Galion Meadows Skilled Nursing And Rehabilitation

Review of the Elopement Evaluation dated 05/17/26 revealed Resident #59 did not wander within the facility or have a history of wandering.

Further review revealed no exit seeking behavior or attempts of actual elopement were noted.Interview on 05/18/26 at 5:35 P.M. with Resident #59's sister and Power of Attorney (POA) revealed Resident #59 came to the facility for rehabilitation after falling at an assisted living facility. Resident #59's sister was surprised that Resident #59 needed to be moved to the secured memory care unit and she was unaware of a dementia diagnoses. Resident #59's sister stated the resident was moved to the secured memory care unit soon after admission, but she was unsure of the exact date.Interview on 05/26/26 at 1:58 P.M. with Regional Director of Nursing (RDON) #307 revealed Resident #59 was moved to the secured memory care unit on 05/15/26 after showing exit seeking behaviors of going to the front doors. Resident #59 never exited the facility, but staff were concerned of possible attempts to elope. RDON #307 further confirmed that there were no assessments completed, and that the physician was not contacted related to moving Resident #59 into the secured memory care unit.

Review of the facility policy titled Memory Care Unit Policy, dated 09/2024 revealed residents exhibiting behavioral changes or acute decline will be promptly assessed and interventions implemented as indicated.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

Review of the medical record for Resident #31 revealed an admission date of 01/27/26.

Diagnoses included pulmonary embolism, emphysema, chronic obstructive pulmonary disease, and asthma.

Review of the quarterly MDS assessment dated [DATE] revealed the resident had a Brief Interview for Mental Status (BIMS) score of 15 indicating the resident was cognitively intact.

Further review revealed no behaviors were identified.

Additional review revealed the resident required extensive to dependent assistance with activities of daily living, utilized a wheelchair, and had shortness of breath with exertion and while lying flat.

Review of the care plan initiated 03/19/26 and revised 03/28/26 revealed the resident received psychotropic medications related to antipsychotic, antianxiety, and antidepressant medication use.

Further review of the care plan revealed an intervention for staff to monitor for and report adverse effects of antipsychotic medication use including drowsiness, dizziness, restlessness, weight gain, dry mouth, constipation, nausea and vomiting, blurred vision, low blood pressure, uncontrolled movements, tics, tremors, seizures, and increased risk for falls.

Review of physician orders revealed an active order dated 04/01/26 for Lurasidone Hydrochloride 20 milligrams by mouth every evening related to bipolar disorder.

Review of the MAR from 04/01/26 through 05/19/26 revealed the resident received the antipsychotic medication daily as ordered.

Further review revealed no documented monitoring for effectiveness, adverse effects, or side effects related to the antipsychotic medication.

Interview on 05/19/26 at 11:52 A.M. with Regional Director of Nursing #307, and Director of Nursing, confirmed the only location for monitoring adverse effects related to antipsychotic medications was located in the care plan.

They further confirmed there was no documentation the resident was monitored for adverse effects related to the resident's antipsychotic medication use.

Review of the facility policy titled, Documentation: Charting, dated 08/2023, revealed documentation in the clinical record was to include adverse reactions to medications and responses to medications and treatments.

Further review revealed charting was to be complete and accurate and include follow-up action to nursing observations.

Review of the facility policy Psychotropics, dated 09/2021, revealed the facility would use psychotropic medication appropriately working with the interdisciplinary team to ensure appropriate use, evaluation, and monitoring.

Adverse reaction would be monitored according to the resident plan of care.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

Review of the employee record for Administrator revealed a date of hire of 07/28/25.

Further review revealed there was no abuse registry check completed upon hire.2.

Review of the employee record for Director of Nursing (DON) revealed a date of hire of 12/23/25.

Further review revealed there was no abuse registry check completed upon hire.3.

Review of the employee record for Business Office Manager/Human Resources #500 revealed a date of hire of 11/12/25.

Further review revealed there was no abuse registry check completed upon hire.4.

Review of the employee record for Activities Director #248 revealed a date of hire of 05/19/25.

Further review revealed there was no abuse registry check completed upon hire.5.

Review of the employee record for Licensed Practical Nurse (LPN) #258 revealed a date of hire of 04/09/26.

Further review revealed there was no abuse registry check completed upon hire.6.

Review of the employee record for Med Tech #238 revealed a date of hire of 04/29/26.

Further review revealed there was no abuse registry check completed upon hire.7.

Review of the employee record for Med Tech #266 revealed a date of hire of 04/23/26.

