Health inspection·January 14, 2025

F 0761 label but the label was blank without any writing on it. Level of Harm - Minimal harm or potential for actual harm During an interview on 1/13/2025 at 10:34 AM, MA A said she had been employed at the facility since September 2024 and worked 6 am - 2 pm. She said medication bottles should have labels on them and the bottle of morphine for Resident #8 did not. She said normally the bottles of morphine were in boxes that were placed inside of a plastic bag and the bag along with the box would be labeled. She said she was not aware the bottle did not have a label. She said during the narcotic counts conducted with other staff, she would ensure the quantity of the medication was correct but never noticed that the label did not have any writing on it. She said she would let LVN B know about the medication. She said she had never given Resident #8 any of the morphine and the only time the medication was administered was during the evening shift. She said if a medication was not labeled properly, the resident could potentially be given the wrong dose or medication. Residents Affected - Few During an interview on 1/13/2025 at 10:38 AM, LVN B said she had been employed at the facility for a year and worked 6 am - 6 pm. She said she was not aware of the morphine for Resident #8 not having a label on the bottle. She said the bottle should have a label that included the prescriber, resident's name, date prescribed, date of birth , route, and directions. She said normally if morphine came from the facility pharmacy, it would be in a box. She said the bottle of morphine for Resident #8 came from the hospice pharmacy. She said the facility would place the box in a zip lock bag as a safety net. She said if the sticker fell off the bottle, staff would not have any idea of what the medication was and could potentially cause a medication error. She said she contacted hospice to notify them as the medication was dispensed through the hospice pharmacy and they would take care of it. During an interview on 1/14/2025 at 12:07 PM, the ADON said the medication aides were responsible for checking the medication carts weekly to ensure medications were properly labeled. She said she was aware of the bottle of morphine for Resident #8 that was found in the medication cart that was not labeled properly. She said Resident #8 received the morphine prn and had not received it since September 2024. She said medications should be labeled with the name of the resident, date it was filled, route to be given, and dosage to confirm how to be given. She said residents could be at risk of a medication error if medications were not labeled properly. During an interview on 1/14/2025 at 12:37 PM, the DON said the medication aides were responsible for checking the medication carts at least weekly. He said medication bottles should have labels that included identifier information for the residents that included date filled, route, dose, and time to be given. He said he was made aware of the bottle of morphine for Resident #8 that was found on yesterday 1/13/2025. He said the facility started an in-service with the nurses and medication aides for proper labeling of medications. He said residents could be at risk for medication errors if medications were not labeled properly. Record review of a facility in-service dated 1/13/2025 titled Medication Aides and Nurses indicated that if medications had missing/incomplete, improper, or incorrect labels they were to immediately contact the pharmacy for instruction. The DON conducted the training. During an interview on 1/14/2025 at 1:36 PM, the Administrator said the medication aides along with the charge nurses were responsible for checking the medication carts at least weekly. He said his expectations were to make sure staff were following the proper policy and procedures. He said if staff were not able to see a label on a prescription, then a resident could be given the wrong medicine. Record review of a facility policy titled Medical Labeling and Storage revised February 2023 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675964 If continuation sheet Page 2 of 3 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 675964 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mrc Creekside 1433 Veterans Memorial Parkway Huntsville, TX 77340 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete indicated, .Medication Labeling, 1. Labeling of medications and biologicals dispensed by the pharmacy is consistent with applicable federal and state requirements and currently accepted pharmaceutical practices. 2. The medication label includes, at a minimum: a. medication name (generic and/or brand); b. prescribed dose; c. strength; d. expiration date, when applicable; e. residents' name; f. route of administration; and g. appropriate instructions and precautions. 8. If medications containers have missing, incomplete, improper, or incorrect labels, contact the dispensing pharmacy for instruction regarding returning or destroying these items. 10. Only the dispensing pharmacy may label or alter the label on a medication container or package . Event ID: Facility ID: 675964 If continuation sheet Page 3 of 3