Health inspection·April 18, 2024

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of 1 of 30 residents reviewed for pharmaceutical services The facility failed to administer Resident (#2) scheduled medication (Prednisone 40 mg ) with the correct dosage according to physician orders. This failure could affect the resident by not receiving a therapeutic dose and could prevent the resident from receiving the highest possible benefit from their medication. Findings included: Record review of [AGE] year-old male resident with history of hemiplegia (paralysis that affects only one side of your body) of right side, altered mental status (comprises a group of clinical symptoms rather than a specific diagnosis, and includes cognitive disorders, attention disorders, arousal disorders, and decreased level of consciousness), and traumatic brain injury (an injury that affects how the brain works) with recent diagnosis of Pneumonia (an infection that inflames the air sacs in one or both lungs) on 04/13/24. His most recent MDS 03/01/24 revealed BIMS summary score of a 0 (severe impairment), and he was non-interviewable. Record review of Physician Orders on 04/17/24, revealed: Prednisone give 20 milligrams (2 tabs =40mg) by mouth one time a day for Pneumonia for 5 Days. The eMAR read to administer Prednisone 40mg by mouth one time a day for 5 Days. Give 2 tabs (40mg) tab. After the state surveyor interview with the MA, the order was changed to Prednisone oral tab 20mg: Give 1 tablet by mouth two times a day related to Pneumonia. Observation and interview on 04/17/24 at 2:37 p.m. with MA A revealed only (1) Prednisone 20 mg tablet missing from the blister pack while doing medication cart check. The instructions on blister pack read to administer Prednisone (2) 20 mg tablets by mouth one time a day. MA A said, she should have administered both prednisone 20 mg tablets to equal a total of Prednisone 40 mg, instead of just (1) 20 mg tab. She said, the risk of not getting his full dosage is that it was not meeting the requirements that was ordered by the physician. In an interview on 04/18/24 at 10:50 a.m., the DON said, MA A didn't fully read the entire order and only administered (1) Prednisone 20mg tab. She said, we spoke with the physician yesterday, and the order was changed to Prednisone 20 mg BID. The risk of not receiving their full medication dosage (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: 675899 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 675899 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matagorda Nursing & Rehabilitation Center 4521 Ave F Bay City, TX 77414 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)