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 Page 1 of 3 455608 455608 01/24/2023 Hacienda Oaks at Beeville 4713 Business 181 N Beeville, TX 78102

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the med rooms and central supply and thought the central line dressing kits were only in the central supply, but there were none in the central supply. The ADON stated that staff get and stash them for easier access. The ADON stated it was important that central line dressing kits were not expired because using the contents could cause infection. Observation on 01/23/23 at 03:10 PM of the A Hall medication cart with the DON revealed an approximate half bottle of 1000 stool softener tablets expired as of 12/22. Observation on 01/23/23 at 03:12 PM of the B-Hall medication cart with the DON was an opened 100ml (milliliter) bottle of normal saline that was undated, timed, or initialed. Observation on 01/23/23 at 03:14 PM of the east wing treatment cart revealed a partial 8-ounce spray bottle of wound cleanser that expired on 12/22. An interview with the DON on 1/23/23 at 03:15 PM revealed it was important not to administer expired medications because the expiration dates were there for a reason. The DON stated the medications could lose their potency or cause an unexpected reaction because their chemical makeup could be altered after the expiration dates. According to the FDA website, drug expiration dates reflect the time period during which the product is known to remain stable, which means it retains its strength, quality, and purity when it is stored according to its labeled storage conditions. If a drug has degraded, it might not provide the patient with the intended benefit because it has a lower strength than intended. In addition, when a drug degrades it may yield toxic compounds that could cause consumers to experience unintended side effects. Sterility may be compromised after the expiration date on medical devices such as IV tubing, catheters, and other sterilized products. 455608 Page 2 of 3 455608 01/24/2023 Hacienda Oaks at Beeville 4713 Business 181 N Beeville, TX 78102

F 0912 Level of Harm - Potential for minimal harm Residents Affected - Many Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. Based on observation, interview, and record review, the facility failed to provide the required 80 square foot per resident in 48 of 48 multiple resident rooms (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 27, 28, 29, 30, 31, 33, 34, 35, 36, 37, 38, 39, 41, 42, 43, 44, 45, 46, 48, 49, 50, 51, and 52. All 48 facility multiple resident rooms did not have the required square footage. This deficient practice could affect residents who resided in rooms with less than the required square footage and make it difficult for the residents to move around in their rooms. The findings were: rooms with two beds and four rooms (23, 24, 51, and 52) with three beds. Beginning at 1:30 p.m. on 10-29-19 during the facility's previous recertification survey, this surveyor, using an agency laser measuring device, obtained measurements for all 48 resident rooms. Rooms with two beds measured between 149.0 and 156.5 square feet. Rooms with three beds measured between 220.1 and 220.9 square feet. None of the bedrooms measured provided the required 80 square feet per resident. On 01/22/2023, the Administrator provided a letter requesting a room size waiver. 455608 Page 3 of 3