Health inspection·February 28, 2020

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, interviews, and policy review the facility did not ensure that the medication error rate was less than 5 percent in regards to 6 errors in 27 opportunities for one resident (#278) out of 7 sampled residents, resulting in a 22.2%. medication error rate. Residents Affected - Few Findings included: Resident #278 was admitted to the facility with a diagnosis of congestive heart failure (CHF), according to the face sheet in the admission record. On 2/28/20 at 10:10 a.m. an observation was conducted during medication administration with Staff E, Licensed Practical Nurse (LPN). Staff E, LPN poured medications for Resident #278, including spironolactone 25 mg (milligrams), furosemide 20 mg, sertraline 25 mg, glucosamine chondroitin complex two pills, omeprazole 40 mg, and losartan potassium 25 mg. Resident #278 came into the hallway where Staff E, LPN was pouring her medications, and was heading to therapy. Staff E, LPN told Resident #278 she was preparing her medications. Resident #278 waited next to the medication cart where Staff E, LPN was preparing the medications. Resident #278 said it was ok to give them to her in the hallway. Staff E, LPN poured some water in a plastic cup and handed Resident #278 her medications. Resident #278 took her pills with the water, one at a time. When Resident #278 finished her medications, Staff E, LPN took the plastic cup and placed it in the trash receptacle on her mediation cart. Then Staff E, LPN performed hand hygiene. Upon review of Resident #278's February 2020 physician orders in the electronic medical record, the following information was discovered: 2/14/20 Spironolactone tablet 50 mg give 0.5 tablet by mouth one time a day for potassium saving. The medication was scheduled at 8:00 a.m. 2/16/20 Furosemide 20 mg give 1 tablet by mouth one time a day for CHF. The medication was scheduled for 8:00 a.m. 2/14/20 Sertraline HCl tablet 25 mg give 1 tablet by mouth one time a day for depression. The medication was scheduled at 8:00 a.m. 2/14/20 Glucosamine-Chondroitin tablet give 2 tablets by mouth one time a day for osteo bi-flex triple strength. The medication was scheduled for 8:00 a.m. 2/14/20 Omeprazole capsule delayed release 40 mg give 1 capsule by mouth one time a day for gerd (gastroesophageal reflux). The medication was scheduled for 8:00 a.m. Page 1 of 3 105620 105620 02/28/2020 Highlands Lake Center 4240 Lakeland Highlands Rd Lakeland, FL 33813

F 0759 Level of Harm - Minimal harm or potential for actual harm 2/14/20 Losartan Potassium tablet 25 mg give 1 tablet by mouth one time a day for blood pressure. The medication was scheduled for 8:00 a.m. On 2/28/20 at 11:22 a.m. a telephone interview was conducted with the Consultant Pharmacist. She said they are supposed to give medications one hour before or one hour after the scheduled time. Residents Affected - Few On 2/28/20 at 12:39 p.m. an interview was conducted with the Director of Nursing (DON). The DON said they have an hour before and an hour after the scheduled time. Review of the policy titled, Medication Administration - General Guidelines, revised July 8, 2016, revealed the following information: Policy Medications are administered as prescribed in accordance with good nursing principles and practices an only by persons legally authorized to do so. Personnel authorized to administer medications do so only after they have familiarized themselves with the medication. The facility has sufficient staff to allow administering of medications without unnecessary interruptions. B. Administration 2) Medications are administered in accordance with written orders of the attending physician, manufacturer's specifications, and professional standards of practice. 3) Medications should be administered in such a way that the six rights are performed: right customer, right medication, right dose, right time, right route and right documentation. 4) Prior to administration of mediations, the nurse should verify that there is no contraindication for administering the medication, as well as verifies that the medication is being administered at the proper time, in the prescribed dose and by the correct route. 15) Medications are administered within 60 minutes of scheduled time, except before or after meal orders, which are administered, based on mealtimes. Unless otherwise specified by the prescriber, routine medications are administered according to he established medication administration schedule for the facility. 105620 Page 2 of 3 105620 02/28/2020 Highlands Lake Center 4240 Lakeland Highlands Rd Lakeland, FL 33813

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and review of the facility policy, the facility did not ensure that refrigerated controlled Schedule II-IV medications were secured in a locked and permanently affixed compartment in 3 (Park Place, [NAME] Point, and [NAME] Court) medication storage rooms of 3 medication storage rooms. Findings included: On 02/27/20 at 11:48 a.m. the Park Place medication storage room was observed with Staff B, Registered Nurse (RN). An unlocked refrigerator was observed to be opened by Staff B, RN. A locked black plastic box, approximately 4 inches x 18 inches, was observed on the second shelf inside the refrigerator and was not permanently affixed. The black box was taken out, placed on the countertop and unlocked by Staff B, RN. Observed inside the box was a labeled plastic bag that contained a small bottle of oral Ativan, a Schedule IV medication. (Photographic Evidence Obtained). The medication and the box were placed back into the refrigerator. On 02/27/20 at 11:55 a.m. the [NAME] Point medication storage room was observed with Staff C, RN/Unit Manager. An unlocked refrigerator was observed to be opened by Staff C, RN. An unlocked biege metal box, approximately 9 inches by 10 inches, was observed on the second shelf inside the refrigerator and was not permanently affixed. The beige metal box was removed from the refrigerator and opened by Staff C, RN. Observed inside was an unopened and unlabeled vial of Ativan. Staff C, RN stated, Oh! This shouldn't be in there. It should have been sent out. A permanently affixed clear box was observed under the second shelf . Staff C, RN stated the affixed clear box was not being used because they do not have a key, and the beige metal box was not locked because they are having problems with the lock. (Photographic Evidence Obtained). Staff C, RN returned unlocked box and unlabeled Ativan to the refrigerator. On 02/27/20 at 12:08 p.m. the [NAME] Court medication storage room was observed with Staff D, Licensed Practical Nurse (LPN). An unlocked refrigerator was observed to be opened by Staff D, LPN. A black plastic box, approximately 6 inches x 18 inches, was observed on the second shelf and was not permanently affixed. The black box was taken out of the refrigerator by Staff D, LPN, placed on countertop and unlocked. Observed inside the box were two medication cards of Marinol (dronabinol), a Schedule II medication. (Photographic Evidence Obtained.) Staff D, LPN returned the box and medications to refrigerator. On 02/27/20 at 4:13 p.m. in an interview with the Director of Nursing (DON), the reached out to the regional nurse and received a policy titled, Controlled Medication Storage, dated 3/1/08. The policy was reviewed. Documented in Section B on page 1 of 3, it was revealed that Schedule II-V medications and other medications subject to abuse are to be stored in a permanently affixed compartment separate from all other medications. The DON confirmed the policy showed that controlled medication should be stored in a permanently affixed compartment. On 02/28/20 at 11:21 a.m. in an interview with the pharmacist she stated, Controlled medications are usually kept under double lock, the fridge locked, and the medication room locked. The Pharmacist explained that for an unlocked controlled medication, if it is not a medication for the EDK (Emergency Drug Kit), I understand it would be an issue. 105620 Page 3 of 3