Inspection·February 2, 2023

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 the drugs and biologicals used in the facility were stored and labeled in accordance with currently accepted professional principles in 2 of 4 medication carts. Findings include: During an observation of 400 Hall Medication Cart on 1/30/2023 at 9:39 AM with Staff A, License Practical Nurse (LPN), there were one opened Refresh Liquigel Lubricant Eye Gel with no opened date, one opened bottle of Dorzolamide HCl Solution 2% not in the original packing with no opened date, one opened bottle of Brimonidine Tartrate Ophthalmic Solution 0.2% with no opened date, and one opened bottle 0of Artificial Tears eye drops with no opened date and no resident identifier. During an interview on 1/30/2022 at 9:41 AM, Staff A, LPN, stated, Medication should be labeled with opened date and expiration date. Over the counter mediation should also be labeled with resident name. During an observation of 500 Hall Medication Cart on 1/30/2023 at 9:45 AM with Staff B, Registered Nurse (RN), there were one opened Novolog insulin pen with no opened or expiration date, one bottle of Dorzolamide HCI Ophthalmic Solution 2% with no opened date, one bottle of Latanoprost Solution 0.005% with no opened date, and one bottle of Ketorolac 0.5% Ophthalmic Solution with an opened date of 11/22/2022. During an interview on 1/30/2023 at 9:48 AM, Staff B, RN, stated, Medication should be dated with opened date and expiration date. I float. I do not have my own cart. If I would, medication would have dates. During an interview on 1/31/2023 at 12:41 PM, the Director of Nursing stated, My expectations are for medication to be dated and labeled. Review of the facility policy and procedure titled Medication Storage Information reads, Best Practice Guidelines . Date opened: All flushes, multi-dose vials, irrigation solution and IV fluids must be marked with date opened or first used . Pharmacy Labels: All prescription medications must have a pharmacy label attached. If the item is very small, the label may be affixed to a plastic bag or vial. 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: 105488 Printed: 05/28/2026 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 105488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwood Healthcare & Rehabilitation Center 808 S Colley Rd Starke, FL 32091 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)