Health inspection·August 30, 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide pharmaceutical services, including procedures that assured accurate administering of all drugs to meet the needs of the residents, for seven (Residents #1, #2, #3, #4, #5, #6, and #7) of twelve residents reviewed for medication regimen. - Residents #1, #2, #3, #4, #5, #6, and #7 did not receive all their medications according to physician's orders. These failures caused residents to not receive scheduled medication according to physician orders that could cause a worsening of a resident's condition. Findings included: Resident #1 Record review of Resident #1's Face Sheet dated 8/30/23 revealed she was an [AGE] year-old female admitted to the facility on [DATE] and re-admitted on [DATE]. Her diagnoses included pneumonia, mood disorder, impacted cerumen (earwax blockage), malignant neoplasm of overlap sites of left female breast (cancer), hypertension (high blood pressure), pain, multiple sclerosis, Parkinson's disease (shaking, difficulty moving), anxiety, major depression, gastro-esophageal reflux disease without esophagitis (stomach contents move up into the esophagus), and osteoarthritis (degeneration of joint cartilage and the underlying bone). Record review of Resident #1's MDS dated [DATE] revealed cognitive pattern BIMS summary score of 6 revealed severely impaired cognition. Resident #1's medications revealed she received injectable medications, antidepressant, anticoagulant, antibiotics, and opioid medications. Record review of Resident #1's Care Plan dated 5/19/23 revealed a new diagnosis of fracture of left hip with interventions to assess for pain, swelling .Administer pain medication as needed .maintain acceptable level of pain, multiple sclerosis: potential for physical deterioration weakness and heat intolerance with interventions as administer medications as ordered .; Difficulty hearing r/t chronic bilateral impacted cerumen and hearing loss with interventions as ensure ears are free from impacted cerumen (wax); Has potential for excessive weakness and tiredness, weight loss, pain and/or depression from Cancer process. Diagnosed with breast cancer .with interventions as medication as ordered; Has potential for pain r/t of acute pain and Parkinson's disease. Receives Tylenol. Receiving tramadol/Norco for new hip fracture with intervention as administer pain medication. Page 1 of 10 675739 675739 08/30/2023 Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381

F 0755 Record review of Resident #1's Physician's orders undated revealed: Level of Harm - Minimal harm or potential for actual harm Order date 5/22/23 Behavior- Monitor and document any side effects/behaviors related to use of antiepileptic medication. Residents Affected - Some Order date 5/22/23 TID3 Carbidopa-Levo 10-100 mg ODT give 1 tablet (10- 100 mg) PO TID (for Parkinson's disease) Order date 5/22/23 9 a.m. QD Norvasc 2.5 mg tablet (Amlodipine Besylate) give 1 tablet PO daily hold for SBP<110 and DBP<60 (for blood Pressure). Order date 5/22/23 BID2 QD Depakote DR 250 mg tablet- give one by mouth twice daily (do not crush) Order date 5/22/23 BID3 QD Eliquis 2.5 mg tablet- Administer 1 tablet PO BID Order date 5/24/23 8 a.m. QD MiraLAX powder - mix 17 g in 8 oz of water Order date 5/26/23 8 hours QD Norco 5-325 tablet- give 1 tablet q 8 Order date 5/22/23 BID3 QD Namenda 10 mg tablet give 1 tablet (10 mg) BID in AM and PM Record review of Resident #1's Medication Administration Record dated August 2023 revealed: Norvasc 2.5 mg tablet give 1 tablet PO daily hold for SBP<110 and DBP<60 (for blood Pressure) at 9 a.m. was not administered on 8/29/23. MiraLAX powder - mix 17 g in 8 oz of water at 8 a.m. for constipation was not administered on 8/29/23. Norco 5-325 tablet- give 1 tablet q 8 time code 6 a.m., 2 p.m., 10 p.m. for moderate to severe pain Depakote DR 250 mg tablet- give one by mouth twice daily (do not crush) for bipolar was not administered on 8/29/23 at 8 a.m. Eliquis 2.5 mg tablet- Administer 1 tablet PO BID to prevent blood clots/anticoagulant was not administered on 8/29/23 at 9 a.m. Namenda 10 mg tablet give 1 tablet (10 mg) BID in AM and PM for depression was not administered on 8/29/23 at 9 a.m. Carbidopa-Levo 10-100 mg ODT give 1 tablet (10- 100 mg) PO TID (for Parkinson's disease) was not administered on 8/29/23 at 9 a.m. Resident #2 Record review of Resident #2's Face Sheet dated 8/30/23 revealed he was a [AGE] year-old male admitted to the facility on [DATE] and re-admitted on [DATE]. His diagnoses included pneumonia, pain, hyperkalemia (high potassium), delusional disorders, anticoagulants, edema (excess of watery fluid), 675739 Page 2 of 10 675739 08/30/2023 Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381

