Health inspection·December 4, 2023

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure 1 of 5 residents was assessed for self-administration of medications of a total sample of 5 residents, (#1). Residents Affected - Few Findings: Resident #1 was admitted to the facility on [DATE] with diagnoses of multiple sclerosis, dermatitis, rosacea, post mastectomy lymphedema syndrome, and anxiety disorder. On 12/04/23 at 12:24 PM, resident #1 sat in her wheelchair at the side of her bed. On the resident's bedside table was a plastic bag, with label that read Ketoconazole Cre 2%. The plastic bag contained Metronidazole gel 1%, and tube of Clindamycin Phosphate gel 1%. On the bedside table was a vial of Thera Tears and a vial of Ivizia eye drops. Resident #1 stated she used the gels herself but had not used them in two to three days, because they were not doing anything. She stated the eye drops were given to her by her eye doctor and she used the drops daily. Resident #1 could not say if she was assessed for self-administration of medications. She stated she last used the medications approximately two or three days ago. Metronidazole topical gel is used to treat inflammatory lesions (pimples and red bumps) caused by rosacea. (Retrieved from www.nhs.uk>medicines 12/12/23). Clindamycin is an antibiotic which works by stopping the growth of bacteria. (Retrieved from webmd.com 12/12/23). Thera Tears and Ivizia eye drops are used for relief of dry eyes and eye irritation. Review of the resident's physician orders revealed an order dated 8/16/23 for Clindamycin Phosphate gel 1% apply to red area on nose cheeks and forehead 4 times daily at 9 AM, 1 PM, 5 PM, 9 PM. The order noted the medication was discontinued on 8/21/23. A physician order on 9/28/23 read Metronidazole gel 1% apply topical daily to face for rosacea for 7 days. Documentation indicated the medication was discontinued on 10/02/23A. A physician's order for self-administration of the medications was not identified. On 12/04/23 at 12:59 PM, the South Wing Licensed Practical Nurse/Unit Manager (LPN/UM) stated the facility did not allow residents to administer their own medications. She said if a resident was admitted with medications from home, the medications would be kept in the medication cart, and would be administered by the nurse. On 12/04/23 at 1:41 PM, the Director of Nursing (DON) stated there were not any residents in the facility that were assessed for self-administration of medication. She verbalized that a physician order must be obtained for residents to take their own medications. She added that a care plan would be Page 1 of 2 105839 105839 12/04/2023 Terrace of Kissimmee, The 221 Park Place Blvd Kissimmee, FL 34741

F 0554 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few developed and the medication for self-administration would be kept in the medication cart. The DON stated resident #1 did not have an order for self-administration of medications and was not supposed to have medications at her bedside. On 12/04/23 at 1:48 PM, observation conducted with the DON showed the medications Clindamycin, Metronidazole, Thera Tears, and Ivizia on the resident's bedside table. Resident #1 stated she was given the medications by the dermatologist, and the eye doctor. The resident explained she used the eye drops daily on awakening, a couple of times during the day, and before sleeping. The DON confirmed resident#1 was not assessed for self-administration of medications, and the medications should not be at bedside. On 12/04/23 at 2:10 PM, the DON stated the gels found on the resident's bedside table came from the pharmacy that supplied the facility, so the medications must have been given to the resident by a nurse. She stated the eye drops were not from the facility's pharmacy. The resident's physician orders were reviewed with the DON, and an order for Lubricant eye drops 0.25% 1 drop twice per day at 9 AM, and 9 PM, and for Artificial Tears 1 drop to both eyes as needed. The DON could not say if those eye drops were being administered along with the ones at the resident's bedside. The facility's policy, Administering Medications revised April 2010, read, Residents may self-administer their own medications only if the Attending Physician in conjunction with the Interdisciplinary Care Planning Team, has determined that they have the decision- making capacity to do so safely. 105839 Page 2 of 2