Inspection·February 27, 2025

F 0755 Record review of Resident #1's orders listed as Active orders entered on 02/14/2025 revealed the following: Level of Harm - Minimal harm or potential for actual harm lamoTRIgine Oral Tablet 100 MG-Give 2.5 tablet by mouth one time a day related to other seizures. lamoTRIgine Oral Tablet 150 MG-Give 2 tablet by mouth one time a day related to other seizures. Residents Affected - Few Record review of Resident #1's Medication Administration Record dated 02/1/2025-02/28/2025 revealed that Resident #1 was ordered lamoTRIgine Oral Tablet 200 mg. Give 2.5 tablet by mouth one time a day. Resident #1 was given that medication dosage on 02/05/25, 02/06/25, 02/07/25, & 02/08/25 in the morning. The MAR further revealed that the order was discontinued on 02/14/25. The MAR indicated that Resident #1 was given lamoTRIgine Oral Tablet 100 mg, 2.5 tablet by mouth one time a day on dates 02/15/25-02/27/25 in the morning. The MAR also revealed Resident #1 was given lamoTRIgine Oral Tablet 150 mg-Give 2 tablet by mouth one time a day on 02/05/25-02/07/25 in the evenings and that dosage was given on dates 02/15-02/26 in the evenings. Record review of Resident #1's Lab result from the hospital dated 02/08/25 stated Lamotrigine Level (abnormal). Specimen: Blood. Result: 21.1 2.0-20.0 ug/mL normal range During an interview on 02/27/25 at 10:32 AM, Resident #1 stated that she had only been living in the facility a brief time and had no concerns with her care whatsoever. She stated she recently moved into the facility after leaving the hospital because of difficulties with her seizures. During an interview on 02/27/25 at 10:43 AM, the ADON stated that the charge nurses were responsible for putting new orders in for new admissions, but that she helped put them in and the DON would review them. ADON stated that on, 02/05/25 when Resident #1 was admitted to the facility, she put her admission medications into PCC and they were correct as follows: Lamotrigine 250 mg every morning and Lamotrigine 300 mg every night. The ADON stated because that medication only came in 100 or 200 mg tabs, the pharmacy called and wanted her to put in the order for the morning dose as 100 mg, 2.5 tabs. She stated that she made a mistake by not changing the dosage to 100 mg, she left it at 200 mg in the MAR, so Resident #1 had gotten a 500 mg dose for her morning dosage on dates 02/05/25, 02/06/25, 02/07/25, and 02/08/25. The ADON stated that Resident #1 was sent back to the hospital on [DATE] because her head wound had started bleeding again. She stated that she was not sure what reaction a person could experience by having too much Lamotrigine, so she looked it up on the internet and stated that it could make someone have a rash or be lethargic. The ADON stated that a possible negative outcome for giving a wrong dosage to a resident could be that it could make them lethargic or have a rash. During a phone interview on 02/27/25 at 11:15 AM, the Pharmacist for the facility stated that if a resident had 250 mg more Lamotrigine daily than was ordered, it could not cause a resident to be hospitalized . She stated that that drug would not build up in the system but excretes in urine with a rapid peak of 1-5 hours. The Pharmacist went on to state that the amount given could cause a skin rash in extreme cases, or nausea. She stated it could not cause bleeding. The Pharmacist stated that Lamotrigine, with the dosage being a little bit over would not cause any issues. The Pharmacist was told that Resident #1's Lamotrigine blood level was checked at the hospital and the lab came back one point above the normal range. She stated it would not cause any issues being that close to the normal range. During an interview on 02/27/25 at 1:15 PM, the DON stated that her expectations of medications (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 2 of 3 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 455675 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Landmark of Amarillo Rehabilitation and Nursing Ce 5601 Plum Creek Dr Amarillo, TX 79124 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 0755 Level of Harm - Minimal harm or potential for actual harm being put in at admission was that either the charge nurse or the ADON would take discharge papers from hospital or orders from the PCP, wherever the resident was admitting from, and put the orders in correctly and timely. She stated that a possible negative outcome for putting medications in incorrectly, upon admission, could be a medication error. If the medication was the wrong dose, either too low or too high, the medication could be too effective or not effective enough. Residents Affected - Few Record Review of the facility's policy titled, Receiving a New Medication Order, dated 2/2024 revealed in part, the following: . The nurse that receives a new medication order, should be responsible for the following: Order received is accurate and includes all necessary information. Order must be transcribed accurately to the MAR sheet unless electronic MAR's are used by the facility . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 3 of 3