Health inspection·September 6, 2019

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview and record review, the facility failed to ensure expired oral medications and topical creams were removed from the current medication supplies. In addition, nasal sprays, eye drops, and pain patches were commingled with the current medication supplies readily available for residents' use. Also, the medication room temperature was not consistently monitored as required. These failures had the potential for unsafe storage of medications thereby losing the efficacy of the medications. Findings: 1a. On 9/4/19 at 9:32 A.M., a medication storage inspection of the treatment cart and interview was conducted with Licensed Nurse (LN) 1. The treatment cart had five drawers. In the first drawer, there was half a box of individual packets of hydrocortisone cream (topical medication used to help relieve redness, itching, swelling) with an expiration date of 8/19. In the fifth drawer, there was one opened tube of benzoyl peroxide 10 % (medication used to treat mild to moderate acne) with an expiration date of 9/18, and one tube ointment of a soothe and cool barrier (moisture ointment) with an expiration date of 8/19. LN 1 stated the LNs should have been checking at the expiration date of the medications and discarded the expired treatment medications. LN 1 acknowledged the policy and guidelines on storage of medications should have been followed. On 9/5/19 at 2:10 P.M., an interview was conducted with the Director of Nursing (DON). The DON LNs should have checked the treatment and medication carts to ensure medications were current. A review of the facility's policy titled, Storage and Expiration of Medications, Biologicals, Syringes and Needles, revised 10/31/16, indicated, Procedure . 3. General Storage Procedures: . 3.2 Facility should ensure that external use medications and biologicals are stored separately from internal use medications and biologicals . 5. Once any medication or biological package is opened, Facility should follow the manufacturer/ supplier guidelines with respect to expiration dates for opened medications . 5.2 Medications with a manufacturer's expiration date expressed in month and year (e.g. May 2019) will expire on the last day of the month . 2. On 9/4/19 at 10:17 A.M., a medication storage inspection, interview, and record review was conducted with LN 1. There were 15 missing signatures in the medication room temperature log in PM shifts. The dates were identified as follows: 1/3, 1/5, 1/7, 1/8, 1/9, 1/15, 1/16, 1/17, 1/21, 1/27, 1/29, (continued on next page) 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 Page 1 of 4 Event ID: 055500 Printed: 05/15/2026 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 055500 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Valley Vista Post Acute 1025 W. Second Avenue Escondido, CA 92025 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)