Health inspection·March 25, 2025

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure, in accordance with State and Federal laws, the facility stored all drugs and biologicals in locked compartments under proper temperature controls and permitted only authorized personnel to have access to the keys for one of one nurses' treatment cart reviewed for medication storage. The facility failed to ensure Resident #1's prescription shampoo was stored in the locked treatment nurse cart and instead was stored in the open shower room. This failure could place residents at risk of misuse of medications leading to harm . Findings include: Record review of Resident #1's face sheet, dated, 03/25/2025, reflected an [AGE] year-old male who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included need assistance for personal care (assistance with basic daily activities like bathing, dressing, eating, toileting, and grooming), chronic obstructive pulmonary disease ( a group of lung diseases that cause ongoing damage to the airways in the lungs), and pain unspecified ( an unpleasant sensory and emotional experience, the specific location not clearly identified). Record review of Resident #1's admission MDS Assessment, dated 01/15/2025, reflected the resident had a BIMS score of 12, which indicated his cognition was moderately impaired. Resident #1 required substantial/maximum assistance with showers (helper does more than half the effort). He required partial/moderate assistance (helper does less than half the effort) with personal hygiene, lower body dressing, and toileting hygiene. Resident #1 required supervision with upper body dressing. Record review of Resident #1's Comprehensive Care Plan, with a start date of 01/22/2025 and a Interventions: Assist with personal hygiene as required such as hair, shaving, oral care as needed. Bathing with one staff assistance. Avoid scrubbing and pat dry due to sensitive skin. Resident #1 had chronic obstructive pulmonary disease. Record review of Resident #1's physician order reflected ketoconazole external shampoo 2% was ordered on 01/15/2025. Medication class antifungal ( organisms that can live on or in the human body), dermatological ( these can range from common skin rashes and acne to more serious issues such as: skin cancer and eczema ( a dry skin condition characterized by itching and scaly skin). Apply to head Page 1 of 4 675897 675897 03/25/2025 Franklin Nursing Home 700 Hearne St Franklin, TX 77856

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few topically one time a day every Monday, Wednesday, and Friday for dry flaking skin. Order type: wound treatment (with med ). Route of Administration topically ( apply to the surface of the body particularly the skin). Record review on 03/25/2025 at 12:05 PM of the facility's shower schedule located at the nurse's desk reflected Resident #1 received a shower on Monday, Wednesday's and Fridays. Record review on 03/25/2025 at 2:45 PM of the facility's in-service on medication cart locks was conducted on 08/15/2025. There was not any information provided of what was reviewed during this in-service. Treatment Nurse B did attend the in-service. The Director of Nurses was the instructor of the in-service. Observation on 03/25/2025 at 8:35 AM revealed the 400-hall shower door was unlocked. There was a prescription of medicated shampoo located on a shelf in the shower room . Observation on 03/25/2025 from 8:35 AM to 3:00 PM there was not any residents wandering on the 400 hall. Interview on 03/25/2025 at 9:20 AM, CNA/Shower Aide A stated she did not lock the door when she left the shower room. She stated she was not aware there was prescription shampoo for Resident #1 in the shower room . CNA/Shower Aide A stated Resident #1 received a shower Monday, Wednesday, and Friday. She stated she was off on Monday and she was not going to give Resident #1 a shower today (03/25/2025). CNA/Shower Aide A stated the treatment nurse kept the prescription shampoo locked in the treatment nurse's cart. She stated when it was time for Resident #1's shower the shower aide would ask for the prescription shampoo from Treatment Nurse B and she would bring the prescribed shampoo to the shower room or the shower aide would go to the treatment nurse and she would give it to them at the treatment cart. She stated when the shower aide was finished with the prescribed shampoo it was expected for the shower aide to return the shampoo to the treatment nurse or the treatment nurse would come to the shower and get the prescribed shampoo. She stated CNA C gave showers in her place on 03/24/2025. CNA/Shower Aide A did not reveal how she knew CNA C gave showers on 03/24/2025 on Resident #1. She stated she was in serviced to keep the shower doors locked. CNA /Shower Aide A did not recall the date of the in-service. She stated she had not witnessed any residents on 400 hall wandering. CNA/Shower Aide A stated she worked on 400 hall several times a week. Interview via phone, attempted on 03/25/2025 at 10:30 AM with CNA C. A voice message was left for CNA C to return the phone call and a text message was also sent to CNA C asking for her to return the phone call. CNA C did not return phone call. Interview on 03/25/2025 at 9:45 AM, Treatment Nurse B stated Resident #1 was prescribed shampoo. She stated the shampoo was expected to be locked on the treatment nurse cart. She stated she delivered the prescribed shampoo to CNA C on 03/24/2025. She stated it was after 12:30 PM. Treatment Nurse B stated either the CNA/Shower Aide would return the prescription shampoo to her when they were finished or she would go to the shower room and get the prescribed shampoo and place it in the locked treatment cart. She stated she observed Resident #1 receiving a shower on 03/24/2025. She stated it was her responsibility to ensure the prescribe shampoo was returned to her and locked in the treatment nurses' cart. She stated she forgot to check on the prescribed shampoo and CNA C did not return it to her on 03/24/2025. Treatment Nurse B stated if a resident ingested the shampoo she would call the doctor and follow the doctors' orders. She stated she could not comment if there would be any adverse effect on a resident if the resident ingested the shampoo or if the shampoo was in the residents' 675897 Page 2 of 4 675897 03/25/2025 Franklin Nursing Home 700 Hearne St Franklin, TX 77856

