Health inspection·October 3, 2024

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 observations, facility policy review, and staff interviews, it was determined that the facility failed to store drugs used in the facility in accordance with currently accepted professional principles and the expiration dates for three of three medication carts observed (B Hall, C Hall, and G Hall medication carts). Findings Include: Review of facility policy, titled 5.3 Storage and Expiration Dating of Medications and Biologicals, last revised August 1, 2024, revealed it stated, 2. Facility should ensure that medications and biologicals are stored in an orderly manner in cabinets, drawers, carts, .3. Facility should ensure that food is not to be stored in the refrigerator, freezer, or general storage areas where medication and biologicals are stored .11. Once any medication or biological package is opened, the facility should follow manufacturer/supplier guidelines with respect to expiration dates for opened medication. Facility staff should record the date opened on the primary medication container (ie., vial, bottle, inhaler) when the medication has a shortened expiration date once opened or opened .11.3 If a multi-dose vial of an injectable medication has been opened or accessed (e.g., needle-punctured), the vial should be dated and discarded within 28 days unless the manufacturer specifies a different (shorter or longer) date for that opened vial .12. Facility should destroy and reorder medication and biologicals with soiled, illegible, worn, makeshift, incomplete, damaged, or missing labels or cautionary instructions . Observations of the G Hall medication cart on September 30, 2024, at approximately 12:00 PM, revealed the following: One insulin glargine prefilled pen that was in use with no opened date on the medication. One Lantus Solostar insulin pen with no opened date on the medication. One Admelog insulin pen with no opened date on the medication. One Lispro multidose vial of insulin with no opened date on the medication. Two Novolin 70/30 insulin multidose containers with no opened date on the medication. One prefilled insulin pen which had a sticker adhered to it that covered the name of the medication, the manufacturer's expiration date, and lot number of the medication. Page 1 of 2 395395 395395 10/03/2024 River's Bend Health & Rehab Center 800 King Russ Road Harrisburg, PA 17109

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During the observation, the Director of Nursing (DON) confirmed that there should be a date written on the aforementioned medications identifying when they were opened; also that, there should not have been a sticker covering the manufacturers information on the insulin pen. Observation of the C Hall medication cart on September 30, 2024, revealed food contained in a restaurant paper bag was stored in the drawer used to store multi-dose medication containers that are in use on the unit. The bag of food was found to be resting on top of the medication containers. It was also observed that the C hall medication cart had an excessive amount of loose medication pills and pill dust (degraded medication tablets) contained within the drawers and outside of the drawer on the lowest interior portion of the medication cart. Observation of the B Hall medication cart revealed an excessive amount of loose medication pills were found in the drawers and in the lowest interior portion of the medication cart. It was also observed that four medication blister packs (plastic cards that pills are packaged in) were found on the lowest interior portion of the medication cart. All four medication blister packs contained medication within them. During a staff interview on September 30, 2024, at approximately 1:30 PM, Nursing Home Administrator (NHA) revealed the facility did not have a current medication cart cleaning schedule at that time. During the interview, NHA stated that it was believed to have been the night shift nurses' responsibility but, at the time of the interview, the facility had no policy, procedure, or schedule for cleaning the medication carts. During a staff interview on October 1, 2024, DON confirmed that food should not be stored in the medication cart and that medications should be labeled with opened dates per the policy. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.12(d)(1)(5) Nursing services 395395 Page 2 of 2