Health inspection·September 22, 2022

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview on 09/22/22 at 10:04 AM LVN B stated Resident #94's feed should have been infusing at 65 ml/hr and her flush should be infusing at 40 ml/hr. LVN B said the night nurse, LVN C, hung the bag. She said she did rounds with LVN C, but things were crazy this morning because she got to work late around 6:35 AM. LVN B said she was supposed to start work at 6:00 AM. LVN B said she had not gotten the chance to check Resident #94's g-tube feeding. LVN B said it was important to give the resident the right feeding rate because they could become dehydrated. LVN B said the resident could also be malnourished from not getting the proper nutrients. In an interview on 09/22/22 at 11:13 AM LVN C stated she did not know what happened with Resident #94's feeding and the water flush. LVN C said she thought she set the pump right. LVN C said she made rounds with LVN B, after LVN B got to work late. LVN C said maybe someone could have turned the pump off during incontinent care, she was not sure. She said she did not want to make excuses. LVN C said if a resident got too much fluid, then the resident could get fluid overload. LVN C said a resident could lose weight from not getting the proper feed. In an interview on 09/22/22 at 10:22 AM the DON stated her expectations were for the nurses to follow the physician's orders when providing enteral feedings. The DON said the nurses were expected to check the feedings during rounds. The DON said increased fluids could cause fluid overload for the resident or inadequate nutrition from not getting enough feed. The DON said Resident #94 had several comorbidities and kidney issues which caused her to go in and out the hospital. Record review of the facility policy Enteral Feeding: Ready to Hang dated 05/16/2016 revealed Procedure: 1. Verify physician's order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675454 If continuation sheet Page 2 of 4 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 675454 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West Oaks Nursing & Rehab Center 3625 Green Crest Houston, TX 77082 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)

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. Based on observation, interview, and record review, 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 residents for 1 of 4 medication carts (100 Hall Nursing Cart) reviewed for pharmacy services. - The facility failed to ensure the 100 Hall Nursing Cart did not contain a discontinued, expired Insulin Lispro pen. This failure could place residents at risk of not receiving the therapeutic benefit of medications or adverse reactions to medications. Findings Included: In an observation and interview on 09/21/22 at 09:12 AM, inventory of the 100 Hall Nursing Cart with LVN A revealed: - An open and in use Insulin Lispro pen with an open date of 08/18/22. LVN A said nursing staff are expected to check their carts daily as used for expired or inappropriately labeled medications. She said once an insulin pen is opened/taken from the refrigerator an open date must be recorded on the pen in order to track the beyond use date. LVN A said the Insulin Lispro pen expired 28 days (09/15/22) after opening so it was currently expired. She said when insulin expires it can lose potency, become cloudy or contaminated so the Insulin Lispro pen could not be used. LVN A said she was new and didn't know the exact drug disposal process, but she would remove the pen from the cart and submitted it to the DON for destruction. She said the use of expired insulin could place residents at risk for uncontrolled blood sugar and possible infection. In an interview on 09/21/22 at 10:47 AM, the DON said nursing staff are expected to check their carts daily as used for expired medications. She said all insulin pens should be labeled with the date they are taken out of the fridge and/or used in order to track their expiration date and the binder on each nursing cart contained a list of the Insulin Beyond Use Dates that nursing staff could reference. She said after insulin expires it can lose its potency and use in residents would risk side effects or uncontrolled blood sugars. The DON said the resident's Insulin Lispro order for the expired pen found in the cart was discontinued prior to the manufacturer assigned 28 day (09/15/22) expiration date so the medication had not been administered to the resident. She said once an order is discontinued, the nursing staff who received the order to discontinue is responsible for removing the medication from circulation, leaving it in a secure location until it is discarded. The DON said leaving expired or discontinued medications in the medication carts could place residents at risk for medication errors. Record review of the facility provided document titled Insulin Beyond Use Date revised on 12/01/22 revealed, Name of Insulin: Humalog vials and Kwikpen (lispro), Beyond Use Date After Opening at room temp- 28 days. Record review of the facility policy titled Medication Management revised April 2011 revealed, Medications are stored, dispensed and destroyed in a manner to ensure safety and conformance with state (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675454 If continuation sheet Page 3 of 4 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 675454 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West Oaks Nursing & Rehab Center 3625 Green Crest Houston, TX 77082 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)

F 0755 and federal laws. Guidelines: 5- Medications discontinued shall be maintained in a secure area until returned to pharmacy or destroyed. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675454 If continuation sheet Page 4 of 4