Health inspection·August 17, 2022

F 0689 Level of Harm - Minimal harm or potential for actual harm Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observations, interviews, and record review the facility failed to ensure the environment was free from accident hazards in the one of one storage closets reviewed near the nurse's station. Residents Affected - Few The facility failed to ensure that approved chemicals were stored properly. This failure could expose residents to harmful chemicals. Findings included: During an observation on 08/15/22 at 3:35 PM, the janitorial and housekeeping closet across from nurse's station was found unlocked. Chemicals observed in the closet included: 3 - 32-ounce spray bottles labeled bleach cleaner Label revealed Keep out of reach of children 1 - bottle labeled glass cleaner concentrate. Label revealed Keep out of reach of children, harmful if swallowed, harmful if inhaled. Causes serious eye irritation. May cause drowsiness or dizziness. Flammable liquid and vapor. 1 - 2.1-quart bottle labeled germicidal disinfectant. Label revealed Keep out of reach of children. 1 - bottle labeled acid cleaner & descaler. Label revealed Keep out of reach of children. Warning Corrosive causes burns to eyes and skin. Avoid contact. Contains Hydrochloric Acid. 2 - 32-ounce bottles labeled no rinse carpet cleaner 1 - 5-gallon bucket of bird seed. No label and no date found on the bucket. 6 - 1-gallon jugs labeled deodorizer. Label revealed Keep out of reach of children. Caution: May irritate eyes. 1 - spray bottle containing a clear liquid not labeled hanging on side of a red metal cart 1 - 20-ounce bottle of aloe gel. 1 -1-quart spray bottle of deodorizer In an unlocked cart in the janitorial and housekeeping closet contained the following: Page 1 of 5 675645 675645 08/17/2022 Mesa Springs Healthcare Center 7171 Buffalo Gap Rd Abilene, TX 79606

F 0689 2 spray bottles labeled bleach. Label revealed Keep out of reach of children. Level of Harm - Minimal harm or potential for actual harm 1 -33.8-ounce jug labeled hand sanitizer. 1 bottle labeled toilet bowl cleaner. Label revealed Keep out of reach of children. Residents Affected - Few During an observation on 08/15/22 at 3:35 PM for approximately 18 minutes, the janitorial and housekeeping closet was located more than 30 feet from resident rooms. One resident (Resident #16) was sitting in a wheelchair at nurse's station, approximately 32 feet from the unlocked closet. Resident #16 was resting with her head down and eyes closed. No staff was at the nurse's station. During an interview on 08/15/22 at 3:53 PM, the Maintenance Director said the janitor closets should always be locked. He said the closet was unlocked probably because staff was in a hurry and nervous when state was in the building. The Maintenance Director said training on chemical safety was his or the Housekeeper's responsibility. He said training was done with new employees upon hire. During an interview on 08/15/22 at 4:02 PM, the Regional Nurse Consultant said it was housekeeping staff's responsibility to lock the closet. She said she suspected the housekeeper on duty did not make sure the door was locked before leaving for the day. She said the consequences of the closet being left unlocked was risk of injury to the residents. During an interview on 08/16/22 at 09:02 AM, the HS said the housekeepers were responsible for keeping storage closets locked. She said the floor tech also used the closet for storage of mopping supplies. The HS said the key to the janitorial and housekeeping closet was kept at the nurse's station in case staff needed supplies when housekeeping staff was not in the building. The HS could not provide a reason for the janitorial and housekeeping closet being left unlocked. The HS said she overheard an aide [name unknown] ask where the key was yesterday, and she thought CMA B had the key in his pocket. She said she sent out a group text asking who left the closet unlocked. She said no one knew. She did not know who the aide was that asked for the key. The HS said she was responsible for training housekeeping staff. She said the consequences of leaving the supply closet door unlocked was that the residents can go get chemicals and hurt themselves or others. During an interview on 08/16/22 at 09:06 AM, CMA B said the closet key was at nurse's station. CMA B said he did not use the closet. He said housekeeping was responsible for keeping the door locked. CMA B said consequences could be a resident could get into the chemicals, and it would be very bad. During an interview on 08/16/22 at 01:43 PM, the Administrator said the janitorial and housekeeping closet should be kept locked at all times. The Administrator was not able to provide an explanation as to why the closet was left unlocked. She said not locking the closet could lead to a lot of issues in the hands of residents. The Administrator said there were 2 MSDS binders in the facility. One in the kitchen and one at the nurse's station. She said the Maintenance Director and HS were responsible for maintaining the MSDS. During an interview on 08/16/22 at 01:48 PM, CNA A said the MSDS was kept at the nurse's station. During an interview on 08/16/22 at 01:51 PM, LVN A said the MSDS was kept with other binders at the nurse's station. Record review of facility policy titled Chemical Storage dated March 2014 revealed It is the policy 675645 Page 2 of 5 675645 08/17/2022 Mesa Springs Healthcare Center 7171 Buffalo Gap Rd Abilene, TX 79606