Further review revealed there was no abuse registry check completed upon hire.Interview on 05/19/26 at 1:20 P.M. with Business Office Manager/Human Resources #500, revealed the facility was not completing abuse registry checks for employees hired at the facility.Interview on 05/19/26 at 1:59 P.M. with Administrator revealed corporate staff provided monthly Microsoft excel reports indicating no Office of Inspector General matches were identified.

Further interview revealed the facility did not maintain individual abuse registry checks for newly hired employees but only a filled out excel sheet.Interview on 05/19/26 at 3:46 P.M. with Administrator then confirmed the facility had not been completing Office of Inspector General abuse registry checks for newly hired staff to ensure there were no previous abuse concerns prior to employment.

bed-hold policies.

hold notice and a notice of transfer were given to resident or the resident representative upon

facility census was 55.

Findings include:

Review of the medical record for Resident #56 revealed an admission date of 04/10/26 and a discharge date of 04/22/26.

Diagnoses included sepsis due to unspecified organism, cystitis without hematuria, morbid obesity due to excess calories, type II diabetes mellitus with ketoacidosis without coma, unspecified protein-calorie malnutrition, and generalized muscle weakness.Review of nursing documentation dated 04/22/26 at 11:30 A.M. revealed the resident experienced a significant change in condition and was found unresponsive with a snoring sound and no verbal response.

Further review revealed emergency medical services were called, oxygen therapy was initiated, and the resident was transferred to the hospital.

Review of electronic medical record documentation dated 04/23/26 at 12:04 A.M., 04/23/26 at 9:10 P.M., and 04/24/26 at 8:17 A.M. revealed the resident was documented as being at the hospital.

Review of the clinical record revealed no documentation a bed hold notice, or a notice of transfer was provided to the resident or the resident representative.Interview on 05/18/26 at 10:12 A.M. with Social Worker #269, revealed the facility provided Ombudsman notification, but there was no documentation that a notice of transfer or bed hold notice was provided to the resident or the resident representative.

Review of the facility policy titled, Transfer or Discharge Notice, dated September 2021, revealed the facility was required to provide a resident and/or resident representative with a 30-day written notice of an impending transfer or discharge.

The policy further required that written notice includes the reason for transfer or discharge, effective date, location of transfer, appeal rights, bed hold policy information, Ombudsman contact information, and other required state agency contact information.

The policy additionally required that a copy of the notice be sent to the Office of the State Long-Term Care Ombudsman and documented in the resident's medical record.

Review of the facility policy titled, Bed-Holds and Returns, dated September 2021, revealed residents and resident representatives were to be informed prior to transfer of the bed hold policy.

The policy further stated that the facility would provide written information explaining bed hold rights, including Medicaid bed hold limitations, private pay bed hold requirements, and conditions for return to the facility following hospitalization or therapeutic leave.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

Review of the medical record for Resident #03 revealed an original admission date of 07/17/2019 with a discharge to a local hospital on [DATE] and readmission of 12/09/25.

Pertinent diagnoses included paraplegia, type II diabetes mellitus, schizoaffective disorder, bipolar type; cognitive communication deficit, major depressive disorder, post-traumatic stress disorder (PTSD), generalized anxiety disorder, unspecified intellectual disabilities, chronic kidney disease and dysphagia oropharyngeal phase and dysphasia pharyngoesophageal phase. A diagnosis of acute respiratory failure with hypoxia was added 12/09/25 after Resident #03's hospitalization.Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] for Resident #03 revealed Resident #03 was cognitively intact. Resident #03 was assessed to be dependent for toileting and required substantial/maximal assistance for showering/bathing, lower body dressing, including putting on footwear. Resident #03 required supervision or touching assistance for personal hygiene, set up or clean-up for oral hygiene.

Active diagnoses included paraplegia, anxiety disorder, depression, bipolar, schizophrenia, post-traumatic stress disorder (PTSD).

Review of the medical record for Resident #03 revealed a hospital exemption document dated 07/15/19 and no Preadmission Screening and Resident Review (PASRR) documentation in the record.

During an interview on 05/18/26 at 1:02 P.M., Social Services Director #269 said she also could not find a historical PASRR for Resident #03.

Review of the medical record for Resident #03 revealed a PASRR was completed and submitted by Social Services Director #269 on 05/18/26.

Review of the Preadmission Screening and Resident Review Result Notice dated 05/18/26 for Resident #03 revealed to be considered for admission or to continue to reside in a Medicaid certified nursing facility a resident must be screened for indications of serious mental illness and developmental disability. A resident review is required for nursing facility residents upon a significant change in condition.

The results indicated that Resident #03 was selected for a level II evaluation to determine if the facility had the appropriate access to services to provide sufficient psychosocial care to the resident.2.

