Health inspection·May 26, 2024

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 interview, and record review, the facility failed to provide Pharmaceutical Services that accuratly ensured the facility met the needs of each Resident for 1 of 29 residents reviewed for pharmacy services. (Resident #1) 1. The facility failed to ensure LVN A followed the facility's policy to reconcile medications for Resident #1 when admitted on [DATE]. 2. The facility failed to ensure LVN B followed the facility's policy to reconcile medications for Resident #1 when discharging on 09/26/23. This failure could place residents at risk of drug diversion and misuse of medication. Findings included: Review of Resident #1's on face sheet dated 05/25/24 showed Resident #1 was an [AGE] year-old female admitted on [DATE] with diagnoses of Mycoplasma Pneumonia (Walking Pneumonia), Sepsis (Infection), Hypertension (High blood pressure), and Chronic Kidney disease, Stage 4 (Severe). Resident #1 was discharged on 09/26/23. Review of Resident #1's physician orders dated 05/25/24 showed on 09/23/23 Resident #1 was admitted for eight days of Respite Care with prescriptions for Hydrocodone-Acetaminophen oral tablet 7.5-325 MG as needed for pain, Carafate Oral Tablet 1 GM, Docusate Sodium oral tablet 100 MG, and Simvastatin oral tablet 40 MG, and Gabapentin oral tablet 600 MG. During an interview on 05/25/24 at 2:15 PM, the Family Member (FM) said 09/23/23 was not the first time Resident #1 had received respite care at the facility. The FM said when she picked up the medication, after Resident #1's discharge, LVN B did not go over the medication or have her sign anything. The FM said the other time Resident #1 stayed at the facility the discharging nurse went over each medication and had her sign for the medications. The FM said when she arrived home, she noticed there was some medications missing. The FM said she did not remember the names of the medications, but they were medications Resident #1 used every day. The FM said when she called the facility and asked about the missing medications, she was told they did not have them. FM said it was not Resident #1's pain medication. During an interview on 05/25/24 at 3:00 PM, LVN A said he was the nurse that admitted Resident #1 on 09/23/23. LVN A said Resident #1's family brought Resident #1's medication with them when Resident (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: 676187 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 676187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage House of Marshall Health & Rehabilitation 5915 Elysian Fields Road Marshall, TX 75672 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)