Garland Road Nursing & Rehab Center

F 0554

Allow residents to self-administer drugs if determined clinically appropriate.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, record review, and interview, the facility failed to ensure a resident had a physician's order and a self-administration of medication assessment for 1 (#6) of 3 sampled residents reviewed for medication administration.The administrator identified 97 residents resided in the facility. Findings: On 08/20/25 at 12:49 p.m., fluticasone propionate (a corticosteroid) nasal spray was observed on Resident #6's bedside table.A MEDICATION PROGRAM policy, revised 12/01/23, read in part, Residents who self-administration their medication and keep them locked in their room must be counseled at least monthly by community staff to ascertain if the residents continue to be capable of self-administering their medications/treatments and if security of the medications can continue to be maintained. The community must keep a written record of such counseling.A physician's order, dated 03/11/25, showed fluticasone propionate nasal spray 50 micrograms, give one spray twice a day for unspecified cough.Resident #6's quarterly resident assessment, dated 08/09/25, showed the resident had diagnoses which included congestive heart failure and chronic obstructive pulmonary disease. The assessment showed the resident's cognition was intact with a BIMS score of 14.On 08/20/25 at 12:50 p.m., Resident #6 stated they took the nasal spray once a day.On 08/20/25 at 1:48 p.m., LPN #3 stated the resident had to have a physician's order to self-administer medications.On 08/20/25 at 1:54 p.m., LPN #3 stated the resident had fluticasone propionate nasal spray on bedside table. They stated the nasal spray should be administered twice a day.

LPN #3 stated they could not locate a resident self-administration assessment for the nasal spray.On 08/20/25 at 1:57 p.m., LPN #3 stated they could not locate an order for self-administration of the nasal spray.On 08/20/25 at 1:58 p.m., LPN #3 stated they initially educated Resident #6 on the administration of

the nasal spray, but no other education was provided since then.On 08/20/25 at 2:00 p.m., the DON stated residents would need an order and a self-administration assessment to self-administer medications.On 08/20/25 at 2:04 p.m., the DON stated they could not locate an order and an assessment for self-administration of the nasal spray.

Residents Affected - Few

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 REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

Facility ID:

If continuation sheet

Event ID:

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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Garland Road Nursing & Rehab Center

1404 North Garland Road Enid, OK 73703

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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Based on record review and interview, the facility failed to notify the physician when a resident:a. missed their prescribed antibiotic dose; and b. had an abnormal heart rate for 1 (#6) of 3 sampled residents reviewed for medication administration.The administrator identified 97 residents resided in the facility.Findings:A MEDICATION-GUIDELINES ON CLINICAL PRACTICE policy, revised 01/12/20, read in part, Staff will provide medications in accordance with standard practice guidelines.Resident #6's quarterly resident assessment, dated 08/09/25, showed the resident had diagnoses which included congestive heart failure and unspecified atrial fibrillation.A physician's order, dated 07/24/25, showed metoprolol succinate (an antihypertensive) 50 mg tablet, extended release for essential primary hypertension. Give one tablet by mouth three times a day. Take one 50mg tablet if systolic blood pressure is less than 110.A physician's order, dated 08/03/25, read in part, ciprofloxacin hydrochloride (an antibiotic) 500 mg tablet for urinary tract infection. Start 08/04/25 at 08:00 [8:00 a.m.]. Give 500 mg by mouth twice a day at 8:00 a.m. and 8:00 p.m.