Review of the medical record for Resident #16 revealed an admission date of 09/13/19.

Diagnoses included bipolar disorder current episode depressed moderate, severe vascular dementia with behavioral disturbance, epilepsy not intractable without status epilepticus.

Review of the quarterly Minimum Data Set, dated [DATE] revealed a Brief Interview for Mental Status score of 00 indicating severe cognitive impairment, a mood score of 12 and diagnoses that included bipolar disorder, depression, anxiety, and non-Alzheimer's dementia.Review of documentation dated 05/17/26 at 12:05 P.M. revealed the resident had a newly identified diagnosis of bipolar disorder with an onset date of 01/14/26 and no PASRR was completed to reflect the updated mental health diagnosis.Review of documentation dated 05/18/26 at 3:55 P.M. revealed Social Worker #269, stated the facility previously did not have access to PASRR documentation following corporate acquisition and therefore the newly diagnosed bipolar disorder was not captured on an updated PASRR.

Further review revealed a PASRR was completed on 05/18/26 after the deficiency was identified.Review of documentation dated 05/20/26 at 9:28 A.M. revealed the Administrator stated the facility had no policy on PASRR processes.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

Review of Medication Administration Record (MAR) and treatment documentation revealed the ordered bilateral lower extremity wound care was documented as administered through 05/16/26.

Further review revealed no completed documentation on 05/17/26 and an entry indicating a nursing note without corresponding documentation.

Review of nursing documentation dated 05/17/26 at 1:15 P.M. revealed staff reported Kerlix was not available in the facility and the resident's legs were not wrapped.

Further review revealed the resident stated supplies had not been available since the prior week and replacement supplies were not expected until 05/20/26.

Interview on 05/17/26 at 1:33 P.M. with Administrator confirmed Resident #42's legs were not wrapped per physician orders.

Interview on 05/17/26 at 1:49 P.M. with Licensed Practical Nurse (LPN) #247 confirmed Kerlix was out of stock within the facility since 05/13/26.

Interview on 05/17/26 at 2:18 P.M. with DON confirmed Kerlix had been unavailable since approximately the prior week and replacement supply was not expected until 05/20/26.

Interview on 05/18/26 at 7:56 A.M. with resident #42 confirmed refusal of ABD pad application and reported he would not allow leg wrapping until Kerlix supplies were available due to the ABD pads feeling tight on his legs.

Interview on 05/18/26 at 9:21 A.M. with DON indicated the resident's wound care supplies were typically provided after his wound care appointment but there was no documentation or evidence confirming supply delivery following the last dressing change appointment on 05/13/26.

Additionally, she confirmation that ABD pads were being used as an alternative due to Kerlix unavailability.

Interview on 05/20/26 at 9:28 A.M. with the Administrator revealed the facility had no policy on central supply processes.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

Review of a physician order dated 05/04/26 revealed to cleanse area to the right lateral ankle with wound cleanser.

Apply collagen particles and calcium alginate.

Cover with bordered dressing daily and as needed for wound management.

Review of a wound nurse practitioner progress note dated 05/21/26 revealed the resident had a chronic stage three pressure ulcer to the right lateral ankle measuring one centimeter (cm) in length, one cm in width, with a depth of 0.3 cm with 100 percent granulation tissue. A new treatment recommendation was ordered to cleanse the wound with wound cleanser/normal saline, apply collagen with silver, normal saline moistened to base of the wound, secure with bordered dressing, change daily and as needed.

Review of the Treatment Administration Record (TAR) dated 04/01/26 through 05/26/26 revealed there was no documentation the wound treatment to the right lateral ankle had been completed on 04/22/26, 04/24/26, 04/27/26, 04/28/26, and 05/16/26.

Further review of the TAR revealed staff falsely documented the wound treatment was completed on 05/23/26, 05/24/26, and 05/25/26.

Observation on 05/26/26 at 10:46 A.M. of wound care for Resident #49 with the Assistant Director of Nursing (ADON) #263 revealed the resident had a wound dressing in place on the right lateral ankle dated 05/22/26.

Further observation revealed ADON #263 removed the dressing covering the right ankle revealing there was no calcium alginate in place under the wound dressing.

The resident had a stage three pressure ulcer approximately one centimeter in length, one cm in width, with minimal depth.

There was no wound odor and no signs of infection.

There was a small amount of dried yellow exudate on the wound dressing. ADON #263 applied collagen particles to the wound base, applied calcium alginate, and covered with a bordered dressing.

