Health inspection·January 24, 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. Based on observation, interview, and record review, the facility failed to ensure that all drugs and medical devices used in the facility were labeled in accordance with professional standards, including expiration dates for 2 of 2 medication rooms, 2 of 3 medication carts, and 1 of 2 treatment carts observed for expirations dates. The facility had expired Central Line Dressing Kits in the west and east wing medication rooms, and expired medications in the A-hall/B-hall medication carts and the east wing treatment cart. These failures could place residents at risk for infection, a serious drug reaction or not receiving the intended therapeutic benefit of medication. The findings were: Observation of the west wing medication room on 01/22/23 at 01:07 PM revealed the following items: 6 expired Central Line Dressing Kits: 2 expired on 06/30/22, 1 expired on 09/30/22, and 3 expired on 12/31/22. Observation of the east wing medication room on 01/22/23 at 01:10 PM revealed the following items: 14 expired Central Line Dressing Kits: 5 expired on 08/31/22, 3 expired on 09/30/22, and 5 expired on 12/31/22. An interview with the ADON on 01/22/23 at 01:12 PM, the ADON stated there were no residents with central lines at this time; the last one was some time ago. The ADON stated she was in the process of consolidating the supplies to a central location. The ADON stated she was responsible for checking (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 3 Event ID: 455608 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 455608 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hacienda Oaks at Beeville 4713 Business 181 N Beeville, TX 78102 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)