Mayfair Village Nursing Care C

Observation of medication cards for Metoprolol Succinate ER 100mg one tablet and Potassium CL ER 20 mEq one tablet were labeled do not crush on left upper corner.Interview 12/01/25 at 9:10 A.M. with LPN #74 confirmed the three medications were crushed and administered to Resident #45.Observation on 12/01/25 at 9:14 A.M. of LPN # 47's interview with Pharmacist #20 confirmed Metoprolol Succinate ER 100 mg tablet and Potassium CL ER 20 mEq tablet should not be crushed.LPN #47 was observed to call Pharmacist #20 on speaker phone on 12/01/25 at 9:14 A.M. and Pharmacist #20 confirmed Metoprolol Succinate ER 100 mg tablet and Potassium CL ER 20 mEq tablet should not be crushed.

Review of the facility's Administration of Medications policy dated 09/09/25 confirmed staff who are responsible for medication will adhere to the 10 rights of medications administration.

Right drug, compare the order with the medication administration record (eMAR) for accuracy and compare the label on the drug to the information on the eMAR, three times.

Verify the right resident.

Right dose and if there is any doubt about the dose on the MAR or if there is a question on the drug, stop and verify all information before administering.

Review of the facility's policy titled, Medication - Related Errors dated 05/01/10 confirms if a medication reaches a resident in error, the facility should, notify the pharmacy of any possible dispensing occurrence; and notify physician/prescriber and obtain further instructions and/or orders.

Facility staff should monitor the resident in accordance with physician/prescriber's instructions.This violation represents non-compliance investigated under Complaint Number 2647703.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

12/01/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Mayfair Village Nursing Care C

3000 Bethel Rd Columbus, OH 43230

SUMMARY STATEMENT OF DEFICIENCIES

Observation on [DATE] at 9:39 A.M. with Licensed Practical Nurse (LPN) #52 during medication administration revealed a facility stock bottle of Thiamine B1 (vitamin) 100 milligram (mg) tablet which was opened and undated, a facility stock bottle of Famotidine (decreases acid in the stomach) 20 mg bottle which was opened and undated, and container of MiraLAX (laxative)17 mg which was opened and undated.

Other facility stock medication bottles were observed in medication cart had open dates written on top of lid of medication bottle.Interview on [DATE] at 9:45 A.M. with LPN #52 confirmed the bottles of Thiamine, Famotidine, and MiraLAX were open but were not labeled with the open date. LPN #52 was observed labeling the bottles. 2.

Observation on [DATE] at 11:25 A.M. of the medication storage room revealed unopened but expired items including a bottle of Fiber Powder Psyllium husk with the expiration of [DATE], a bottle of Vitamin A 3,000 mcg, B2 Riboflavin with an expiration date of [DATE], nasal spray moisturizing spray with an expiration date of [DATE], and nasal decongestant PE Phenylephrine HCL 10 mg expiration date of [DATE].Interview on [DATE] at 11:45 A.M. with the Assistant Director of Nursing (ADON) confirmed the medications were expired.

Review of the facility's policy titled, Storage and Expiration Dating of Medications and Biologicals last revised on [DATE] confirms the facility should ensure medications and biologicals that: (1) have an expired date on the label; (2) have been retained longer than recommended by manufacturer or supplier guidelines,: or (3) have been contaminated or deteriorated, are stored separate from other medications until destroyed or returned to the pharmacy or supplier.

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