Interview on 05/26/26 at 10:46 A.M., ADON #263 verified the wound dressing was dated 05/22/26 and had not been completed per physician orders. ADON #263 revealed the wound dressing to the right lateral ankle should have been changed daily.

Follow up interview with ADON #263 verified the facility had not implemented the new order for wound care treatment recommended by the wound care provider on 05/21/26.

Interview on 05/26/26 at 1:23 P.M. with the Director of Nursing (DON) and Regional Director of Nursing (RDON) #307 verified there was no documentation wound treatments were completed on 04/22/26, 04/24/26, 04/27/26, 04/28/26, and 05/16/26.

Further interview with the DON and RDON #307 verified the resident's wound treatments were incorrectly documented by agency staff as completed on 05/23/26, 05/24/26, and 05/25/26.

The DON revealed the facility was going to notify the agency staffing providers.

Review of the facility policy Wound Care, dated 09/2021, revealed wound treatments would be administered as ordered by the physician.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

prevent accidents.

record review, resident interview, staff interview, and facility policy review, the facility failed to

reviewed for accidents.

The facility census was 55.

Findings include:

Review of the medical record for Resident #31 revealed an admission date of 01/27/26.

Diagnoses included pulmonary embolism, emphysema, chronic obstructive pulmonary disease, and asthma.

Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 15 revealing the resident had intact cognition.

Additionally, the resident was dependent for bed mobility, transfers, and activities of daily living.

Review of the fall risk assessment dated [DATE] revealed the resident was at high risk for falls.

Review of the plan of care dated 05/15/26 revealed the resident was at risk for falls due to generalized weakness, history of falls, decreased strength and endurance, and need for assistance with activities of daily living.

Interventions included educate the resident and family to call for assistance before transferring, food and fluids within reach, implement preventative fall interventions and devices, maintain call light within reach and educate the resident to use the call light, maintain needed items within reach, monitor for changes in mobility, non-skid footwear, physical therapy and occupational therapy evaluations, and low bed.

Review of the fall investigation dated 05/15/26 revealed the resident was found on the floor on her left side with a knot noted to the left side of her head.

The resident stated her legs slid out of the bed first which pulled her body out.

The contributing factor identified was the bed left up too high by staff after a transfer. At the time of the fall the resident was dependent for bed mobility and transfers.

Two staff members had assisted the resident into bed prior to the fall yet the bed was not lowered.

The resident was on anticoagulant medication and was sent to the emergency department for evaluation. A previous positioning fall occurred on 01/28/26 from the recliner.

The care plan was updated after the fall to include the low bed intervention.

The facility investigated the fall and determined changes were required to ensure consistent implementation of existing interventions.Review of a nursing note dated 05/17/26 at 7:39 P.M. revealed the resident was status post fall out of bed.

The resident was moving extremities as per baseline with stable vital signs and no acute pain complaints.Interview on 05/19/26 at 2:14 P.M. the Certified Nursing Assistant (CNA) #259 stated the resident could not move her own feet without assistance, her feet were hanging off the side of the bed, she was yelling for help prior to the fall, and the bed was raised up high prior to the fall.Interview on 05/19/26 at 2:30 P.M. Resident #31 stated she was unable to reach the call light due to upper extremity impairment and had to yell for help.

She also confirmed that two staff assisted her into bed prior to the fall.Interview on 05/19/26 at 2:37 P.M. CNA #244 stated protocol for dependent residents is to lower the bed when placing them in bed.Interview on 05/19/26 the Director of Nursing (DON) and Regional DON 307 confirmed the contributing factor noted on the fall investigation was the bed being up too high.Review of facility policy titled Falls, dated September 2021, revealed the facility's expectation to identify appropriate interventions based on the resident's specific risks, implement additional or different interventions if falling recurs, monitor subsequent falls, and ensure interventions such as low bed positioning are consistently applied to prevent falls and minimize injury.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

Review of the medical record for Resident #27 revealed an admission date of 01/10/25.

Diagnoses included type two diabetes mellitus, chronic obstructive pulmonary disease, end stage renal failure, chronic kidney disease, vascular dementia, hypertension, atrial fibrillation, and dependence on renal dialysis.

Review of the quarterly MDS assessment dated [DATE] revealed the resident had intact cognition.

Review of the care plan dated 02/07/25 revealed the resident had end stage renal disease and was receiving dialysis services.

Review of the nutrition care plan last revised 02/27/26 revealed the resident was on 1800 milliliter (ml) fluid restriction (dietary provides 240 ml at breakfast and lunch, 360 ml dinner; nursing provided 600 ml 7:00 P.M. to 7:00 A.M. and 360 ml from 7 A.M. to 7:00 P.M.Review of a physician order dated 02/26/26 revealed the resident received dialysis services three times per week.

