Inspection·December 3, 2025

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the interdisciplinary team determined if it was clinically appropriate to self-administer medications for 1 of 5 residents (Resident #7) reviewed for medication administration. The facility's interdisciplinary team failed to ensure Resident #7 was clinically appropriate to self-administer antihistamine eyedrops that was at the resident's bedside. This failure could place residents at risk of not receiving the therapeutic benefit of medication or an adverse drug reaction. Findings included:Record review of Resident #7's quarterly MDS dated [DATE] reflected Resident #7 was an [AGE] year-old male admitted to the facility on [DATE]. Resident #7's BIMS score of 15 indicated his cognition was intact. Resident #7's diagnoses included amputation (removal of body limbs), high blood pressure (when the force of blood flowing through the blood vessels is consistently too high), renal insufficiency (characterized by reduced kidney function), diabetes (high blood sugar), lack of coordination, with adequate vision with no use of corrective lenses. Observation and interview on 09/23/25 at 11:30 AM, revealed Resident #7 had a bottle of Olopatadine Hydrochloride Ophthalmic Solution (antihistamine eye drops) at his bedside table. Resident #7 said his family member might have brought him the eye drops because his eyes had been itching, especially his right eye. Resident #7 stated he used the eye drops once in the morning and then again in the evening hours, and he did this daily.Record review of Resident #7's order summary reflected orders for eye drops had been started on 09/23/25 and 09/24/25 with no prior orders, and the orders reflected the following: - Ketotifen Fumarate Ophthalmic Solution 0.035 % Instill 1 drop in right eye two times a day for Itch Relief Active with order date 09/23/25 Start date 09/23/25.- Blink Tears Ophthalmic Solution 0.25 % Instill 1 drop in both eyes one time a day for dry eyes unsupervised self-administration. Active with order date 09/23/25 Start date 09/24/25.Interview with RN C on 09/23/25 at 12:36 PM, who was the charge nurse for Hall 100, revealed he was not aware Resident #7 had eye drops at his bedside to administer to himself. RN C stated he was not aware of any concerns with Resident #7's eye irritation. RN C stated someone from Resident #7's family may have brought him the eye drops, however there was supposed to be a prescription for the eye drops and they should be stored in our mediation cart. I will let the physician know so I can get an order so he can have it at his bedside. According to RN C, a physician's order was required to administer all medications whether it was for nursing staff to administer or residents to self-administer. RN C was observed removing the eyedrops from the bedside table. RN C stated all staff was responsible for removing medications from bedside and alerting the nursing staff, ADONs, or the DON. RN C stated allowing residents to have medications at the bedside without a physician's order placed residents at risk of over-using medication, forgetting how and when to use them. Interview on 09/25/25 at 2:00 PM, ADON B revealed residents should not have any medications in the room with them. ADON B stated residents would have to pass an assessment which would indicate they are capable of administering medications on their own. ADON B stated nursing Residents Affected - Few (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: 675153 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 675153 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage House at Keller Rehab & Nursing 1150 Whitley Road Keller, TX 76248 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)