Health inspection·September 20, 2023

F 0760 Level of Harm - Minimal harm or potential for actual harm Resident was alert, oriented and has no signs of lethargy or distress. Manual blood pressurewas 82/58. NP notified, and orders received to send resident to the emergency room for closer evaluation. Record Review of the facility, Medication Error Forms, for Resident #1's medication error dated 9/15/23 at 12:04 pm stated: Residents Affected - Few Blood pressure medication Metoprolol administered in error by nurse. Immediate assessment completed. No signs of lethargy or distress. Manual blood pressure 82/58. NP notified and orders received to transfer resident to emergency room. Record Review of the facility incident report for Resident #1's medication error dated 9/15/23 at 12:05 pm indicated: Blood pressure medication Metoprolol administered in error by nurse. Immediate assessment completed and resident showed no signs or symptoms of distress or lethargy. Resident had a history of hypotension. Manual blood pressure 82/58. NP notified and orders received to transfer resident to hospital. Resident #1 was alert and oriented. Resident #1 stated she did not feel any different than normal. Resident was oriented to time place and person. Predisposing physiological factors- hypotensive. During an interview on 9/20/23 at 10:00 a.m., RN A stated she was the nurse that committed the medication error while caring for Resident #1. RN A stated she was completing med pass when she was distracted and overwhelmed with other residents asking for her attention and a resident wandering into the covid rooms. She stated was redirecting the wandering resident and trying to assist the other residents with their requests and was not thinking when she gave the Metoprolol to Resident #1 instead of the correct resident. She stated shortly after giving the medication to Resident #1 she realized she had given the medication to the wrong resident. During an interview on 9/20/23 at 1:00 pm, Resident #1's family member (Family Member #2) stated there was no significant problem to Resident #1 after the wrong medication was given. She stated the hospital told her Resident #1 's vital signs were normal, and she did not have any aftereffects of being given the medication. Family Member #2 stated RN A was a good nurse, and she did not give Resident #1 the medication on purpose. During an interview on 9/20/23 at 2:00 pm, the MD stated he was aware of the wrong medication being administered to Resident #1. He stated her blood pressure did go down to the 80's and she was sent to the hospital emergency room. MD stated she did not require any treatment at the emergency room because of this. The MD stated the metoprolol has a 12-hour half-life and within 6 hours we would not expect her to have any ill effects. During an interview on 9/20/23 at 2:45 pm, the DON stated she was notified immediately after the medication error and an assessment was started. The DON stated Resident #1's blood pressure was 82/58. The NP was contacted, and the resident was sent to the emergency room. The DON stated she believed this happened because the nurse was on the way to give the medication and was interrupted with a situation involving another resident needing immediate attention. The DON stated she was responsible for the actions of the nurses and has in-service and trained all the nurses in medication administration. The DON stated the consequences of this incident could be death, confusion, or an allergic reaction of a resident to the wrong medication. During an interview on 9/20/23 at 2:55 pm, the ADM stated she was notified immediately after the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675973 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 675973 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McLean Care Center 605 W Seventh St McLean, TX 79057 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few medication error and an assessment was started on Resident #1. The ADM stated she thought RN#1 was overwhelmed accidentally gave the medication to the wrong resident. The ADM stated to ensure this does not happen again, all nurses were in-serviced on medication administration and felling overwhelmed. The ADM stated the DON was also doing med pass monitoring for the next month. The ADM stated the consequences of a resident getting the wrong medication was death, or an allergic reaction to the wrong medication. Record Review of the facility policy titled, Medication Administration Procedures, dated 2003, stated: Before administering the dose, the nurse must make certain to correctly identify the resident to whom the medication is being administered. Medications prescribed for one resident are not to be administered to any other resident. Medication errors are immediately reported to the resident's physician. In addition, the DON should be notified of any medication errors. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675973 If continuation sheet Page 3 of 3