Health inspection·January 3, 2024

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 insulin (drug used to lower blood sugar) was used in accordance with facility ' s manufacturer ' s recommendations and direction for storage, use, and disposal for two of 14 residents receiving insulin (Residents 4, and 5). 1. Resident 4 insulin was actively in use and available past the manufacturer ' s beyond-use date (BUD- last date a product can be safely used after it has been altered for resident use). 2. Resident 5 insulin was actively in use and available without an open date. These failures had the potential for Residents 4, and 5 to receive insulin with reduced potency which could cause inadequate blood sugar control. These may result in the physician increasing insulin doses based on the blood sugar results placing the residents at risk for harm. Findings: 1. An inspection of a medication cart (the Middle Cart), and interview were conducted with a Licensed Vocational Nurse 2 (LVN 2) on December 19, 2023, at 1:55 PM. An opened 100 units/ milliliter (ml- unit of measurement) multiple-dose vial of insulin lispro (fast-acting insulin), labeled for Resident 4, was observed inside the cart. It was labeled with an open date of 11/19/23 (November 19, 2023) indicating the vial was available for use for 30 days. LVN 2 stated the open date is past 28 days and it should have been changed on December 17, 2023, two days ago. During an interview conducted on December 19, 2023, at 2:45 PM with the Director of Nursing (DON), the DON stated the open date on the insulin vial is passed 28 days and the staff did not follow the facility ' s policy and procedure (P&P). The DON further stated, and it was important to follow P&P to minimize the negative effects it would cause the residents. During a review of the manufacturer ' s recommendations provided by the facility referenced ID: 3273563, . HUMALOG (insulin lispro injections .). Unopened HUMALOG should be stored in a refrigerator (36 degree to 46 degrees Fahrenheit [2 degrees to 8 degrees Celsius]) . In-use HUMALOG vials, . should be stored at room temperature, below 86 degrees Fahrenheit (30 degree Celsius) and must be used within 28 days or be discarded, even if they still contain HUMALOG . A review of the facility ' s undated policy and procedure titled Policy and Procedures for Pharmaceutical Services, indicated, Drugs and biologicals will be stored in a safe, secure and orderly (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: 056372 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 056372 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/03/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookside Healthcare Center 105 Terracina Blvd. Redlands, CA 92373 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)