Health inspection·September 14, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to develop and implement a comprehensive, person-centered care plan for each resident, consistent with resident rights, that included measurable objectives and time frames to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for 1 of 8 residents (Residents #128) reviewed for care plans. The facility failed to ensure Resident #128 had a care plan in place to address urinary tract infection. This failure could place residents at risk of not receiving individualized care and services to meet their needs. The findings included: Record review of Resident #128's Care Plan, last revised 9/11/23, revealed no care plan for urinary tract infection Record review of Resident #128's Quarterly MDS, dated [DATE], revealed: She had a mental status score of 15 out of 15, which indicated no cognitive impairment. She had no signs or symptoms of delirium. She required extensive assistance with bed mobility, dressing, toileting and personal hygiene, limited assistance with transfers and supervision for all other ADLs. She was occasionally incontinent of bladder. Record review of Resident #128's admission Record, dated 09/14/2,3 revealed: The resident was a [AGE] year-old female who was originally admitted to the facility on [DATE]. Her admission diagnoses included urinary tract infection (infection of the urinary system), hypotension (low blood pressure), and acute kidney failure (kidneys no longer filtering waste, causing bloods chemical makeup to be out of balance). Record review of Resident #128' Order Summary, dated 9/9/23, revealed the following orders: Page 1 of 4 455690 455690 09/14/2023 Parks Health Center 111 Parks Village Dr Odessa, TX 79765

F 0656 Admit to skilled care for urinary tract infection. Level of Harm - Minimal harm or potential for actual harm Interview on 9/14/23 at 11:35 AM, the DON stated the new MDS nurse had only been hired a week ago and that was why some care plans were not up to date. The DON stated that she should have caught it on admission. Residents Affected - Few Record review of the facility policy Care Plans, Comprehensive Person-Centered, revision date 3/20/2022 revealed in part: 1. The interdisciplinary team (IDT), in conjunction with the resident and his/her family or legal representative, develops and implements a comprehensive, person-centered care plan for each resident. 2. The comprehensive, person-centered care plan is developed within seven (7) days of the completion of the required MDS assessment (Admission, Annual or Significant Change in Status), and no more than 21 days after admission. 3. The care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment. 4. Each resident's comprehensive person-centered care plan is consistent with the resident's rights to participate in the development and implementation of his or her plan of care . 7. The comprehensive, person-centered care plan: a. includes measurable objectives and timeframes; b. describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being, including: (1) services that would otherwise be provided for the above, but are not provided due to the resident exercising his or her rights, including the right to refuse treatment 455690 Page 2 of 4 455690 09/14/2023 Parks Health Center 111 Parks Village Dr Odessa, TX 79765

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to provide pharmaceutical services, including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals, to meet the needs of each resident for 2 of 4 Medication Carts and 1 of 2 Medication Storage Rooms reviewed for pharmacy services. 1. The facility failed to ensure Medication Cart #1 did not include expired Melatonin 1 mg tablets, Pepcid AC 10 mg tablets, Vitamin D3 capsule, Mag Oxide 400 mg tablets, and Timolol Maleate eyedrops. 2. The facility failed to ensure Medication Cart #2 did not include expired Med Honey Gel 15 ml tubes, Iodoform Packing Strips, and Benzoin Tincture Sterile Applicators. 3. The facility failed to ensure the Medication Storage Room did not contain expired Pneumovax 23 Polyvalent Vaccines 0.5 ml single-use syringes. These failures could place residents at risk of not receiving the therapeutic benefit of medications, adverse reactions to medications and worsening of symptoms of diseases. Findings Include: In an observation on [DATE] at 9:25 AM, inventory of the Medication Room with LVN C revealed: - ten single-use injection syringes of Pneumovax 23 Polyvalent Vaccine, expired [DATE] In an observation on [DATE] at 10:00 AM, inventory of Medication Cart #1 with LVN A revealed: - one bottle (approximately 90 tablets) of Melatonin 1 mg, expired 06/23 - one bottle (approximately 90 tablets) Pepcid AC 10 mg, expired 08/23 - one bottle (approximately 110 tablets) Vitamin D3 125 mcg/5000 IU, expired 06/23 - one bottle (approximately 120 tablets) of Mag Oxide 400 mg, expired 07/23 - one bottle (5ml) of Timolol Maleate 0.5% solution, expired 04/23 In an observation on [DATE] at 10:20 AM, inventory of Medication Cart #2 with LVN A revealed: - two tubes of Med Honey Gel 0.5 fluid ounces (15ml), expired [DATE] - one container of Iodoform Packing Strip ¼ x 5 yards, expired [DATE] - one package Benzoin Tincture Sterile Applicator, expired [DATE] In an interview on [DATE] at 9:25 AM, LVN C stated the Central Supply or the nurses checked the 455690 Page 3 of 4 455690 09/14/2023 Parks Health Center 111 Parks Village Dr Odessa, TX 79765

F 0755 Level of Harm - Minimal harm or potential for actual harm medication storage room for expired meds. She also stated the CMA also checked the medication storage room for expired meds. In an interview on [DATE] at 10:20 AM, LVN B stated the nurses checked the medication carts daily for expired meds. LVN B stated they checked dates on everything they opened. Residents Affected - Some In an interview on [DATE] at 1:30 PM, the DON stated the facility just had a mock survey last month and she did not know why there were expired meds. She stated the eyedrops belonged to a patient's family. The DON stated the med aids were supposed to check the med storage rooms the beginning of each month and put anything in the destruction area that was expired or expiring that month. Record review of the facility policy titled Storage of Medications, with a revision date of [DATE], read in part: Drug containers that have missing, incomplete, improper, or incorrect labels are returned to the pharmacy for proper labeling before storing. Discontinued, outdated, or deteriorated drugs or biologicals are returned to the dispensing pharmacy or destroyed. 455690 Page 4 of 4