Health inspection·December 8, 2023

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 reconcile, dispose, and account for a discontinued controlled medication (medications that are regulated by the government due to the likelihood for being misused and high risk for abuse) to prevent drug diversion (the illegal distribution or abuse of prescription drugs) for one resident (Resident 1). As a result of this deficient practice, six tablets of the controlled medication went missing, and there was an inaccurate count of the controlled medication. Findings: Resident 1 was re-admitted to the facility on [DATE] with the diagnoses including chronic respiratory failure with hypoxia (a condition where there is not enough oxygen in the body) and dependence on ventilator (breathing machines that keep lungs working) according to the facility's admission Record. An abbreviated survey for a facility reported incident was conducted on 11/16/23. During an interview and concurrent observation with the Assistant Director of Nursing (ADON) on 11/16/23, at 9:20 A.M., the ADON showed a large, white container in the medication room. The ADON stated non-controlled medications (medications prescribed by a physician and over the counter medications) were disposed in the container and sealed once full. The ADON further stated controlled medications were given to the Director of Nursing (DON) for disposal. The ADON then went to the DON's office and the DON showed a locked drawer. The DON unlocked the drawer, and it contained one card of Alprazolam 0.5 milligrams (mg) labeled with Resident 1's name. The medication count sheet titled, Controlled Drug Record, was reviewed with the DON. The count sheet did not have signatures under dose given, but had two signatures dated 7/6/23, indicating 30 doses were received. During an observation of Resident 1 on 11/6/23, at 9:27 A.M., Resident 1 was in bed with eyes closed. Resident 1 was observed with a tracheostomy (an opening on the neck with a tube to help with breathing) connected to a ventilator. An interview and concurrent record review was conducted with Licensed Nurse (LN) 1 on 11/16/23, at 10:43 A.M. LN1 stated discontinued controlled medications were counted and compared with the count sheet to ensure accuracy. LN 1 stated any inaccuracies were reported to the DON. LN 1 stated (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: 555871 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 555871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Somerset Subacute and Care 151 Claydelle Ave El Cajon, CA 92020 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)