Vista Care Center Of Milan

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

approach done by staff for their own convenience or to discipline the resident. Review of the undated facility policy Abuse Prohibition, revealed residents would not be subjected to abuse, neglect, exploitation, mistreatment, or misappropriation of property by anyone. A thorough investigation of all alleged violations would be conducted. Any alleged allegation was to be communicated immediately to the Administrator or designee. Residents would be assessed by the Director of Nursing or designee. The attending physician would be notified, along with family or responsible party. Residents would be interviewed if cognitively able to communicate. All alleged violation concerning abuse, neglect, misappropriation of property, and injuries of unknown origin are reported immediately to the Administrator/Designee. Allegations involving abuse or result in serious bodily injury would be reported to the state agency within two hours after the alleged incident was discovered. Reporting of allegations not involving abuse or serious bodily injuries must not exceed 24 hours. The results of a thorough investigation of the allegation would be reported to the state agency within five working days of the incident.This deficiency represents non-compliance investigated under Complaint Number 1331531.

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

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Vista Care Center of Milan

185 S Main St Milan, OH 44846

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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

pulled the staffing schedules to check where LPN #174 had worked. The DON also revealed she would have checked allergies for the residents on unit one and notified the pharmacy to check for medication interactions. The DON revealed staff, and the potentially affected residents should have been interviewed, monitored, and assessed for adverse reactions and there should have been documentation of the notifications, interviews, monitoring, and assessments. Interview on 09/09/25 at 1:36 P.M., LPN #160 revealed on 05/21/25 she gave report to LPN #174. LPN #160 revealed she witnessed LPN #174 set up all

the resident medications for unit one and put Tylenol PM in the cups, then taking the cart down the hall and start passing the medications. LPN #160 revealed during her training she noticed LPN #174 would also watch movies on her phone and sleep at the nurses station. LPN #160 stated she wrote a statement on 05/21/25 and reported the incident to ADON #196. LPN #160 revealed other nurses had previously reported LPN #174 doing the same thing to FDON #566 but nothing was ever done about it. Interview on 09/09/25 at 3:12 P.M., Resident #55 revealed a nurse used to give her two Tylenol PM. Resident #55 revealed the two Tylenol PM were helpful, but she only received one Tylenol PM now. Resident #55 was unable to remember the name of the nurse. Review of LPN #174's personnel record revealed a hire date of 04/09/23 and a termination date of 06/04/25 for performance and violation of company policy. Review of the undated facility policy Psychotropic Drug and Unnecessary Drug Use, revealed the use of chemical restraints was not consistent with the facility guidelines or standard of practice. A chemical restraint was viewed as an approach done by staff for their own convenience or to discipline the resident. Review of the undated facility policy Abuse Prohibition, revealed residents would not be subjected to abuse, neglect, exploitation, mistreatment, or misappropriation of property by anyone. A thorough investigation of all alleged violations would be conducted. Any alleged allegation was to be communicated immediately to the Administrator or designee. Residents would be assessed by the Director of Nursing or designee. The attending physician would be notified, along with family or responsible party. Residents would be interviewed if cognitively able to communicate. All alleged violation concerning abuse, neglect, misappropriation of property, and injuries of unknown origin are reported immediately to the Administrator/Designee. Allegations involving abuse or result in serious bodily injury would be reported to

the state agency within two hours after the alleged incident was discovered. Reporting of allegations not involving abuse or serious bodily injuries must not exceed 24 hours. The results of a thorough investigation of the allegation would be reported to the state agency within five working days of the incident.This deficiency represents non-compliance investigated under Complaint Number 1331531.

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

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Vista Care Center of Milan

185 S Main St Milan, OH 44846

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 - Minimal harm or potential for actual harm Residents Affected - Some

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

would develop a plan of care and implement interventions to manage falls. The licensed nurse would perform a fall risk assessment immediately if the resident was deemed to be at risk. The care plan would be updated routinely and with significant change in the resident ' s condition. Review of the facility procedural guidelines Safe Patient Handling and Mobility, revealed to consult with physical therapy for best transfer methods for resident and physical therapy would conduct a functional assessment. Staff were to use a gait belt, sling, or lapboard (as needed), lateral transfer device, mechanical lift or stand assist lift device for transfers. If the resident was partially or not at all able to assist and was greater than 200 pounds then use

a ceiling lift with supine sling, a lateral transfer device or air-assisted device with three caregivers. This deficiency represents non-compliance investigated under Complaint Number 2570390, Complaint Number 1331531, and Complaint Number 1331530.

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

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Vista Care Center of Milan

185 S Main St Milan, OH 44846

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 - Some

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

where LPN #174 had worked. The DON also revealed she would have checked allergies for the residents

on unit one and notified the pharmacy to check for medication interactions. The DON revealed staff, and the potentially affected residents should have been interviewed, monitored, and assessed for adverse reactions and there should have been documentation of the notifications, interviews, monitoring, and assessments.

Interview on 09/09/25 at 1:36 P.M., LPN #160 revealed on 05/21/25 she gave report to LPN #174. LPN #160 revealed she witnessed LPN #174 set up all the resident medications for unit one and put Tylenol PM

in the cups, then taking the cart down the hall and start passing the medications. LPN #160 revealed during her training she noticed LPN #174 would also watch movies on her phone and sleep at the nurses station.

LPN #160 stated she wrote a statement on 05/21/25 and reported the incident to ADON #196. LPN #160 revealed other nurses had previously reported LPN #174 doing the same thing to FDON #566 but nothing was ever done about it. Interview on 09/09/25 at 3:12 P.M., Resident #55 revealed a nurse used to give her two Tylenol PM. Resident #55 revealed the two Tylenol PM were helpful, but she only received one Tylenol PM now. Resident #55 was unable to remember the name of the nurse. Review of LPN #174's personnel

record revealed a hire date of 04/09/23 and a termination date of 06/04/25 for performance and violation of company policy. Review of the facility policy Medication Administration, dated 12/2012 revealed prior to administration, nurses would review and confirm medication orders for each individual resident on the Medication Administration Record. Personnel authorized to administer medication do so only after they have familiarized themselves with the medication. Medications are administered in accordance with written orders of the prescriber. Medications were to be administered at the time they were prepared. Note allergies or contraindication the resident may have prior to medication administration. The individual who administers the medication dose records the administration on the residents MAR immediately following the medication being given. Once removed from the package/container, unused medication doses shall be disposed of according to the nursing care center policy. Observe resident for medication actions/reactions and record in the nurses notes as appropriate.This deficiency represents non-compliance investigated under Complaint Number 1331531.

Event ID:

Facility ID:

If continuation sheet