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. (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: 675599 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 675599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Robert Lee Care Center 307 West 8th St Robert Lee, TX 76945 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)