Health inspection·October 31, 2024

F 0761 Level of Harm - Minimal harm or potential for actual harm 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 ensure: Residents Affected - Few 1. Medications (med) were stored properly. 2. Medication Refrigerator temperatures were documented consistently for one of one medication refrigerator. 3. Medication room temperatures were documented consistently for one of one medication room. These failures had the potential for unsafe storage, contamination of medication and altered efficacy of resident medications. Findings: 1. On 10/30/24 at 4:27 P.M., a joint observation of the med cart in the back hall and an interview was conducted with Licensed Nurse (LN) 1. There were oral medications in liquid forms, tablet, and capsule forms, comingled with eye drops in the second drawer of the med cart. LN 1 stated, There should be no liquid medication form and eye drops there. LN 1 stated the medications should not be mixed up. On 10/31/24 at 7:48 A.M., an interview was conducted with LN 1. LN 1 stated the importance of keeping the med cart organized was to prevent contamination and ease of med identification. On 10/31/24 at 9:43 A.M., an interview was conducted with the Director of Nursing (DON). The DON stated the importance of organizing the med cart was to prevent spillage of liquid medications to the tablet forms. A review of the facility's policy, titled Storage of Medications, revised 10/2018, indicated, .B. External use drugs in liquid, capsule .shall be restored separately .a. Example: Separate oral tablets/ capsules from oral liquids .from ophthalmic drops . 2. On 10/30/24 at 4:27 P.M., an observation of the med refrigerator and review of log for the med refrigerator, and an interview was conducted with Licensed Nurse (LN) 1. Inside the med refrigerator, there were tubersol (solution used for skin testing for tuberculosis [TB, respiratory infection]), flu (respiratory virus) vaccines and a vancomycin (antibiotic) eye ointment for a resident. (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 5 Event ID: 555906 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 555906 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meadowbrook Village Christian Retirement Community 100 Holland Glen Escondido, CA 92026 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)