Health inspection·July 25, 2024

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review; the facility failed to ensure drugs were stored and labeled in accordance with currently accepted professional principles for 1 of 2 medication rooms. -The facility failed to store Hydrocodone-Acet 325mg properly by putting them with non-controlled discontinued medication in Medication room [ROOM NUMBER] and then later putting the medication in an ADON's office. This failure could result in a drug diversion placing residents at risk of not getting their medications as ordered. Findings included: In an observation on [DATE] at 5:00 AM, revealed Medication room [ROOM NUMBER] had a black plastic bin where non controlled discontinued medications were stored. The black bin had a slit and a hole on the lid and a combination lock on the bin. In an Interview on [DATE] at 5:00 AM, LVN A stated that the medications that were in the bin in the medication room were over the counter, non-controlled, discontinued medications. All controlled medications stayed in the mediation cart until the Pharmacy Nurse retrieved the medication. In an interview with on [DATE] at 5:30 AM, LVN B stated that all narcotics stayed on the locked medication cart until the pharmacy nurse retrieved the medication. LVN B stated that non-narcotic drugs that were discontinued went into the black bin in the medication room. In an interview with on [DATE] at 5:40 AM, LVN C stated that she did not see RN D, or the Hospice Nurse put the Hydrocodone in the black bin but was told that was what occurred. LVN C stated that the Pharmacy Nurse was responsible for removing any narcotics from the medication cart. In an interview with on [DATE] at 6:00 AM, ADON F stated that RN D took Hydrocodone 325 mg and disposed of it on [DATE] and put the medications in the black bin in Medication room [ROOM NUMBER]. ADON F stated that when RN D realized she made a mistake she called RN E the next morning and told her the mistake. RN E went to the bin and took the medication out of the bin and put it under ADON G's door until she could give it to the Pharmacy Nurse. The medication was in ADON G's office until the following day when ADON G took it to the Pharmacy Nurse. ADON F stated the negative outcome for medications not to be properly stored would be that a nurse could take them, and a resident could miss (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: 676157 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 676157 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ussery Roan Texas State Veterans Home 1020 Tascosa Rd Amarillo, TX 79124 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)