Health inspection·October 10, 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure drugs and biologicals were stored in locked compartments for 2 of 2 medications. -Medication bubble pack was left unattended on medication cart on Hall 400 -Medication discovered was left on bedside table for Resident #1 These failures could place all residents at risk for obtaining medications that could cause adverse reactions. Findings included: Observation on 10/10/2023 at 9:28am revealed the medication cart in Hall 400 was unattended with a medication bubble pack left on the top of medication cart. Medication was turned over and reflected that the medication pack was full of Lasix medication. The Investigator stood next to medication cart for 5.5 minutes with no staff in sight. There was a resident sitting in a wheelchair next to the medication cart who asked, Is that medication mine? Investigator stated to resident that she was unsure who the medication belonged to. During an interview on 10/10/2023 at 9:33am, LVN A was asked why the medication was left unattended. She stated that she was going to go get the medication. LVN A was asked if any residents wandered down the halls, and LVN A stated yes there was one. LVN walked away from Investigator. Observation on 10/10/2023 at 9:53am revealed Resident #1 was lying in her bed. Observed a cream, Betamethasone Valerate 0.1%, next to the bed. Resident #1 was asked if the medication was hers, she stated that it was, and it was for her eczema and it was ordered for her to apply to herself. Interview on 10/10/2023 at 10:08am with LVN A regarding medication on top of medication cart. LVN A was asked what a negative outcome would be, LVN A stated, Someone could grab it. LVN A was asked about medications left at bedside, LVN stated that if the resident was with it they do not have to be supervised because they will take 1 pill at a time, and they are care planned for that. Record Review of Resident #1's medical chart revealed the following, but not limited to: Resident is an [AGE] year-old female who was admitted to the facility on [DATE] (continued on next page) 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: 455480 Printed: 05/15/2026 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 455480 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Convalescent Center 1009 Clyde St Amarillo, TX 79106 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)