Review of a physician order dated 02/27/26 revealed the resident was ordered a 1500 milliliter (ml) fluid restriction (420 ml from nursing and 1080 ml from dietary with 380 ml of fluids provided at breakfast, 240 ml at lunch, and 120 ml at dinner).

Review of the treatment administration record from 04/01/26 through 05/19/26 revealed the nurses had placed a check mark each shift for the residents' 1500 ml fluid restrictions.

There was no documentation of the fluid amount the resident had received.

Review of the nursing notes dated 04/01/26 through 05/19/26 revealed no documentation the resident had refused to follow the physician ordered fluid restriction.

Observation on 05/17/26 at 11:30 A.M. revealed a large water cup on the resident's bedside table.

The cup was half full of water.

Observation on 05/18/26 at 2:31 P.M. revealed there was a large water cup in the resident's room on the bedside table.

The cup was approximately half full.

Interview on 05/18/26 at 2:31 P.M., Resident #27 revealed staff filled the water cup when it was empty. Resident #27 was unaware of how much fluid he was allowed each day. Resident #27 revealed he tried not to drink many fluids.

Interview on 05/18/26 at 2:33 P.M., LPN #230 revealed Resident #27 was on fluid restrictions. LPN #230 revealed he gave the resident about 120 ml of fluids with his medications. LPN #230 verified the large cup on the resident's bedside table was half full of water.

Interview on 05/18/26 at 2:43 P.M., CNA #218 revealed Resident #27 was on fluid restrictions, so she only filled the resident's water cup half full of water and the other half with ice.

Observation on 05/18/26 at 3:17 P.M., with the Assistant Director of Nursing (ADON) #263 revealed ADON #263 measured how much water the resident's water cup would hold when full.

Further observation revealed the resident's cup held 580 ml of water.

Observation on 05/19/26 at 10:50 A.M. of Resident #27 revealed LPN #522 provided the resident with his morning medications.

LPN #522 provided the resident with a water cup with 200 ml of water to take the medications.

Further observation revealed the resident drank 60 ml of water with the medications. LPN #522 then took the remaining water out of the room.

Continued observation revealed LPN #522 had not documented the amount of fluid given to the resident.

Concurrent interview with LPN #522 verified the resident was on fluid restrictions and she had provided the resident with 200 ml of water. LPN #522 revealed the nurses were not required to document the amount of water the resident consumed.

Interview on 05/19/26 at 11:33 A.M., the DON verified the monitoring of the resident's fluid restriction was not adequate.

The DON revealed the nursing staff should be documenting the amount of fluids the resident had received.

The DON verified the resident's physician order for a 1500 ml fluid restriction was not consistent with the 1800 ml fluid restriction noted in the resident's care plan.

The DON revealed only the nurses should be providing the resident with fluids not the CNAs.

The DON revealed the resident should not have a water pitcher in his room.

Review of the facility policy Hydration, dated 09/2021, revealed no guidelines no guidelines for fluid restrictions.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

Review of a physician order dated 05/28/25 revealed to check tube placement every shift prior to feeding, flushing, and administering medication.

Review of the physician orders dated 08/05/25 revealed an enteral feed order to provide a 90 milliliter (ml) fluid flush every four hours.

Observation on 05/19/26 at 4:05 P.M. revealed Licensed Practical Nurse (LPN) #272 administered a 90 milliliter (ml) enteral flush for Resident #9.

LPN #272 had not checked for tube placement prior to flushing the feeding tube.

Interview on 05/19/26 at 4:05 P.M., LPN #272 verified she had not checked for placement prior to flushing the feeding tube.

Interview on 05/19/26 at 4:17 P.M., the Director of Nursing (DON) verified the nurse should have checked for placement prior to flushing the feeding tube.

Review of the facility policy Gastrostomy Tube/Jejunostomy Tube Care, dated 09/2021, revealed to follow treatments as ordered by a physician. To confirm placement of tube in stomach, attach syringe to end of tube and place stethoscope over left quadrant of resident's abdomen.

Instill 20 ml of air into the tube and listen for swooshing sound in stomach.

Aspirate stomach contents by attaching syringe to end of tube and gently pulling back on plunger.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

Observation at the time of the interview revealed no date on the oxygen tubing. Resident #29 also stated the filter on the concentrator was fuzzy and that he could smell whatever was growing on the filter.

