F 0761
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
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 observation, interview, and record review, the facility failed to store all drugs and biologicals in
locked compartments on 1 of 1 medication carts (fourth floor) reviewed for storage of drugs.
One medication cart on fourth floor was left unattended and unlocked by nurse's station area on the fourth
floor.
This deficient practice could affect residents who have medications in the Nurses' medication cart and
could result in lost medications, drug diversion, or harm due to accidental ingestion of unprescribed
medications.
Findings included:
Observation on 5/19/2023 at 10:40am revealed an unlocked/unattended med cart on 4th floor by nurse's
station. This surveyor was able to open all drawers of medication cart recognizing the cart being unlocked.
Multiple medications in bulk bottles and blister packs were easily assessable for removal. Charge nurse
(LVN A) responsible for medication cart was in a resident room down the hall for approximately five
minutes. There were seven plus residents and staff within a five to fifteen feet radius of the unlocked
medication cart making it easily assessable to unauthorized individuals.
Interview on 5/19/2023 at 10:45am with LVN A. LVN A walked out of the resident's room located at the end
of the hall and identified herself as being responsible for the unlocked medication cart. LVN A walked up to
medication cart and locked it with her elbow after realizing it was unlocked. LVN A stated, she always
locked her cart but stepped away to assist a resident and did not realize the medication cart was left
unlocked. LVN A stated, it is important to always lock medication carts due to anyone being able to open it
and get medications not prescribed to them. LVN A stated, I have been working at this facility for about 3
years, and always locked my medication cart, but this time I forgot. LVN A stated she had a headache and
got distracted.
LVN A stated, last in-service on medication carts was about a few months ago, maybe 3 or 4 months ago,
and I usually work on the third floor and not the fourth floor. LVN A stated, the infection control nurse,
ADON, and DON usually makes floor rounds and makes sure medication carts are locked.
Interview on 5/19/2023 at 10:54am with 4th floor ADON and DON. DON stated, the importance of
medication carts being locked is so unauthorized people do not have access to medications that do not
belong to them and possibly having adverse reactions. ADON stated In-service on medication carts was
(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:
455575
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
455575
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/19/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Windsor Nursing and Rehabilitation Center of Morga
2322 Morgan Ave
Corpus Christi, TX 78405
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)
F 0761
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
done about a few months ago. DON stated medication carts are always locked and rounds on the floors are
conducted to make sure all medication carts are locked when not in use.
5/19/2023 at 12:25pm, ADON handed this surveyor an in-service log on Locking Medication Carts when
not in use dated 5/19/2023 and would be continuing in-service through the week. LVN A was listed on this
in-service.
Review of facility policy of Medication Administration and Medication Carts states, the facility maintained
equipment and supplies necessary for the preparation and administrations of medications to residents. The
mobile medication cart will be used to facilitate administration of medications to residents. The purpose of
the mobile medication system is to ensure appropriate control and surveillance of resident assigned
medications.
Line 2. The medication cart is locked at all times when not in use.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455575
If continuation sheet
Page 2 of 2
