Health inspection·June 19, 2025

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 observation, interview, 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 each resident for 1 of 3 residents (Resident #147), reviewed for pharmaceutical services. MA A failed to dispose of Resident #147's used Fentanyl Transdermal Patch, 12 micrograms/hour (applied to the skin to treat moderate to severe chronic pain around the clock. Fentanyl is extremely potent. 2 to 3 milligrams of this drug can lead to death due to decreased breathing which can quickly lead to coma and death.) per facility policy. This failure could place residents at risk for obtaining Fentanyl patches out of the trash and overdosing on them. Findings included: Record review of Resident #147's face sheet, dated 06/20/25, reflected she was a [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnoses included colon cancer and a Stage IV pressure ulcer. Record review of Resident #147's June 2025 Physician Orders reflected, 06/14/25 Fentanyl Transdermal Patch, 72 Hour use (replace patch every 72 hours), 12 micrograms/hour. Record review of Resident #147's Care Plans, dated 06/06/25, reflected: Pain Facility interventions included: Administer pain medication as ordered. An observation on 06/18/25 at 9:00 AM of Medication Pass with MA A revealed she removed Resident #147's used Fentanyl patch, dated 06/14/25, and threw it in the trash. An interview on 06/18/25 at 9:24 AM with MA A revealed she said she was supposed to throw used (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: 676135 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 676135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Presbyterian Village North Special Care Ctr 8600 Skyline Dr Dallas, TX 75243 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)