Health inspection·September 13, 2023

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 that included the accurate acquiring and receiving of all drugs and biologicals to meet the needs of each resident noted in 1 of 3 medication areas (medication room) reviewed for medication storage. The facility medication room contained 3 prescription medications that were expired. The facility's failure to ensure medications were stored in accordance with currently accepted professional principles could result in a resident receiving the incorrect medication or a medication that would be ineffective for their treatment resulting in exacerbation of the resident's condition and disease processes. Findings include: During an observation on 09-12-2023 at 09:31 AM of the facility's medication room with the DON and CRN present the following medications were noted to be expired that were present in the overflow bin for room [ROOM NUMBER]A: Atorvastatin 1 bottle with expiration of 4-26-2023 and one bottle with expiration of 8-30-2023 Losartan 1 bottle with expiration of 6-21-2023 and one bottle with expiration of 8-30-2023 Gabapentin 1 bottle with expiration of 8-30-2023 During an interview on 9-12-2023 at 09:33 AM the DON and CRN they verified that the three prescription medication were expired, were part of the overflow stock, and that if the primary medication cart on the floor was out of medication, then the nurse would grab what they needed from this stock in the medication room. The DON reported that she did not feel the expired medication would be a problem because the staff are trained to check each medication for expiration prior to being administered. The DON stated, The chance an expired medication would be given would be slim. We check dates when we pass any meds. The CRN agreed. The DON reported that the expired medications were brought in when the resident in room [ROOM NUMBER]A was admitted recently and they expected him to be short term but he has since decided to stay and the medications he brought in were not discarded as they should have been. During an interview on 09-13-2023 at 08:52 AM LVN A reported that if a resident is out of a prescription medication in the medication cart, they will check the medication room for the overflow (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 4 Event ID: 675049 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 675049 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Pampa 1504 W Kentucky Ave Pampa, TX 79065 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)