F 0755 Level of Harm - Minimal harm or potential for actual harm hypertension (high blood pressure), functional dyspepsia (upset stomach), contracture (fixed tightening of muscle, tendons, ligaments or skin) of left and right hand, major depressive disorder, bipolar disorder (mood disorder), anxiety, bacterial infections, cerebral palsy, acute kidney failure, acute embolism and thrombosis of unspecified iliac (blood clot that moves through your bloodstream can become stuck) and muscle weakness. Residents Affected - Some Record review of Resident #2's MDS dated [DATE] revealed cognitive pattern BIMS summary score of 3 indicating severely impaired cognition with active diagnoses included renal insufficiency. Medications included antipsychotic, antidepressant, antibiotic and diuretic. Record review of Resident #2's Care Plan dated 8/22/23 revealed Resident #2 has potential for mood swings r/t diagnosis bipolar. Can hit at staff and become aggressive at times toward staff. Can become aggressive with other residents. Sent to psych unit for medication adjustment with intervention .medication as ordered; antipsychotic drug use: At risk for side effects with interventions .administer medications as ordered; No injury related to antidepressant medication usage/side effects daily and ongoing over the next 90 days with intervention . Administer medications as ordered .; Resident #2 has been depressed off and on and started on an antidepressant Zoloft with intervention as administer medications as ordered .; Requires Mechanically altered diet d/t Oropharyngeal dysphagia s/p CVA with interventions including administer MVI as ordered Record review of Resident #2's Physician's orders undated revealed: Order date 8/22/23 12H2 QD Risperidone 1 mg tablet- give one tablet by mouth every 12 hours Order date 8/30/23 12 H2 QD Bactrim DS 800 mg-160 mg tablet give 1 tablet (s) oral 8 a.m., 8 p.m. every day Order date 8/22/23 4HR1 QD Ciprofloxacin 0.3% eye drop- Administer 1 drop every 4 hours while awake x's 5 days stop date 9/1/23 Order date 8/22/23 8 AM QD Fluoxetine 10 mg Admin 1 tablet PO daily (give with 20 mg tablet to equal 30 mg) Order date 8/29/23 8 AM QD Lasix 40 mg tablet: by mouth 8 a.m. every day. Order date 8/30/23 8 a.m. QD Spironolactone 25 mg tablet: give 1 tablet(s) by mouth 8 a.m. every day: Document resident blood pressure. Order date 8/22/23 TID2 QD Divalproex sodium DR 125 mg tablet- give one tablet by mouth three times daily with divalproex sodium DR 250 mg to equal 375 mg (do not crush) Record review of Resident #2's Medication Administration Record dated August 2023 revealed: Fluoxetine 10 mg Admin 1 tablet PO daily (give with 20 mg tablet to equal 30 mg) at 8 a.m. for major depressive disorder Lasix 40 mg (Furosemide) tablet: by mouth 8 a.m. every day. for edema Spironolactone 25 mg tablet: give 1 tablet(s) by mouth 8 a.m. every day: Document resident blood 675739 Page 3 of 10 675739 08/30/2023 Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381

F 0755 pressure (hypertension) Level of Harm - Minimal harm or potential for actual harm Risperidone 1 mg tablet- give one tablet by mouth every 12 hours at 8 a.m. and 8 p.m. for bipolar disorder Bactrim DS 800 mg-160 mg tablet give 1 tablet (s) oral 8 a.m., 8 p.m. every day for blister of left upper arm Residents Affected - Some Divalproex sodium DR 125 mg tablet- give one tablet by mouth three times daily with divalproex sodium DR 250 mg to equal 375 mg (do not crush) at 8 a.m., 12 p.m. and 4 p.m. for bipolar disorder Ciprofloxacin 0.3% eye drop- Administer 1 drop every 4 hours while awake x's 5 days stop date 9/1/23 at 1 a.m., 5 a.m., 9 a.m., 1 p.m. and 5 p.m. for acute follicular conjunctivitis Resident #3 Record review of Resident #3's Face Sheet dated 8/30/23 documented she was an [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included metabolic encephalopathy (alteration in consciousness caused by brain dysfunction), chronic obstructive pulmonary disease (inflammatory lung disease), dementia (loss of cognitive functioning), emphysema (damage of lung tissue), hypertension (high blood pressure), Atherosclerotic heart disease (thickening or hardening of the arteries), cerebral infarction (stroke), erythematous condition (abnormal redness of the skin due to accumulated blood), chronic ischemic heart disease (narrowed coronary arteries that supplies blood to the heart), anemia, gastro esophageal reflux disease (acid reflux), dehydration and anxiety disorder. Record review of Resident #3's MDS dated [DATE] revealed cognitive pattern BIMS summary score of two indicating severely impaired cognition. Medications included injectable medication, antianxiety, and antidepressants. Record review of Resident #3's Care Plan dated 6/30/23 revealed Resident #3 had antidepressant medication use: At risk for side effects of Lexapro and Mirtazapine with interventions as administer medications as ordered; Antianxiety medication use: At risk for side effects of Buspirone with interventions as .administer medications as ordered Record review of Resident #3's Physician's orders undated revealed: Order date 6/22/23 12H2 QD Divalproex Sodium DR 125 mg tablet- give 1 tablet PO BID Order date 6/22/23 8 AM QD Amlodipine Besylate 10 mg tablet- Administrate 1 tablet PO QD (Hold if SBP<110 or pulse<60) Order date 6/22/23 12H2 QD Famotidine 20 mg tablet- Administer 1 tablet PO BID Order date 8/15/23 8 AM QD Lexapro 10 mg tablet- give 1 tablet PO QD Order date 6/22/23 BID2 QD Carvedilol 3.125 mg tablet- Administer 1 tablet PO BID (hold for SBP<110, Pulse <60) Order date 6/22/23 TID2 QD Buspirone HCl 10 mg tablet- Administer 1 tablet PO TID 675739 Page 4 of 10 675739 08/30/2023 Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381

F 0755 Order date 6/30/23 8 AM QD Prostat- give 30 ml QD x 60 days Level of Harm - Minimal harm or potential for actual harm Record review of Resident #3's Medication Administration Record dated August 2023 revealed: Residents Affected - Some Amlodipine Besylate 10 mg tablet- Administrate 1 tablet PO QD (Hold if SBP<110 or pulse<60) at 8 a.m. for hypertension (high blood pressure) was not administered on 8/29/23 and 8/30/23. Prostat- give 30 ml QD x 60 days at 8 AM for encephalopathy was not administered on 8/29/23 and 8/30/23. Lexapro 10 mg tablet- give 1 tablet PO QD at 8 AM for depression was not administered on 8/29/23 and 8/30/23. Divalproex Sodium DR 125 mg tablet- give 1 tablet PO BID at 8 AM and 8 PM for dementia was not administered on 8/29/23 and 8/30/23 at 8 AM. Famotidine 20 mg tablet- Administer 1 tablet PO BID at 8 AM and 8 PM for gastro- esophageal reflux disease was not administered on 8/29/23 and 8/30/23 at 8 AM. Carvedilol 3.125 mg tablet- Administer 1 tablet PO BID (hold for SBP<110, Pulse <60) at 8 AM and 4 PM for hypertension (high blood pressure) was not administered on 8/29/23 and 8/30/23 at 8 AM. Buspirone HCl 10 mg tablet- Administer 1 tablet PO TID at 8 AM, 12 PM and 4 PM for anxiety was not administered on 8/29/23 and 8/30/23 at 8 AM and 12 PM. Resident #4 Record review of Resident #4's Face Sheet dated 8/30/23 revealed she was a [AGE] year-old female admitted to the facility on [DATE] and re-admitted on [DATE]. Her diagnoses included seizures (a sudden, uncontrolled burst of electrical activity of the brain), erythematous condition (abnormal redness of the skin due to accumulated blood), mood disorder, aphasia (language disorder caused by damage in the brain), epilepsy (damage in the brain caused by repeated seizures), adjustment disorder with mixed disturb of emotions and conduct, cough, abnormal sputum, cognitive communication deficit, anxiety, major depressive disorder, conversion disorder with seizures or convulsions (physical and sensory problems, such as paralysis, numbness), pseudobulbar affect (sudden and uncontrollable and inappropriate laughing or crying), polyneuropathy (simultaneous malfunction of many peripheral nerves throughout the