Observation of the filter revealed it appeared to be covered in dust.Interview on 05/17/26 at 1:33 P.M. the Resident #29's roommate, Resident #42 confirmed all of the above concerns voiced by Resident #29 being shared with facility staff, including the dusty filter and the lack of a humidifier bottle.Interview on 05/17/26 at 1:43 P.M.

Licensed Practical Nurse (LPN) #247 stated humidifier bottles are only used when oxygen is continuous. LPN #247 confirmed the resident's oxygen was ordered as continuous.Interview on 05/19/26 at 11:25 A.M. the Director of Nursing (DON) stated all residents on continuous oxygen should have humidifier bottles.Review of facility policy titled Oxygen Administration, dated September 2021, revealed the facility's expectation to administer oxygen therapy safely and noted that bacterial contamination associated with certain nebulizers and humidifiers may occur.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had intact cognition.

Review of the care plan dated 02/07/25 revealed the resident had end stage renal disease and was receiving dialysis services. An intervention dated 02/27/26 revealed for staff to coordinate resident's care in collaboration with the dialysis center.

Review of a physician order dated 02/26/26 revealed the resident received dialysis services three times per week.

Review of the medical record revealed no dialysis communication forms were found in the medical record from 01/01/26 through 05/26/26.

Review of a blank dialysis communication report form used by the facility revealed the nurse would record the residents vital signs, weight, glucose level, cognition status, COVID-19 status, pain medications administered, and any changes in condition since the last dialysis day prior to sending the resident to dialysis.

The dialysis center would return the form with the resident's post dialysis weight, vital signs, treatment duration, kilograms of fluid removed, medications administered, condition or events during/post dialysis, and any special instructions.

Interview on 05/18/26 at 2:33 P.M., Licensed Practical Nurse (LPN) #230 revealed a packet including a dialysis communication form was prepared by the night shift staff. LPN #230 revealed the form was sent with the resident and returned after dialysis and placed in a file. LPN #230 reviewed the electronic medical record and revealed there were no dialysis communication forms scanned into the medical record since 01/01/26.

Interview on 05/19/26 at 11:28 A.M., the Director of Nursing (DON) revealed the dialysis communication forms should be in a binder or folder at the nurse's station.

The DON revealed she was unable to find the communication forms at the nurses station.

Interview on 05/20/26 at 9:30 A.M., the DON revealed a communication form was sent with residents to dialysis for Resident #27 with the transport driver and the forms were returned to the facility by the transport driver.

The DON revealed she was unable to find any dialysis communication sheets for Resident #27 or the binder they were kept in.

The DON revealed they had received two reports from dialysis dated 05/15/26 and 05/18/26.

The DON also provided a copy of blank dialysis communication form.

Follow-up interview on 05/26/26 at 4:00 P.M., the DON verified shewas still not able to locate the resident's dialysis binder with the dialysis communication forms for surveyor review.

Review of the facility policy Hemodialysis dated 09/2021, revealed staff would coordinate with the dialysis center.

There were no guidelines regarding the use of dialysis communication forms.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

During an interview on 05/18/26 at 1:02 P.M., Director of Social Services #269 confirmed there was no mention in the care plan of Resident #03's trauma history or triggers.

She also confirmed she did not know the resident's triggers and did not have trauma assessment.

During an interview on 05/19/26 at 6:54 A.M., Licensed Practical Nurse (LPN) #273 said Resident #03 was very childlike and she had seen him pick at his colostomy bag.

She said she also had seen him eat his own scabs four or five times.

She said she didn't think she had documented either because it wasn't a big deal.

She said she didn't know what triggered his behaviors.

During an interview on 05/20/26 at 10:35 A.M.

Certified Nursing Assistant (CNA) #228 said Resident #03 cried frequently.

She said he cried whenever he was told what to do.

She said she did not know his triggers.

During an interview on 05/20/26 at 12:43 P.M., Certified Physician Assistant (CPA) #300 confirmed she managed Resident #03's psychiatric medications.

She confirmed she was not a therapist and she confirmed she did not suggest interventions to staff regarding Resident #03 ingesting his feces.

She said she only knew of the couple of documented instances of Resident #03 eating his feces.

She said she received her information from record review and the nurses and did not speak with any of the aides.

She said she was not aware that there were behaviors that were not documented.

She said had she known that his behavior of eating his feces and copious amounts of salt was more chronic she would have listed pica (consumption of non-food items) or copraphogia (consumption of feces) as a diagnosis. CPA #300 said the resident would benefit from talk therapy and that if she had known about the ongoing behaviors, she would have explored more with the resident as to what was going on. CPA #300 also stated she did not know his triggers or trauma history.

