Health inspection·May 2, 2025

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to correctly administer a wound treatment medication for one of four sampled residents reviewed for medication errors (Resident 1). Residents Affected - Few As a result, wrong wound treatment medication was administered. In addition, this failure has the potential to delay Resident 1 ' s wound healing. Findings: On 5/2/25 at 8:30 A.M., an unannounced onsite visit at the facility was conducted related to treatment medication error. Resident 1 was admitted to the facility on [DATE] with diagnoses including bullous pemphigoid (a rare skin condition that causes large fluid-filled blisters) according to the facility ' s Face Sheet. During an observation and interview on 5/2/26 at 8:44 A.M. with Resident 1, Resident 1 was observed in bed with a dressing on his right arm, close to Resident 1 ' s elbow. Resident 1 stated he had a wound on the right arm, and it was not getting better. Resident 1 stated a nurse administered the incorrect medication on his right arm wound. During a review of the MDS (a clinical assessment tool) dated 5/6/25 for Resident 1 listed a cognitive (thinking, reasoning, or remembering) score of 15, indicating cognition was intact. A review of Resident 1 ' s physician orders was conducted. A physician ' s order dated 2/2/25 indicated, metronidazole [an antibiotic] 500 mg [milligrams] [1tablet] TABLET Topical .crush and sprinkle in the lesion on the right arm indefinitely .Two Times Daily .DISCONTINUED [4/25/25] . A joint record review and interview was conducted on 5/2/25 at 9:07 A.M. with Licensed Nurse (LN) 1. LN 1 reviewed Resident 1 ' s care plans in the electronic medical record (EMR) at the nursing station. LN 1 stated there was a care plan for Resident 1 initiated on 12/28/22 for Resident 1 ' s lesion on the right arm. LN 1 stated the care plan included an intervention dated 2/2/25 which indicated, .Indefinite use of Flagyl to the RUE [right upper extremity] lesions . LN 1 stated another care plan was initiated for Resident 1 which indicated, .Medication Error-Applied Methadone [a strong medication used for severe pain] to the Right Arm cancerous lesions instead of prescribed Metronidazole topical treatment . LN 1 showed Resident 1 ' s wound measurements from a form titled, Non-Pressure Sore Skin Problem Report which indicated, .R [right] lateral elbow .4-13-25 15x15 cm [centimeter] .4-24-25 16x16 cm . LN (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 2 Event ID: 555144 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 555144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St. Pauls Health Care Center 235 Nutmeg Street San Diego, CA 92103 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)