Health inspection·June 20, 2025

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 and permit only authorized personnel to have access for one (Hall 400) of three medication carts reviewed for pharmacy services. On 06/19/25, LVN A failed to ensure medication cart was locked when not being used at the nursing station on Hall 400. This failure could place residents at risk of having access to unauthorized medications and/or lead to possible harm or drug diversion. Findings included: Observation on 06/19/25 at 11:10 am revealed the medication cart was unlocked in front of the nurse's station. The drawers faced the hallway, and no staff was in sight. LVN A walked by the medication cart and pressed the lock closed and left 400 Hall with a resident. The medication cart was left unlocked for approximately 5 minutes and no residents and visitors were in the area at that time. Interview on 06/19/25 at 11:20 am, LVN-PRN B stated the medication cart should be locked when not in use because residents could take medications out of the cart and take the wrong medication. Interview on 06/19/25 at 12:10 pm, LVN A stated she had a resident that returned from dialysis and went to go check on the resident. LVN A stated she was taking a resident off of the hall, checked the cart, and locked it. LVN A stated she should have locked the cart when she walked away. Interview on 06/20/25 at 9:15 am, the DON stated the medication cart should be locked to prevent drug diversion and access to medications by residents. Record review of the facility's policy titled Care and Treatment/ Pharmacy revised July 2023 reflected: It is the policy of this facility to store all drugs and biological in locked compartments .The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications . Medication rooms, carts, and medication supplies are locked or attended by persons with authorized access. 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 5 Event ID: 455727 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 455727 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Village Healthcare and Rehabilitation 207 E Parkerville Rd Desoto, TX 75115 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)