Health inspection·January 27, 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, interview and record review, the facility failed to ensure that drugs and biologicals used in the facility were secured properly for one (Hall 200 nurse medication cart) of four nurse medication carts for drug storage, as evidenced by: -Nurse medication cart on Hall 200 had medication on top of cart and was unattended This deficient practice could place 27 residents who reside on Hall 200 at risk for harm and place the facility at risk for possible drug diversion. The findings include: Based on observation, interview and record review, the facility failed to ensure that drugs and biologicals used in the facility were secured properly for one of four nurse medication carts (Hall 200 nurse medication cart) reviewed for drug storage, as evidenced by: -Nurse medication cart on Hall 200 had medication on top of cart and was unattended This deficient practice could place residents who reside on Hall 200 at risk for harm and place the facility at risk for a possible drug diversion. The findings include: Observed on 1/27/2023 at 9:07 am on top of medication cart in 200 Hall a bag of liquid medicine labeled Piperacillin Sodium-Tazobactam Sodium (PIP/Tazo) 3.375/NS in 100 ml Normal Saline (NS)(solution to supply water and salt (sodium chloride) to the body) unattended until 9:11 am (PIP/Tazo is a medication given for infection (An infection is the invasion of tissues by pathogens (is any organism or agent that can produce disease), their growth, and the reaction of host tissues to the infectious agent and the toxins they produce)). LVN A approached the medication cart. Interviewed LVN A on 1/27/2023 at 9:11 am she stated she is not supposed to leave medication on top of the cart unattended, as it can be dangerous to other residents and compromise patient privacy. She stated she went to retrieve intravenous (IV), (medicine that goes into the veins) flushes (syringes filled with normal saline (solution to supply water and salt (sodium chloride) to the body) for the intravenous (IV) medication to be administered into the residents' vein. Interviewed the IP on 1/27/2023 at 11:17 am he said medications should be locked in medication Page 1 of 3 675894 675894 01/27/2023 Park Manor of Conroe 1600 Grand Lake Dr Conroe, TX 77301

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few cart, not on top of medication cart unattended, because the medication could be picked up, taken by another resident, resident could have adverse signs and symptom (get sick) if take wrong medication. He reported the medication left unattended , is against the facility policy and procedure and also is against the nursing standard of care. Interviewed the DON on 1/27/2023 at 11:22 am regarding medication and orientation process. She reported all medications should be locked in the medication cart, not on top of medication cart unattended, because the medication could be picked up, taken by another resident, a resident could have adverse signs and symptom (get sick) if take wrong medication. She reported leaving medication unattended is against the facility policy and procedure and also is against the nursing standard of care. Record review of the facility policy titled Storage of Medications (Revised April 2007) read in part: Policy Statement The facility shall store all drugs and biologicals in a safe, secure, and orderly manner. Policy Interpretation and Implementation 7. Compartments (including, but not limited to, drawers, cabinets, rooms, refrigerators, carts and boxes.) containing drugs and biologicals shall be locked when not in use, and trays or cars used to transport such items shall not be left unattended if or otherwise potentially available to others. . 675894 Page 2 of 3 675894 01/27/2023 Park Manor of Conroe 1600 Grand Lake Dr Conroe, TX 77301

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for food procurement in that: -Food items not labeled and not dated. These failures could affect residents who ate food from the facility kitchen and place them at risk of food borne illness and disease. Findings include: Observation of the facility's kitchen and interview on 01/24/23 between 8:30 am and 8:40 am with the Food Service Manager revealed the following: A container of canned Pineapple dated 1/18/23 No used by date A container of grits no label no used by date A container of scrambled eggs dated 1/13/23 No used by date A Carton of Cream Cheese expiry date 1/11/23 1 Bag of Shredded Carrots expiry date 12/28/22 1 case of Corn Flakes expiry date 12/16/20 The above food should have been labeled and dated so that the staff will know when the used-by date of the food and should have been discarded after the used by date. Interview with the Food Service Manager on 01/24/23 at 9:00 AM he stated that he is responsible for training staff on labeling and storage requirements ensuring dietary requirements are met. Record review of facility's Nutrition Services Policies and Procedures dated 9/2017 read in part .Refrigerated Storage Guidelines: Leftovers must be labeled and dated with the date they are prepared and the use by date. . 675894 Page 3 of 3