Inspection·November 17, 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, interviews and record reviews, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 resident (Residents #1) out of 8 residents reviewed for medication administration in that: The facility failed to ensure Resident #1 was administered medications according to physician parameters. This deficient practice could place residents at risk of not receiving the intended therapeutic benefit of the medications, could result in a worsening or exacerbation of chronic medical conditions, hospitalization and or a diminished quality of life. The findings include: Record review of the admission Record revealed Resident #1 was a [AGE] year-old female, originally admitted to the facility on [DATE]. Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #1's primary medical condition for admission was amputation of two or more right lesser toes. Other active diagnoses included: Hypertension [high blood pressure] and dependence on hemodialysis [mechanical process in which waste and excess fluids are filtered from the blood when the kidneys are no longer adequately able to function]. Resident #1 had a summary BIMS score of 10, indicative of moderate cognitive impairment. Record review of the Order Details printed 11/17/2023 at 11:39 AM, revealed Resident #1 had physician orders for Midodrine [a medication used to elevate low blood pressure] 10 milligrams by mouth three times a day with a start date of 8/17/2023 including parameters to hold if systolic blood pressure was greater than 110 or diastolic blood pressure was greater than 70. Record review of the Care Plan revealed Resident #1 had a problem area of impaired tissue perfusion related to hypotension; with the following associated interventions: give medications as ordered, initiated on 9/8/2023. ? Record review of Medication Administration Record, printed 11/17/2023 at 11:28 AM, revealed (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 3 Event ID: 675395 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 675395 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Val Verde Nursing and Rehabilitation Center 100 Hermann Dr Del Rio, TX 78840 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)