body), pain, dysphagia (swallowing difficulty), cerebral palsy (disorder that affects a person's ability to move and maintain balance and posture), hypertension (high blood pressure), neuralgia and neuritis (nerve pain usually caused by inflammation, injury or infection), contracture of left hand, dysphagia (swallowing difficulty), major depressive disorder and acute respiratory failure with hypoxia (insufficient oxygen in the tissues). Record review of Resident #4's MDS dated [DATE] revealed cognitive pattern BIMS summary score of resident was noted rated due to Resident #4 was rarely/never understood. Medications included antipsychotics were received on a routine basis. Record review of Resident #4's Care Plan dated10/13/22 revealed Resident #4 had antidepressant medication use: At risk for side effects with interventions to administer medications as ordered, antipsychotic drug use: at risk for side effects with interventions to monitor blood pressure in sitting 675739 Page 5 of 10 675739 08/30/2023 Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381

F 0755 Level of Harm - Minimal harm or potential for actual harm and then in standing position, .administer medications as ordered, antianxiety medication use: At risk for side effects with interventions as administer medications as ordered; Mood disorder and Resident #4 scream in public areas with interventions as Depakote as ordered and administer behavior medications as ordered by physician. Residents Affected - Some Record review of Resident #4's Physician's orders undated revealed: Order date 7/8/22 12H2 QD Metoprolol tartrate 50 mg tablet- Administer 1 tablet PO Q12H- hold if systolic BP less then 110 or HR less then 60. Order date 7/8/22 12H2 QD Levetiracetam 100 mg/mL solution- Administer 7.5 mL PO Q12H Order date 7/9/22 8 AM QD Cymbalta 60 mg capsule give 1 tablet QD Order date 7/8/22 8 AM QD Famotidine 20 mg tablet give 1 tablet PO daily crush meds and put in pudding or apple sauce. Order date 9/29/22 8 AM QD Lasix 20 mg tablet- Administer 1 tablet by mouth daily Order date 12/27/22 8 AM QD Zinc-220 capsule- give one capsule by mouth daily. Order date 7/14/22 8H1 QD Acetaminophen 500 mg tablet- give one tablet by mouth every eight hours (do not exceed 3 grams in 24 hours) Order date 7/8/22 BID2 QD Seroquel 50 mg tablet- give 1 tablet BID Order date 7/8/22 BID3 QD Docusate sodium 100 mg capsule- Administer one capsule PO BID Order date 7/7/23 BID5 QD Valproic Acid 250 mg/5 mL solution-Administer 5 mLs PO BID Order date 7/8/22 TID2 QD Buspirone HCL 7.5 mg tablet give 1 tablet PO three times daily Order date 7/8/22 TID2 QD Gabapentin 300 mg capsule- administer 1 capsule PO TID Record review of Resident #4's Medication Administration Record dated August 2023 revealed: Cymbalta 60 mg capsule give 1 tablet QD at 8 AM for major depressive disorder was not administered on 8/29/23 and 8/30/23. Famotidine 20 mg tablet give 1 tablet PO daily crush meds and put in pudding or apple sauce at 8 AM for gastro-esophageal reflux disease was not administered on 8/29/23 and 8/30/23. Lasix 20 mg tablet- Administer 1 tablet by mouth daily at 8 AM for hypertension (high blood pressure) was not administered on 8/29/23 and 8/30/23. Zinc-20 capsule- give one capsule by mouth daily at 8 AM for vitamin deficiency was not administered on 8/29/23 and 8/30/23. Metoprolol tartrate 50 mg tablet- Administer 1 tablet PO Q12H- hold if systolic BP less then 110 or 675739 Page 6 of 10 675739 08/30/2023 Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381

F 0755 Level of Harm - Minimal harm or potential for actual harm HR less then 60 at 8 AM and 8 PM for hypertension (high blood pressure) was not administered on 8/29/23 and 8/30/23 at 8 AM. Levetiracetam 100 mg/mL solution- Administer 7.5 mL PO Q12H at 8 AM and 8 PM for seizures was not administered on 8/29/23 and 8/30/23. Residents Affected - Some Seroquel 50 mg tablet- give 1 tablet BID at 8 AM and 4 PM for major depressive disorder was not administered on 8/29/23 and 8/30/23 at 8AM. Docusate sodium 100 mg capsule- Administer one capsule PO BID at 9 AM and 5 PM was not administered on 8/29/23 and 8/30/23 at 9 AM for constipation. Buspirone HCL 7.5 mg tablet give 1 tablet PO three times daily at 