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few of this facility that all products containing a hazardous chemical or substance will be properly labeled for use by employees and stored properly to ensure a safe, hazard-free environment for residents. Procedure: Products containing hazardous chemicals or substances will be secured: a. for use by housekeeping staff, secured when not in use inside cart or housekeeping closet. Record review of the facility's MSDS dated 9/2012 revealed the bleach cleaner may cause irritation of the respiratory tract, headaches, dizziness, nausea, vomiting, and tiredness if inhaled. Ingestion may cause central nervous system depression, stomach irritation, nausea, vomiting, and diarrhea. The glass cleaner MSDS dated 1/14/2003 revealed the product may cause eye and skin irritation, stomach irritation if swallowed, headache or dizziness if inhaled and possibly be harmful if absorbed through the skin. The germicidal disinfectant MSDS dated 3/2/2006 revealed the product was corrosive, may cause irreversible eye damage, may be fatal if absorbed through the skin. The acid cleaner & descaler MSDS revealed the product contained phosphoric and hydrochloric acid and was corrosive to skin, eyes, and respiratory tract. The 1-gallon jug of deodorizer MSDS dated 2/7/2003 revealed do not induct vomiting if ingested. The spray bottle of deodorizer MSDS 10/1/2013 revealed the product was hazardous to the skin, eyes, gastrointestinal and respiratory tracts. Record review of the MSDS binder at the nurse's station revealed no MSDS for the aloe gel, no rinse carpet cleaner, or the toilet bowl cleaner. 675645 Page 3 of 5 675645 08/17/2022 Mesa Springs Healthcare Center 7171 Buffalo Gap Rd Abilene, TX 79606

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 observations, interviews, and record reviews, the facility failed to store all drugs and biologicals in locked compartments and/or those medications were kept in original packaging when stored in medication carts for 2 of 3 (Cart 1, 2) medication carts reviewed for medication storage. The facility failed to ensure that medications were kept in original packaging, with no unidentified loose pills in medication cart 2. The facility failed to ensure Cart 1 was not left unlocked and unsecured while unattended. These failures could place residents who received medications at risk of not receiving the intended therapeutic effect of the medications and drug diversion. The findings included: During an observation on 08/16/2022 at 01:52 PM, medication cart 1 was unlocked and unattended at nurses station near Hall 200 with no residents on the hallway. Contents of the medication cart included Narcotics: Tylenol #3, Tramadol, DipHE, atropine, Pregabalin, Hydromorphone, Phentermine. Drawer 1 of unlocked medication cart contained Insulin, lancets, and glucometer and over the counter medications. Drawer 2 of unlocked medication cart contained narcotics lock box and 10 residents' medications. Drawer 3 of the unlocked medication cart contained wound care dressings and 10 residents' medications. Drawer 4 of unlocked medication cart contained breathing treatments medications, eye, and nose medications and 2 residents' medications. During an interview on 08/16/2022 at 01:52 PM, CMA-A said that it was her responsibility to ensure the medication cart was locked until she completed the narcotic count with oncoming LVN and gave her the keys to the medication cart. She said there were approximately 27 residents' medications in this medication cart. She said the medication cart should always be locked. She said the potential harm would be resident safety. She said that she did not know why she left the medication cart unlocked. During an observation on 08/17/2022 at 10:10 AM of medication cart 2 for Hall 200, there were 5 whole loose pills and 2 tabs that were halved in drawer 2. One round white pill with score marks and 477 on one side found loose in medication cart. One oblong shaped blue pill marking 002 found loose in medication cart. One oblong shaped white pill with markings ZF on one side and 41 on the other side found loose in medication cart. One round blue pill with markings F5 found loose in medication cart. One round yellow pill scored with markings L 20 on one side found loose in medication cart. 1/2 of white pill found loose in medication cart. 1/2 of a yellow pill found loose in medication cart. During an interview on 08/17/2022 at 01:52 PM, MA B said he did not know what the loose pills were or who they belonged to. He said the loose pills should not have been in the bottom of the medication drawer. He said the medication carts were cleaned at least once a week but no one person was responsible for cleaning the medication carts. He said that he did not know why the pills were not in their package. During an interview on 08/17/2022 at 10:30 AM, the IDON said that medication carts were cleaned at least once a week by the person assigned that medication cart. She said there should not have been 675645 Page 4 of 5 675645 08/17/2022 Mesa Springs Healthcare Center 7171 Buffalo Gap Rd Abilene, TX 79606

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some any loose pills and if there were they should have been discarded immediately into the sharp's container. She said her expectations were that the medication carts would be clean, and no loose pills would be in the medication carts. She said she did not know how or why that happened. She said all medication carts should have been locked when not in use. She said the LVN, or CMA assigned that cart were responsible for ensuring the medication cart was locked when not in use. She said that she did not know how or why that happened. She said her expectations were that the medication carts would be kept locked when not in use. She said that this could place residents in harm if a medication that had not been prescribed for the resident was taken by that resident. Review of Facility Policy titled: Medication Access and Storage (Revised 05/2007) revealed: Policy: It is the policy of this facility to store all drugs and biological in locked compartments under proper temperature controls. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. PROCEDURES: 1. The provider pharmacy dispenses medications in containers that meet legal requirements, including requirements of good manufacturing practices where applicable. Medications are kept and stored in these containers. Transfer of medications from on container to another is done only by a pharmacist. 12. Outdated, contaminated, or deteriorated medications and those in containers that are cracked, soiled, or without secure closures are immediately removed from stock, disposed of according to procedures for medication destruction and reordered from the pharmacy, if current order exists. 13. Medication storage areas are kept clean, well-lit and free of clutter. 675645 Page 5 of 5