Health inspection·August 17, 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. 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 2 Medication Carts and 1 of 2 Treatment Carts reviewed for pharmacy services. - The facility failed to ensure the Medication Cart did not include the following expired medications: Eszopiclone 1 mg tablets, Olmesartan Medoxomil 40mg tablets, Aspirin 81mg, and Carboxymethylcellulose Sodium 0.5% lubricating eye drops. These failures could place residents at risk of receiving expired medications. Findings included: Medication Cart In an observation on 08/16/23 at 09:18AM, inventory of the Medication Cart with LVN A revealed: - one card (28 tablets) of Eszopiclone 1mg, expired 05/17/23 - one card (30 tablets) of Olmesartan Medoxomil 40mg, expired 07/23 - one bottle (29 tablets) of Aspirin 81mg, expired 02/22 - one opened box (4 sealed packages inside) of Carboxymethylcellulose Sodium Lubricating eye drops Single Use, expired 05/23 In an interview on 08/16/23 at 10:40 AM, the LVN stated the carts are checked for expired medications one time monthly. The LVN stated they try to check the carts for expired medications before the Pharmacist comes each month. The LVN stated there was no documentation to validate if the medication cart had been checked for expired medications. The LVN stated she knew the importance of checking the expiration date prior to administration. In an interview on 08/17/23 at 10:55 AM, the DON stated the Pharmacist month and reviews the medications in the medication carts and medication room storage areas for expiration dates. The DON stated the CNA's review the medication carts weekly for expired medications and review the medication expiration dates as they are being administered. Page 1 of 4 675599 675599 08/17/2023 Robert Lee Care Center 307 West 8th St Robert Lee, TX 76945

F 0755 Review of the facility policy titled Storage of Medications revised April 2019, reads in part: Discontinued, outdated, or deteriorated drugs or biologicals are returned to the dispensing pharmacy or destroyed. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 675599 Page 2 of 4 675599 08/17/2023 Robert Lee Care Center 307 West 8th St Robert Lee, TX 76945

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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. Based on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were labeled and stored in locked compartments , for 1 of 2 Medication Carts and 1 of 2 Treatment Carts reviewed for pharmacy services. - The facility failed to ensure the Medication Cart did not include the following medications found loose in the medication drawer: Gabapentin 100mg x 2 capsules, Namenda 10 mg x 1 tablet, Buspar 15 mg x 1 tablet and Buspar 5mg x 1 tablet. - The Treatment Cart was unlocked and had Insulin, Oral Glucose, syringes, and lancets. These failures could place residents at risk of receiving expired medications. Findings included: Medication Cart In an observation on 08/16/23 at 09:18AM, inventory of the Medication Cart with LVN A revealed: - two capsules of Gabapentin 100 mg, found loose in medication drawer - one tablet of Namenda 10 mg found loose in medication drawer - one tablet of Buspar 15 mg found loose in medication drawer - one tablet of Buspar 5 mg found loose in medication drawer Treatment Cart In an observation on 08/15/23 10:00AM, the treatment cart was found unlocked. The following items were identified: Top Drawer: - 2 tubes Oral glucose gel lemon flavored 15 grams - 6 packages of Sani-Cloth Germicidal Disposable Wipes - 1 pen Novolog Flex Pen 100Units/ML (Insulin) Second Drawer: - 1 box of approximately 33 count Insulin pen needles - 1 box of approximately 50 count Lancets 675599 Page 3 of 4 675599 08/17/2023 Robert Lee Care Center 307 West 8th St Robert Lee, TX 76945

F 0761 Fourth drawer: Level of Harm - Minimal harm or potential for actual harm - 2 boxes of 100 count lancets - One box of approximately 100 count 1ml Insulin Safety Syringes Residents Affected - Some In an interview on 08/16/23 at 10:40 AM, the LVN stated the loose pills in the cart were a result of the cards coming loose or missing the cups when pills were being popped out of the cards. The LVN stated she knew the importance of keeping the medication carts and treatment carts locked when not in use. In an interview on 08/17/23 at 10:55 AM, the DON stated she believed the loose pills were related to accidental puncture of the cards as well as excessive inventory in the medication cart storage areas. The DON also stated the reason the treatment cart was open was because the nurse responsible for that cart was busy with a resident admission and it was an oversight. The DON stated all nurses know the medication carts and treatment carts must be always locked when not in use. Review of the facility policy titled Storage of Medications revised April 2019, reads in part: Discontinued, outdated, or deteriorated drugs or biologicals are returned to the dispensing pharmacy or destroyed. Compartments (including, but not limited to drawers, cabinets, rooms, refrigerators, carts, and boxes) containing drugs and biologicals are locked when not in use. 675599 Page 4 of 4