8 AM, 12 PM and 4 PM for disorder due to physiological condition was not administered on 8/29/23 and 8/30/23 at 8 AM and 12 PM. Gabapentin 300 mg capsule- administer 1 capsule PO TID at 8 AM, 12 PM and 4 PM for neuralgia and neuritis was not administered on 8/29/23 and 8/30/23 at 8 AM and 12 PM. Acetaminophen 500 mg tablet- give one tablet by mouth every eight hours (do not exceed 3 grams in 24 hours) at 5 AM, 1PM and 9 PM for pain was not administered on 8/30/23 at 5 AM and 1 PM. Valproic Acid 250 mg/5 mL solution-Administer 5 mLs PO BID at 9 AM and 9PM for seizures was not administered on 8/29/23 and 8/30/23 at 9 AM. Resident #5 Record review of Resident #5's Face Sheet dated 8/30/23 revealed she was an [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included Alzheimer's disease, nausea, pain, constipation and anxiety (feelings of tension and worry) . Record review of Resident #5's MDS revealed it had not been completed due to her admission dated 8/30/23. Record review of Resident #5's Care Plan dated 8/25/23 revealed Resident#5 had an open Lesion: Head to toe allergic drug reaction while at hospital with shedding of epidermal layer from scalp to palm of hands and soles of feet. Aquaphor applied after bath and as needed. Stage II to sacrum with border foam dressing applied. Incontinent with moisture barrier applied to perineum. Record review of Resident #5's Physician's orders revealed: 8/23/23 6 HR QD Hydromorphone 1 mg/mL oral liquid: give 1 mL- 1 mg give by mouth 12A, 6 A, 12P, 6P every day. Resident #6 Record review of Resident #6's Face Sheet dated 8/30/23 documented she was a [AGE] year-old female admitted to the facility on [DATE] and re-admitted on [DATE]. Her diagnoses included dementia, contracture, oropharyngeal dysphagia (difficulty swallowing), traumatic brain injury (violent blow or jolt to the head or body), spastic hemiplegia (muscle stiffness and contraction), polyneuropathy 675739 Page 7 of 10 675739 08/30/2023 Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some (malfunction of many peripheral nerves), contracture, bipolar disorder (mood disorder), anxiety, epilepsy (disorder of the brain characterized by repeat seizures), muscle weakness (lack of strength in the muscles), neuralgia and neuritis (nerve pain), intracranial injury w LOC of unspecified duration, mood disorder, cellulitis (bacterial skin infection), pain, candidiasis (fungal infection caused by yeast), constipation, pseudo bulbar affect (sudden uncontrollable and inappropriate laughter), anxiety disorder, hyperlipidemia (high cholesterol), hyperosmolality and hypernatremia (condition caused by decrease in total body water), seborrheic dermatitis (skin condition that affects the scalp), bipolar disorder (mood disorder), delusional disorders. Record review of Resident #6's MDS dated [DATE] revealed cognitive pattern BIMS summary score was a 3 indicating severely impaired cognition. Medications included antipsychotic, antianxiety, and hypnotic. Record review of Resident #6's Care Plan dated 10/12/22 revealed antianxiety medication use: At risk for side effects. Has history of outbursts r/t diagnosis of schizophrenia r/t brain trauma from MVA with interventions as administer medication as ordered, Behavior: verbally aggressive behavior at times and yells out for attention seeking. Take to Dr 15 minutes early and serve tray early, as to not disrupt other residents dining time when yelling. Hits self at times on chest, arms, and legs (increase risk for bruising). Observe for behaviors. Hypnotic medication use: At risk for side effects. Receives Ambien nightly with intervention as administer medications as ordered. Record review of Resident #6's Physician's Orders undated revealed: Order date 8/6/23 6HR1 QD Lactulose 10 gram/15 mL oral solution administer 30 mL PO Q 6 HRS. Order date 5/3/23 8 AM QD Aripiprazole 10 mg tablet- give one tablet by mouth daily Order date 10/18/21 8H5 QD Carbamazepine ER 100 mg tablet- give 3 tablets TID (Do not crush) Order date 7/12/23 BID2 QD Depakote DR 125 mg Sprinkle CP- Administer 1 CAP PO BID Order date 5/6/21 BID3 QD Lyrica 25mg capsule give 1 capsule by mouth twice daily for pain Order date 7/14/23 TID2 QD Ativan 0.5 mg tablet- Administer half tab to equal 0.25 mg PO TID Record review of Resident #6's Medication Administration Record dated August 2023 revealed: Aripiprazole 10 mg tablet- give one tablet by mouth daily at 8 AM for Bipolar disorder was not administered on 8/30/23 Depakote DR 125 mg Sprinkle CP- Administer 1 CAP PO BID at 8 AM for Bipolar disorder was not administered on 8/30/23 Lyrica 25mg capsule give 1 capsule by mouth twice daily for pain at 9 AM for polyneuropathy was not administered on 8/30/23 Ativan 0.5 mg tablet- Administer half tab to equal 0.25 mg PO TID at 8 AM, 12 PM, 4 PM for anxiety disorder was not administered on 8/30/23 at 8AM and 12 PM. 675739 Page 8 of 10 675739 08/30/2023 Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381

F 0755 Level of Harm - Minimal harm or potential for actual harm Lactulose 10 gram/15 mL oral solution administer 30 mL PO Q 6 HRS. at 5 AM, 11 AM, 5 PM and 11 PM for Bipolar disorder was not administered on 8/30/23 at 5 AM and 11 AM. Carbamazepine ER 100 mg tablet- give 3 tablets TID (Do not crush) at 7 AM, 3 PM and 11 PM for epilepsy was not administered at 7 AM on 8/30/23. Residents Affected - Some Resident #7 Record review of Resident #7's Face Sheet dated 8/30/23 revealed she was an [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included pulmonary fibrosis (lung disease that affects the respiratory system), dementia (memory), rheumatoid lung disease with rheumatoid arthritis (lung problems related to arthritis), long term anticoagulants (blood thinners to prevent clots), dry eye syndrome of left lacrimal gland, major depressive disorder, benign intracranial hypertension (high blood pressure), hypothyroidism (low activity of the thyroid gland), dysphagia (difficulty with speech), atrial fibrillation (abnormal heart beat), muscle wasting and atrophy, abnormalities of gait and mobility, contracture of right and left hand. Record review of Resident #7's MDS dated [DATE] revealed cognitive pattern BIMS summary score of 11 indicating moderately impaired cognition. Medications included antidepressants, and anticoagulants. Record review of Resident #7's Care Plan dated 10/12/22 revealed Resident had potential for pain r/t diagnosis of arthritis. Tylenol prn with interventions to administer pain medication; had potential for excessive weakness or tiredness r/t diagnosis hypothyroidism. Receives hypothyroidism with interventions as medication as ordered; Deep vein Thrombosis: At risk for DVT or acute embolism r/t to history of with interventions as initiate anticoagulant precautions and administer anticoagulant as ordered; Potential for bleeding and/or bruising secondary to anticoagulant therapy, antiplatelet therapy, and/or aspirin therapy. Receives Xarelto .with interventions as initiate anticoagulant precautions; Potential for shortness of breath due to diagnosis of pulmonary fibrosis with interventions as administer antibiotics as ordered Record review of Resident #7's Physician's Orders revealed: Order date 9/2/19 5 AM QD Levothyroxine 125 mcg tablet 1 tablet PO daily- (QD) Order date 4/6/23 8 AM QD Lexapro 5 mg tablet give 1 tablet PO Q HS Record review of Resident #7's Medication Administration Record dated August 2023 revealed: Lexapro 5 mg tablet give 1 tablet PO Q day at 8 AM for major depressive disorder Levothyroxine 125 mcg tablet 1 tablet PO daily- (QD) In an observation, interview and record review on 8/30/23 at 11:30 a.m. with Med Aide A of Medication Administration Record revealed she stated she was still currently passing medications for 8 AM because someone called off work and the facility called her at 8 AM. Med Aide A stated she was getting ready to give meds to Resident #2. Observation revealed Med Aide A already had Resident #2's meds in a cup and Record review of the Medication Administration Record revealed the 8 a.m. med's had not been administered yet and showed in red for being late. Med Aide A stated she was really behind on passing meds and was just now passing the 8 a.m. meds. Med Aide A stated she still had not passed 675739 Page 9 of 10 675739 08/30/2023 Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381

F 0755 Level of Harm - Minimal harm or potential for actual harm medication for Resident #1, Resident #3, Resident #5 and Resident #7. Med Aide A stated she did not get to the facility until 8:30 a.m., and she would usually be finished. She stated she finished passing medication on the 100 hall. Med Aide A stated she also needed to pass 8 a.m. meds for Resident #4 and Resident #6. Med Aide A stated the medication policy was the medication should be administered within an hour before the time on the physician order or an hour after the time for meds. Residents Affected - Some Interview on 8/30/23 at 11:46 a.m. with Med Aide A, she stated she just gave the other residents their meds so she just had to give Resident #4 and Resident #6 their medication. In an observation and interview with Med Aide A on 8/30/23 at 2:01 p.m. she stated she gave Resident #1 her 12 meds about 30 minutes ago. Med Aide A stated she was administering blood pressure medication and she stated the residents could go into withdrawals. She stated it normally did not happen with her that she was late with medication. Med Aide A stated the resident could experience withdrawals without medications on time, so when they did not get the meds or got them late they were not supposed to be late. Med Aide A stated she could not give the 12 p.m. medications on time so she gave the residents who had medication for 12 p.m. at 1 p.m. Observation revealed Med Aide A was in the breakroom clicking on the medications for each resident for the administration and Med Aide A stated the medication administration record on the computer revealed the medication was showing late as if the medication were not given. Med Aide A stated there were issues with connectivity for the internet so she could not click on the late medication. She stated she came into the supply room so she could connect to the internet and click all of them. Observation of the medication administration for each resident on the computer screen revealed residents did not receive medications on 8/29/23 and she stated yesterday's medications on 8/29/23 at 8 AM indicated they were not given for Resident #1, Resident #3 and Resident #4. Med Aide A stated the med aide for 8/29/23 was Med Aide B and she thought she did not get to finish charting. Med Aide A stated she (Med Aide A) was still in the building because she was waiting for the med aide to come today, 8/30/23, to relieve her and it was 2:12 p.m. Med Aide A stated the facility had trouble ever since they got a new computer system with being able to chart medication administration. She stated the medications from today, 8/30/23 were all done at almost 2 p.m. She stated she did not give the meds close together because the residents were taking the same meds at 12 p.m., so they were administered close to 1:30-1:40 p.m. In an interview on 8/30/23 at 2:44 p.m. with the DON she stated if there were medications administered late, the facility needed to let the provider, the family and the resident know. The DON stated the resident's doctor should be informed. The DON stated the facility needed to look to see if there were negative outcomes for medication administration. She stated late medication administration did not happen a lot, but there were times that it did happen. The DON stated there were times that the patient refused and they had to go back to administer their medication. The DON stated she confirmed with the nurse yesterday, 8/29/23 that all the meds were administered. The DON stated the staff had to do all their charting in the building. The DON stated the facility would review the residents and make sure they followed the appropriate protocol for the residents' medication administration. In an interview with the Administrator on 8/30/23 at 3 p.m. she stated she had never seen the internet that bad and today and she was getting the servers replaced. Record review of Facility's policy Adverse Consequences and Medication Errors undated revealed, .A medication error is defined as the preparation or administration of drugs or biological which is not in accordance with physician orders, manufacturer specifications, or accepted professional standards and principles of the professional (s) providing services. Examples of medications errors include: a. Omission- a drug is ordered but not administered .wrong time . 675739 Page 10 of 10