Health inspection·May 31, 2024

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 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 of four (Medication Cart #1) medication carts reviewed for pharmacy services. The facility failed to ensure Medication Cart #1 was locked when unattended on 05/24/24. This failure could place residents at risk of having access to unauthorized medications and/or lead to possible harm or drug diversion. Findings included: In an observation and interview on 05/24/24 at 7:50 AM, Medication Cart #1 was observed unlocked and unattended, with the keys on top of the cart. Medication Cart #1 was facing the entrance of room [ROOM NUMBER], and the residents were in the room. Charge Nurse A was observed as he entered the hallway from the main area near the nurses' station and dining hall about 5 minutes later. Charge Nurse A stated he had to go assist with the food trays. He stated he was sorry for leaving the medication cart unlocked and unattended. Charge Nurse A stated the risk of the unlocked medication cart was a resident could get medications from the cart. In a telephone interview on 05/24/24 at 8:00 AM, Administrator stated it was a requirement to keep the medication carts locked. She stated anyone could get the medication off the cart. In an interview on 05/24/24 at 11:45 AM, Director of Nursing B stated her expectation was that all medication carts should be locked at all times. She stated all staff know the carts should be locked when unattended. Director of Nursing B stated the risk was anyone could get medications off the cart. Record review of the facility's policy titled, Medication Storage and dated 1/20/21, reflected the following: Policy Explanation and Compliance Guidelines 1. General Guidelines: a. All drugs and biologicals will be stored in locked compartments (i.e., medication carts, cabinets, drawers, refrigerators, medication rooms) under proper temperature controls. (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: 675057 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 675057 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Balch Springs Nursing Home 4200 Shepherd LN Balch Springs, TX 75180 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)