F 0761 Level of Harm - Minimal harm or potential for actual harm eyes. She stated she did not know if she was in serviced on locking medications. Treatment Nurse B stated there was not any residents who wandered on the 400 hall ( hall where the unlocked shower was located). She stated she would answer the question if she was in-serviced on storing medications after she reviewed the in-services. Treatment Nurse B did not report prior to exit if she received in-service on medication storage and locking medications. Residents Affected - Few Interview on 03/25/2025 at 10:33 AM, the Director of Nurses stated her expectations was all prescribed medications which included prescribed shampoo was to be locked in a medication cart or treatment nurses' cart when not in use. She stated leaving prescribed shampoo in the shower room was not acceptable. She also stated the shower room was to be locked at all times. The Director of Nurses stated the protocol for the shower aides to have the prescribed shampoo was the treatment nurse would give it to the shower aide and when the shower aide was finished with the prescribed shampoo, the shower aide would return it to the treatment nurse to be locked in the treatment cart. The Director of Nurses stated they did not have a shower schedule it would be under each resident's name in the electronic medical records beside the shower log. She stated if there was any suspicion of a resident ingested the prescribed shampoo, a nurse would contact the physician and the poison control. The Director of Nurses stated there was not any residents who wandered on the 400 hall (where the shower room was not locked). She stated she was not aware of any in-services in the past year of ensuring prescribed medications required to be locked. Interview on 03/25/2025 at 11:03 AM, the Medical Director stated the prescribed shampoo (ketoconazole external shampoo 2%) for Resident #1 would not cause harm to a resident. He stated it was a fungal type of shampoo. The Medical Director stated if there was any question if resident ingested the shampoo, the poison control could be called for guidance and he would suggest observing the resident. Interview on 03/25/2025 at 11:49 AM, CNA/Shower Aide D stated the shower doors was expected to be locked at all times. She stated she worked on 03/24/2025 but not as a shower aide. CNA/Shower Aide D stated she was assigned to work on the floor instead of giving showers. She stated CNA E gave showers on the residents she gave showers to and CNA C gave showers on the residents CNA A was assigned to give showers. CNA /Shower Aide D stated she did not give Resident #1 a shower. Resident #1 was not on her shower list. She stated when anyone had prescribed shampoo the protocol was to ask Treatment Nurse B for the prescribed shampoo and when finished with the prescribed shampoo the shower aide was expected to return the prescribed shampoo to the treatment nurse to lock it in the treatment nurse cart. She stated she was in-serviced on keeping the shower door locked but did not recall the date. She stated she was not aware of any residents who wandered on 400 hall where the unlocked shower was located. Interview via phone attempt, to call CNA E on 03/25/2025 at 1:20 PM. CNA E did not return phone call after a voice and text message was left for CNA E. Record review of the facility's Storage of Medications, dated 2003, reflected medications and biologicals are stored safely, securely, and properly following manufacturers recommendations or those of the supplier. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. 1. Only licensed nurses, the consultant pharmacist, and those lawfully authorized to administer medications are allowed access to medications. Medication rooms, carts, and medication supplies are locked 675897 Page 3 of 4 675897 03/25/2025 Franklin Nursing Home 700 Hearne St Franklin, TX 77856

F 0761 and attended by persons with authorized access. Level of Harm - Minimal harm or potential for actual harm 2. Residents Affected - Few Except for those requiring refrigeration, medications intended for internal use are stored in a medication cart or other designated area. 675897 Page 4 of 4