Health inspection·August 3, 2023

F 0755 Level of Harm - Minimal harm or potential for actual harm Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on interview, and record review, the facility failed to ensure an account of all controlled drugs in order to minimize loss or diversion of narcotics when narcotic return bin(s) were not emptied on a daily basis. Residents Affected - Few This failure resulted in one tablet of tramadol (narcotic pain medication) 50 mg (milligram, unit of measure) not being accounted for and had the potential for narcotics to be diverted from the facility. Findings: On 6/20/23 the facility reported to the Department a loss of one tramadol 50 mg tablet. The report indicated, on 4/25/23, at 4:13 a.m., Licensed Nurse (LN 1) documented returning one tramadol 50 mg tablet to the facility's Nursing Station 3's (NS 3) external Pyxis (automated system that automates the distribution, management and storage of medications) return bin. The tramadol tablet was not found in the return bin when it was emptied on 6/6/23 by pharmacy technicians. During an interview on 6/28/23 at 10:30 a.m. with Director of Nursing (DON), DON confirmed the missing tramadol 50 mg tablet was unaccounted for and stated the tramadol should have been in the NS 3's return bin on 6/6/23. During an interview on 6/28/23 at 11:41 a.m. with Pharmacy Technician (PT), PT stated, tramadol 50 mg tablet should have been returned to the return bin on 4/25/23, but it was not found when checking NS 3's return bin on 6/6/23. PT stated, the return bin should have been emptied on 4/25/23 and it was not. PT further stated, according to the facility ' s policy return bins are supposed to be emptied every day, but they are not. During an interview on 6/28/23 at 11:51 a.m., with Diversion Program Manager (DPM), DPM stated, tramadol 50 mg was documented as being returned to NS 3's return bin on 4/25/23. When the return bin was emptied on 6/6/23, the tablet was not found in the bin. DPM was unable to recall the last time the return bins were emptied, and stated, They should be emptied daily. During a concurrent interview and document review on 6/28/23 at 12:03 p.m. with Director of Pharmacy (DOP), DOP reviewed documentation when the narcotic return bin was emptied during the year 2023. The documentation indicated, NS 3's return bin was emptied on 2/4/3, 3/22/23, and 4/18/23 . DOP stated the return bin should be emptied every day, and it was not. During a review of the facility ' s internal guidance document titled, Return Bin Instructions, (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 2 Event ID: 056200 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 056200 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Community Memorial Continuing Care Center 1306 Maricopa Highway Ojai, CA 93023 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)