Health inspection·January 2, 2025

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, and interview and record review the facility failed to ensure that drugs and biologicals were secured and stored in locked compartments, and permit only authorized personnel to have access to the keys for 1 of 2 treatment and medication carts (Hall 200 treatment cart ) observed for medication storage, The treatment cart on hall 200 was left unlocked in the hallway by room # 216. This failure placed the residents at risk for medications being misappropriated or for potential harm and adverse reactions from access to medications not prescribed for them. The findings included: In an observation and interview on hall 200 on 12/31/24 at 9:16 AM a treatment cart was left unlocked in the hallway beside room [ROOM NUMBER]. There were no staff members or residents in view of the cart. The State Surveyor walked down the hallway and around a corner . The Administrator was observed sitting at a table doing paperwork at a table located in a sitting area. The cart was not in view by the administrator. The surveyor informed the administrator of the unlocked treatment cart on the 200 hall. The administrator stated it should be locked, and she would take care of it. The administrator then escorted the surveyor to the conference room and left . In an observation on hall 200 and interview at 9:20 AM on 12/31/24, the cart was still unlocked and parked beside the wall next to the door of room [ROOM NUMBER] with the drawers facing the hallway . There were no staff or residents in the hallway at that time. The DON came down the hallway and locked the cart . She stated, I locked the cart and started to walk away. The surveyor asked her to come back and open the cart. She turned around to come back, and as she started back toward the cart the Wound Care Nurse and the Wound Care Physician came out of a resident room. In an interview and observation on 12/31/24 at 9:23 AM the Wound Care Nurse stated the DON had told her she left the cart unlocked. She stated she was not sure how long she was in the room to do wound care. She stated the cart should be locked and never left unattended in order to prevent residents from getting a medication that was not meant for them. She stated there were all sorts of adverse outcomes that could occur, but she really couldn not think at the moment. She then stated Well, they could get into something that was not meant for them. She opened the cart at the surveyor's request. There were several tubes of topical prescription and non- prescription creams which included antifungal creams, prescription antibiotic cream, nonsteroidal anti-inflammatory gels, and different dressing supplies and topical medication used for wound care. There was also a pair of scissors in a (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 2 Event ID: 675633 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 675633 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Holland Lake Rehabilitation and Wellness Center 1201 Holland Lake Dr Weatherford, TX 76086 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)