Health inspection·July 13, 2023

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. Based on observation and interview the facility failed to ensure drugs and biological's used in the facility were labeled in accordance with currently accepted professional principles, and included the appropriate accessory and cautionary instructions, and the expiration date when applicable and the facility failed to ensure, in accordance with State and Federal laws, all drugs were stored in locked compartments under proper temperature controls, and permitted only authorized personnel to have access to the keys for 1 of 4 medication carts (#1 ) reviewed for medication storage. 1. The facility failed to ensure the medication cart #1 was secured and unable to be accessed by unauthorized personnel and residents. These failures could place residents at risk for not receiving drugs and biological's as needed and a drug diversion. An observation on 07/13/23 at 10:00 a.m. a medication cart was observed on the west front side of the facility nursing station. The cart was facing the nursing station and pushed up close to the counter. The cart was unattended, accessible to resident, visitors and employees walking nearby. There were 2 residents ambulating pass the medication cart in their wheelchairs. Surveyor moved cart and observed the lock pulled out. The medication drawer was opened and contained several resident's blister medication packets. RN-G continued to review documents behind the nursing station and his head and back were turned away from the medication cart. At 10:03 a.m. Surveyor gained RN-G's attention and asked for him to approach the unattended medication cart. In an interview on 07/13/23 10:13 a.m. RN-G was observed working behind the nursing station working. The cart was unlocked and turned facing nursing station counter. He said the medication cart was working and needed repaired, and in the meantime was turning the cart toward the counter. He said he was waiting for the lock to be repaired. He turned the medication cart with the drawer and lock turned back to the counter. He said when he locks the cart it was difficult to open, He said that leaving the medication cart unlocked was not safe and could lead to resident accessing and harm. In an interview on 7/13/23 at 10:05 a.m. with the DON stated that the cart would be repaired today. She said that she would put the medication cart in the locked medication storage room. She said medication carts should be always supervised when unlocked to prevent others from accessing medication. She has notified maintenance to come and repair the lock. In an interview on 7/13/23 at 10:07 a.m. Administrator stated that it was his expectations was for the cart to be locked when unattended. He said that in the event the medication lock jams again, (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 3 Event ID: 675703 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 675703 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Timbers Rehabilitation and Healthcare Center 3315 Cross Timbers Rd Flower Mound, TX 75028 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)