Review of facility policy titled Behavioral Assessment, Intervention and Monitoring, dated September 2021, revealed the facility's expectation that as part of the comprehensive assessment, staff will evaluate the resident's typical or past responses to stress, fatigue, fear, anxiety, frustration and other triggers.

The policy requires the interdisciplinary team to thoroughly evaluate behavioral symptoms, incorporate findings into the care plan, and monitor residents with impaired cognition and behavior.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

During an interview on 05/26/26 at 12:53 P.M., Physician #295 said he could not find any record that he was notified on 12/03/25 regarding the resident eating feces.

Physician #295 reported he wasn't sure whether there was anything that could be done to stop Resident #03 from eating his feces. He said the care plans are done by nursing so he wouldn't be involved. He said he would expect that they [staff] clean the room and the resident.

Physician #295 reported he had not been informed that the guardianship process did not go forward. He said that if Resident #03 didn't understand the implications of his decisions, then that would indicate guardianship might be beneficial.

Physician #295 reported he planned to do another capacity evaluation and stated a guardian would also be able to advocate for a counselor as well if that was something Resident #03 wanted.

Physician #295 stated we have to do what we can for [Resident #03] to have a good quality of life.

Review of the facility policy titled, Behavioral Assessment, Intervention and Monitoring, dated September 2021 revealed as part of the comprehensive assessment, staff will evaluate, based on input from the resident, family and caregivers, review of the medical record and general observations: the resident's typical or past responses to stress, fatigue, fear, anxiety, frustration and other triggers.

The interdisciplinary team will thoroughly evaluate new or changing behavioral symptoms to identify underlying causes and address any modifiable factors that may have contributed to the resident's change in condition.

The interdisciplinary team will evaluate behavioral symptoms in residents to determine the degree of severity, distress and potential safety risk to the resident and develop a plan of care accordingly.

Safety strategies will be implemented immediately if necessary to protect the residents and others from harm.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

Review of the facility policy Medication Errors, dated 09/2021, revealed medication errors include the wrong medication, wrong time, wrong dose, wrong route or form, wrong resident, and omission.

Medication errors would be reported to the physician and Director of Nursing.

Residents with medication errors would be monitored closely.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

Review of the resident's meal ticket for 05/18/26 revealed the resident had a mechanical soft diet with an added grilled cheese at each meal.

Observation on 05/18/26 at 12:22 P.M. revealed Resident #38 received his meal tray for lunch.

Further observation of the meal tray revealed the resident had received a whole (not ground) cube steak.Interview on 05/18/26 at 12:22 P.M., Certified Nursing Assistant (CNA) #218 verified Resident #38 was on a mechanical soft diet.

CNA #218 verified the resident had received a whole cube steak which was not appropriate for a mechanical soft diet.

Interview on 05/18/26 at 12:25 P.M., Dietary Manager (DM) #284 verified the resident's cube steak should have been ground up and not served whole. DM #284 further revealed the dietary staff should have checked the meal ticket before sending the tray on the hall cart.

Review of the facility policy Therapeutic Diets dated 09/01/21 revealed mechanically altered diets, as well as diet modified for medical or nutritional needs would be considered therapeutic diets.

Further review of the policy revealed the food service manager would establish and use a tray identification system to ensure each resident received their diet as ordered.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

Observation and interview during the initial kitchen tour on 05/17/26 between 8:19 A.M. and 8:44 A.M. revealed multiple cleanliness concerns. A black substance was present under the sink.

Vents above the stove and food preparation areas had loose dust with additional dust collected on the ceiling light fixture.

Dust was hanging around the sprinkler head above the food preparation area.

The vent by the refrigerator and freezer was heavily coated in dust. A fan with a large amount of dust on the back was blowing directly onto clean dishes.

These findings were confirmed at the time of observation with Dietary Aide #232 and Dietary Manager #284 at 8:45 A.M.

Observation and interview on 05/17/26 between 8:19 A.M. and 8:44 A.M. revealed multiple food storage and labeling concerns. In the dry storage, two bags of pasta noodles and one bag of spaghetti were open with no open dates. In the refrigerator at 33 degrees Fahrenheit (F), a pitcher of lemonade had no label, open date, or expiration date. In the large refrigerator at 34 degrees F, an open bag of beef had no open date, open chicken base had no open date, sausage patties in a metal container had no label or open date, and multiple opened blocks and bags of cheese had no open dates or labels. In the freezer at 0 degrees F, opened hash browns, sausage patties, and three bags of Eggos had no open dates or labels.

These findings were confirmed at the time of observation with Dietary Aide #232 at 8:45 A.M.