Stop on 08/11/25 at 8:00. Finish all of this medication unless otherwise directed.An August 2025 Medication Record for;a. ciprofloxacin hydrochloride showed Resident #6 had a missed dose on 08/04/25 for 8:00 a.m. and 8:00 p.m. dose, and on 08/11/25 for 8:00 a.m. dose; andb. metoprolol showed the resident had missed their metoprolol dose on 08/15/25 for the 12:00 p.m. and 8:00 p.m. doses. The record showed

the resident received metoprolol on 08/16/25 at 8:00 a.m. with a heart rate of 120 bpm.On 08/22/25 at 11:39 a.m., LPN #2 stated they could not locate documentation the physician was notified of the missed antibiotic doses.On 08/22/25 at 11:53 a.m., LPN #2 stated they would notify the physician of the elevated heart rate and rechecked until the resident returned to their baseline heart rate.On 08/22/25 at 11:56 a.m., LPN #2 stated they could not locate documentation the physician was notified of the elevated heart rate.On 08/22/25 at 1:10 p.m., the DON stated the metoprolol parameters meant to take one 50 mg tablet if systolic blood pressure is less than 110.On 08/22/25 at 1:29 p.m., the DON stated notification to the physician on elevated heart rate depended on the physician's preference. They stated the facility's physician informed facility staff verbally of their notification preference. The DON stated the facility's physician wanted to be notified of residents' heart rate above 150 bpm for non-frequent episodes or 130 bpm if regularly elevated.On 08/22/25 at 1:39 p.m., the DON stated the physician should be notified of the missed antibiotic doses.

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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Garland Road Nursing & Rehab Center

1404 North Garland Road Enid, OK 73703

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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

showers from 08/01/25 through 08/19/25.On 08/20/25 at 12:41 p.m., Resident #6 stated they went 10 days without a shower. They stated they never refused a shower.On 08/20/25 at 12:42 p.m., Resident #6's representative stated staff would write refuse on the paper but that was false.On 08/21/25 at 3:27 p.m., CNA #1 stated Resident #6's shower schedule was on Tuesday, Thursday, and Saturday. They stated they did not see any showers for the dates above.On 08/21/25 at 3:34 p.m., LPN #1 stated the CNAs would inform the nurse of resident refusal of showers and the nurse would encourage the resident to have a shower. They stated the CNA would document refusal on the shower sheet. LPN #1 stated the facility was going to implement resident sign off on refusals, but they had not implemented the process at this time.On 08/21/25 at 3:41 p.m., the DON stated they expected staff to follow resident shower schedules to provide showers.

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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Garland Road Nursing & Rehab Center

1404 North Garland Road Enid, OK 73703

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 0684

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Level of Harm - Minimal harm or potential for actual harm

Based on record review and interview, the facility failed to ensure a resident with low blood sugar received appropriate care for 1 (#5) of 3 sampled residents reviewed for medication administration.The DON identified 28 residents received insulin resided in the facility. Findings:A HYPOGLYCEMIA TREATMENT policy, revised 02/12/20, read in part, Guidelines for Mild Hypoglycemia: Treat, even if biochemical hypoglycemia is not present with a. glucose-15 40% oral gel (Dextrose) gm gel, b. Glucose 15 gm tablets.Repeat blood glucose level in fifteen (15) minutes.A physician's order, dated 06/21/25, showed Humalog kwikpen 200 units/1mL solution. Give one dose subcutaneous for blood sugar 70-100= 0 units, 100-150= 4 units, 151-200= 6 units, 201-250= 8 units, 251-300= 10 units, 301-350= 12 units, 351-400= 14 units, 401-500= 16units, over 500, give 5 additional fast acting units before meals and bedtime for type 2 diabetes mellitus with ketoacidosis without coma.A Medication Record for Humalog sliding scale on 07/06/25 for 7:00 a.m. dose, showed insulin was held due to vital signs parameters. The record showed the resident's blood sugar was 39.There was no documentation Resident #5's blood sugar was rechecked in 15 minutes according to the facility's hypoglycemia policy.There was no documentation interventions were implemented for the resident's low blood sugar according to the facility's hypoglycemia policy.Resident #5's discharge assessment return not anticipated, dated 07/12/25, showed the resident had diagnoses which included type 2 diabetes mellitus without complications.On 08/21/25 at 3:59 p.m., the ADON stated they could not see what interventions were done for Resident #5's low blood sugar on 07/06/25.On 08/21/25 at 4:05 p.m., the ADON stated they could not locate documentation to show a recheck was performed.

