the labs were not collected properly.

This deficiency represents non-compliance investigated under Complaint Number 2599291.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet