Health inspection·November 10, 2023

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on interview and record review, the facility failed to establish a system of records of receipt and disposition of all controlled drugs in sufficient detail to enable an accurate reconciliation, and maintain an account of all controlled drugs for 1 of 24 controlled medications reviewed for security. The facility failed to ensure hydrocodone-acetaminophen 10-325mg, a prescribed narcotic medication, was secured. This failure could place residents at risk of not receiving prescribed narcotic medications and pain. Findings were: Record Review of the Provider Investigation Form 3613-A dated 10/13/2023 revealed on 10/06/2023 at 8:30 p.m., there were 180 tablets of hydrocodone-acetaminophen 10-325mg missing from the medication cart. Further review of Form 3613-A revealed the facility reviewed all medication counts for the resident since admission, and all medication carts were assessed to ensure medications were not placed in a different cart. The resident was discharged on the same day as the discovery of the missing medication and the resident was contacted to see if the resident was discharged with the medication and advertently and the police were notified. Further review of form 3613-A revealed the facility discovered the correct count of medication on 10/04/2023 at 6:00 PM and again it changed shift on 10/05/2023 at 6:00 a.m. Review of the facility's pharmacy's shipping manifest revealed the facility received 180 tablets of hydrocodone-acetaminophen 10-325 mg on 09/28/2023. There was no evidence of signature of facility recipient. During an interview on 11/8/2023 at 11:23 a.m., the DON stated the resident had not received a dosage of hydrocodone-acetaminophen 10-325 mg since it was ordered on 09/24/2023. The DON said the physician discontinued the medication on 10/6/2023 after the medication was found to be missing from the medication cart. The DON stated the facility was unsure what exact day and time the medication went missing, but it was noticed to be missing on 10/6/2023. The DON said that during the facility investigation, the medication inventory log sheet used to track the medication count was also found to be missing on 10/06/2023. During a follow up interview on 11/9/2023 at 10:45 a.m., the DON stated her expectation was for the nurses to follow facility policy and procedure on security of controlled narcotic medication. The (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: 675746 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 675746 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Coronado 1751 N 15th St Abilene, TX 79603 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)