Observation and interview on 05/17/26 between 8:19 A.M. and 8:44 A.M. revealed equipment concerns. A pipe behind the fan in the large refrigerator had visible mold with a wet box underneath where water was dripping.

The freezer fan had ice buildup with ice chunks on boxes underneath.

The juice spout had a visible substance present.

These findings were confirmed at the time of observation with Dietary Aide #232 at 8:45 A.M.

Observation on 05/18/26 at 11:30 A.M. during lunch meal service revealed multiple hand hygiene violations.

Dietary staff #280 grabbed the outside of the bun bag with gloved hands, then used the same gloves to pick up and place bread onto resident trays.

The same gloved hands then touched her clothes, refrigerator handles, forehead, and dishwasher handles before continuing to handle ready-to-eat bread.

Dietary staff #280 touched the floor to pick up dropped bread with gloved hands, then reached inside the puree mixer and touched the inside of the lid with the same gloves.

Staff also used gloved hands to write temperatures with a pen and then push green beans on plates with those gloved hands.

Multiple times throughout the meal service, Dietary staff #280 removed their gloves, exited the kitchen, returned without washing hands, and immediately put on new gloves before resuming food service.

Staff turned on the gas stovetop with gloved hands and then used those same gloves to handle bread and cheese directly with the same gloves after being cooked.Interview on 05/18/26 at 11:59 A.M. with Dietary staff #280 confirmed all of the above hand hygiene concerns.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief

Review of the care plan dated 12/20/24 revealed the resident required a Foley (indwelling urinary) catheter related to urinary retention and obstructive uropathy.

Interventions included provide catheter care every shift and as needed, monitor for signs and symptoms of urinary tract infection, and report changes to the physician.

Review of physician orders identified an order for Foley catheter care every shift and as needed dated 03/02/25.

Review of the Medication Administration Record (MAR) showed Foley catheter care documented as completed on the morning of 05/18/26 by a licensed nurse.

Review of the nurses notes revealed the resident had been hospitalized from [DATE] to 03/21/26 for an extended spectrum beta-lactamase (ESBL) urinary tract infection and was currently receiving Hiprex (an antibacterial medication used primarily to prevent recurrent or chronic urinary tract infections.

Hiprex is not used to treat active, acute infections but rather as a long-term preventative medication) for urinary tract infection prophylaxis.

Interview on 05/18/26 at 2:10 P.M.

Licensed Practical Nurse (LPN) #230 stated he signed off on catheter care without verifying it was completed and confirmed this was not proper protocol.

Interview on 05/18/26 at 2:36 P.M.

Certified Nursing Assistant (CNA) #600 stated catheter care was not provided that morning due to resident refusal during a bed bath.

Interview on 05/18/26 at 2:20 P.M. the Director of Nursing (DON) confirmed nurses should be providing catheter care.

Review of facility policy titled Documentation: Charting, dated September 2021, revealed the facility's expectation that the clinical record is a legal document that must be accurate and complete.

The policy requires staff to record care given including treatments only after it is given and to document follow-up action to nursing observations.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

when flushing a resident's feeding tube.

and gloves during high contact care activities for residents with known infection or colonization with

indwelling medical devices.

High contact care activity would include caring for or using and indwelling medical device.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833

Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #22 had impaired cognition.

Further review of the MDS revealed Resident #22 was not up to date on the Covid-19 vaccination.

Review of the care plan dated 06/25/25 revealed Resident #22 had impaired respiratory status related to COPD, and pulmonary disease.

Interventions included labs and diagnostics testing as ordered, and treatments as ordered by physician.

Review of the Vaccine Informed Consent Form dated 10/31/25 revealed the facility offered the Covid-19 vaccination, and Resident #22 accepted to receive.Review of Resident #22's immunizations revealed there was no Covid-19 immunization administered.

Review of the physician's orders for Resident #22 revealed no orders for the Covid-19 vaccination.

Interview with Assistant Director of Nursing (ADON) #263 on 05/26/26 at 10:50 A.M. revealed Resident #22 signed to receive the Covid-19 vaccination however the vaccine never arrived from pharmacy. ADON #263 confirmed that it should have been followed up by ADON #263. ADON #263 further stated that a physician's order should have been obtained for the vaccination.

Review of the facility policy titled Covid Vaccine-Residents dated 10/2023 revealed the Covid vaccine shall be offered to residents in accordance with current Centers for Disease Control and Prevention (CDC) recommendations at the time of the vaccination unless is medically contraindicated.

365351 05/26/2026

Galion Meadows Skilled Nursing and Rehabilitation 935 Rosewood Dr Galion, OH 44833