F 0759
Ensure medication error rates are not 5 percent or greater.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to ensure the medication error rate was not 5
percent or greater. The facility had a medication error rate of 6% based on 2 errors for 31 opportunities. The
errors effected 1 resident (Resident #8) of 4 residents reviewed for medication administration.
Residents Affected - Few
-Two medications (Lactobacillus and D-Mannose Oral Capsule 500 mg) for Resident #8 were not
dispensed or administered.
The failure placed resident at risk for inadequate therapeutic outcomes and a decline in health.
Findings included:
Record review of Resident #8's admission Record dated 04/15/25 revealed she was [AGE] years old and
was admitted to the facility on [DATE]. Diagnoses included, but were not limited to, mood disorder,
hypertension (high blood pressure), presence of cardiac pacemaker, congestive heart failure (CHF) and
history of urinary tract infection (UTI).
Observation and interview on 04/14/25 at 8:00 a.m. revealed MA A at that medication cart outside of
Resident #8's room. MA A looked at the April MAR and retrieved the following medications from the
medication cart and dispensed them into a plastic medication cup:
1 tablet of Cranberry (supplement)
1 capsule of Depakote 125 mg (to treat mood disorder)
1 tablet of Folic Acid 1 mg (vitamin)
1 tablet of Lasix 20 mg (to treat CHF)
1 tablet of Nitrofurantoin100 mg (antibiotic to treat UTI)
2 tablets of Acetaminophen 500 mg (to treat pain)
1 tablet of Venlafaxine HCl 100 (to treat depression)
Continued observation revealed MA A closed the medication cart and lock it. The Surveyor asked MA A to
count the number of tablets/capsules in the medication cup. MA A counted, then answered Eight. MA A
entered the room and obtained Resident #6's blood pressure. The blood pressure cuff display
(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 2
Event ID:
676040
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
676040
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/16/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Paradigm at the Prairies
106 Del Norte Dr
El Campo, TX 77437
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 0759
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
revealed Resident #8's blood pressure was 113/68 mmHg and her heart rate was 70 bpm. MA A dispensed
one tablet of Metoprolol 50 mg (for blood pressure) into the cup, making the total 9. MA A administered the
9 tablets/capsules to Resident #8.
Record review of the Physician Order dated 02/15/24 for Resident #8 read, in part, .Lactobacillus oral
tablet. Give 1 tablet by mouth one time a day related to Urinary Tract Infection site not specified (N39.0)
while on antibiotics.
Record review of the April 2025 MAR for Resident #8 revealed the Lactobacillus was listed on the MAR as
current. The Lactobacillus had not been administered on 04/14/25.
Record review of the Physician Order dated 02/03/24 for Resident #8 read, in part, .D-Mannose Oral
Capsule 500 mg (D-Mannose) Give 2 capsule by mouth one time a day related to other Urogenital
Candidiasis [fungal infection].
Record review of the April 2025 MAR for Resident #8 revealed the D-Mannose was listed on the MAR as
current. The D-Mannose had not been administered on 04/14/25.
Observation and interview on 04/15/25 12:40 p.m., revealed MA A searched Resident #8's April 2025 MAR.
She verbalized the Lactobacillus and the D-Mannose were active orders. She said they were in the
refrigerator and had not been administered to Resident #6 on 04/14/25. She said, I did not take it out [of the
refrigerator].
In an interview on 04/16/25 at 1:40 p.m., the DON said the process for administering medications was to
identify the resident, then make sure which medications were to be administered by looking at the MAR.
Next would be to compare it with the medication card, then dispense the right quantity. She said the nurse
or MA should key the entry as they read it and dispensed it into the cup. She said after they keyed it, the
screen would turn a different color. She stated they should key each one as they go singularly. The DON
said Had she [the MA] gone in order and checked it as she went thru them,. she would have seen she
missed the two meds. She said the negative outcomes could be missing medications could cause health
issues. She said A lot could happen.
Record review of the facility policy Medication Administration and Management (revised June 2019) read, in
part, .Step III: Administering the Medication Pass
3. The authorized licensed or certified/permitted medication aide or by state regulatory guidelines staff
member follows the MAR prepared for the patient/resident by identifying the: A. The Right Patient/Resident
B. The Right Drug. C. The Right Dose. D. The Right Time. E The Right Route. F. The Right Charting. G. The
Right Results. H. The Right Reason.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676040
If continuation sheet
Page 2 of 2
