Health inspection·February 19, 2026

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide pharmaceutical services including the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals to meet the needs of each resident for 2 of 5 residents (Resident #1 and Resident #2) reviewed for pharmacy services in that:The facility failed to ensure that a multidose vial of Ativan (a medication used to treat anxiety, agitation, and sometimes seizures), that had not been dated when opened, was not administered after the recommended 28 days from opening to Resident #1 on [DATE], [DATE], and [DATE], and Resident #2 on [DATE].These failures could place residents at risk for non-therapeutic responses to medications.Findings included:1. Record review of Resident #1's face sheet dated [DATE] revealed a [AGE] year-old male with an initial admission date of [DATE] and a current admission date of [DATE]. The pertinent diagnosis included Dementia with behavioral disturbances (a condition which affects memory, thinking, and the ability to perform daily activities, as well as could include symptoms such as agitation, aggression, delusions, and/or hallucinations). Record review of Resident #1's physician orders dated [DATE] revealed Ativan 2 MG/ML, inject 0.5 ML intramuscularly (administered within a muscle) one time only for aggression and combativeness. The physician order dated [DATE] revealed Ativan 2 MG/ML, inject 2 MG intramuscularly one time only for severe aggression, and the physician order dated [DATE] revealed Ativan 2 MG/ML, inject 0.5 ML intramuscularly one time only for aggression and combativeness.Record review of Resident #1's February 2026 MAR revealed IM Ativan was administered on [DATE] (by LVN-C), [DATE] (by RN-D), and [DATE] (by LVN-E).2. Record review of Resident #2's face sheet dated [DATE] revealed an [AGE] year-old female with an admission date of [DATE]. The pertinent diagnoses included Dementia with anxiety (a condition which affects memory, thinking, and the ability to perform daily activities, as well as could include symptoms such as anxiety), and Generalize Anxiety Disorder (nagging feelings of worry or anxiety). Record review of Resident #2's physician orders dated [DATE] (by LVN-C) revealed Ativan 2 MG/ML, give 0.5 ML one time only for aggression and combativeness. Record review of Resident #2's February 2026 MAR revealed Ativan 0.5 ML was administered on [DATE].In an observation on [DATE] at 11:29 AM, a multidose vial of Ativan was observed to be approximately 1/3 full with no written open date or initials on either the vial or the packaging. The vial expiration date was [DATE], but the vial had been opened on [DATE] (as noted on the Ativan Narcotic Count log that coincided with the vial of Ativan). In an interview on [DATE] at 2:15 PM, ADON-A stated multidose vials of medication should be dated and initialed on the vial by the nurse opening it as soon as it was opened. She also stated once the vial had been opened it was good for 28 days, then had to be discarded. ADON-A also stated the ADONs audit the controlled medication logs usually every couple of weeks, so she was not sure how the medication got missed. She also said the nurses were supposed to verify a medication was not expired prior to giving any medication because if the medication was expired it could make a resident sick, or the Page 1 of 2 455455 455455 02/19/2026 Meridian Care of Alice 218 219 N King St Alice, TX 78332

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some medication could be less effective. In an interview on [DATE] at 2:27 PM, LVN-C stated multidose vials of medication were supposed to be dated and initialed by the nurse who opened it, but the vials should be checked for expiration by every nurse who administered it, and he stated he had administered on the dates specified on the MAR and on the Ativan log. He stated he was not sure how long the vial was good for once it had been opened. LVN-C also stated he had not checked to see if the vial was expired prior to using it because he was busy this day, and there were so many things going on at one time. He stated if a medication was expired it could be less effective or even caused a resident harm. In an interview on [DATE] at 3:10 PM RN-D stated she had not check the Ativan for an opened by or expiration date prior to administration. She stated she believed the medication was good for 28 days from the date is had been opened or punctured. RN-D stated residents could have a reaction to the expired medication or it may not work properly if it is expired. RN-D stated the person who opened the vial should date it when it was opened, but any nurse giving the medication should be checking to make sure the medication was not expired prior to giving it. In an interview on [DATE] 3:28 PM, LVN-E stated she had not checked the opened by or expiration date on the Ativan, but she knew she was supposed to because the medication was only good for so many days after opening. LVN-E stated residents could have a possible reaction or the medication could be less effective if given after it has expired. LVN-E stated the nurse who opened the vial was the one who dated it, but every nurse that administered it should check to see if it had expired. In an interview on [DATE] at 10:55 AM, the DON stated multiuse vials of medication were dated and initialed when they were opened, and they were good for 28 days once opened. She stated since the Ativan was initially opened on [DATE], it would have expired on [DATE] and should have been discarded appropriately at the time. The DON also stated every nurse who administered the medication should have checked to see when it was opened and if it was expired because medication could lose its efficacy after expiration or could even have caused harm to a resident. Record review of the Ativan 20 MG / 10 ML multidose vial narcotic log/record, dated [DATE], revealed Ativan was signed out for Resident #1 on [DATE], [DATE], and [DATE]. The log also revealed Ativan was signed out for Resident #2 on [DATE].Record review of the facility's Medication Administration policy, revised [DATE], revealed .12. When opening a multi-dose container, the date opened is recorded on the container. The expiration/beyond use date on the medication label is checked prior to administering.Record review of the facility's Medication Labeling and Storage policy, Revised February 2023, revealed .5. Multi-dose vials that have been opened or accessed are dated and discarded within 28 days unless the manufacturer specifies a shorter or longer date for the open vial. 455455 Page 2 of 2