Residents Affected - Few

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

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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Garland Road Nursing & Rehab Center

1404 North Garland Road Enid, OK 73703

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

11:50 a.m., LPN #2 stated they would had clarified the metoprolol parameters order prior to administering or holding it due to the exclamation mark in the order. They stated they did not know what M meant on the resident's medication record.On 08/22/25 at 11:52 a.m., LPN #2 stated the metoprolol was not administered as ordered for the dates above.On 08/22/25 at 12:56 p.m., CMA #1 stated they did not remember administering any magnesium for Resident #6. They stated the medication did not show up for staff to administer it.On 08/22/25 at 1:08 p.m., the DON stated the medication record did not show Resident #6 received their magnesium oxide from 08/01/25 through 08/21/25.On 08/22/25 at 1:10 p.m., the DON stated the metoprolol parameters meant to take one 50 mg tablet if systolic blood pressure is less than 110.On 08/22/25 at 1:18 p.m., the DON stated according to the metoprolol order, it should not have been held on 08/15/25 at 8:00 p.m. dose. They stated the medication record showed the medication was held on 08/18/25 and they could not determine the medication was administered on 08/15/25 at 12:00 p.m.

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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Garland Road Nursing & Rehab Center

1404 North Garland Road Enid, OK 73703

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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Based on record review and interview, the facility failed to ensure the amount of insulin administered was documented on a resident who received sliding scale insulin for 1 (#5) of 3 sampled residents reviewed for medication administration.The DON identified 28 residents received insulin resided in the facility. Findings:A MEDICATION-GUIDELINES ON CLINICAL PRACTICE policy, revised 01/12/20, read in part, Staff will provide medications in accordance with standard practice guidelines.A physician's order for Resident #5, dated 06/21/25, showed Humalog kwikpen 200 units/1mL solution. Give one dose subcutaneous for blood sugar 70-100= 0 units, 100-150= 4 units, 151-200= 6 units, 201-250= 8 units, 251-300= 10 units, 301-350= 12 units, 351-400= 14 units, 401-500= 16units, over 500, give 5 additional fast acting units before meals and bedtime for type 2 diabetes mellitus with ketoacidosis without coma.A Medication Record reviewed from 06/21/25 through 06/30/25 did not show how many units of the sliding scale insulin was administered for all blood sugars above 100.A physician's order for Resident #5, dated 07/06/25, showed Humalog kwikpen 200 units/1mL solution. Give one dose subcutaneous for blood sugar 70-100= 0 units, 100-150= 2 units, 151-200= 4 units, 201-250= 6 units, 251-300= 8 units, 301-350= 10 units, 351-400= 12 units, 401-500= 14units, over 500, give 5 additional fast acting units before meals and bedtime for type 2 diabetes mellitus with ketoacidosis without coma.A Medication Record reviewed from 07/01/25 through 07/12/25 did not show how many units of the sliding scale insulin was administered for all blood sugars above 100.

Resident #5's discharge assessment return not anticipated, dated 07/12/25, showed the resident had diagnoses which included type 2 diabetes mellitus without complications.On 08/21/25 at 2:44 p.m., the DON stated staff followed the sliding scale order. They stated what they should give was in the order.The DON could not provide documentation on how much of the Humalog was administered for blood sugars above 100 on the dates reviewed.On 08/21/25 at 4:14 p.m., LPN #4 stated the electronic health system the facility used for medication administration may or may not given them an option to document the amount of insulin administered. They stated they personally put that information in a note. LPN #4 stated the facility should provide the option to input what was administered.On 08/21/25 at 4:25 p.m., LPN #4 stated it was important to know what was previously administered for insulin treatment, interventions, and emergencies.

Event ID:

Facility ID:

If continuation sheet