Inspection·January 22, 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, in accordance with State and Federal laws, ensure all drugs and biologicals were stored in locked compartments under proper temperature controls, and permitted only authorized personnel to have access to the keys for 1 of 2 nurse medication carts (Hall 200 nurse medication cart) reviewed for drug storage. The facility failed to ensure the nurse medication cart on Hall 200 was locked and supervised. This failure could place residents at risk for possible misappropriation of property or drug diversion. The findings included: During observations and interview on 1/10/24 at 10:11 a.m., LVN A walked away from the Hall 200 Medication Cart and entered a resident's room approximately 50 feet away from the cart, out of the line of site of the medication cart. The medication cart was left unlocked and unsupervised and parked in the hallway between rooms [ROOM NUMBERS]. The drawers of the medication cart were not facing the wall and was accessible to anyone who walked by in the hallway. There were several grieving family members in the hallway outside of room [ROOM NUMBER] including 3 young children who appeared to be under the age of 5. At 10:16 a.m. LVN A returned to the medication cart, LVN A said the cart is unlocked, I saw you coming down the hallway and swore I locked the cart when I left it. She acknowledged the medication cart was left unlocked and it was out of her line of her sight while she was assisting another resident. She said she was the person responsible for administering medications on the 200 hall and used the cart. LVN A said the cart should not be unlocked and unattended because anyone walking by could get into the medications and risk medication theft or diversion. LVN A said she had been in-serviced to keep the medication cart always locked when not in use. LVN A said she was aware of the facility policy regarding keeping the medication cart locked at all times when not in use and that the cart was to remain in her line of sight when it is not locked, she said that the lock must have malfunctioned because she pushed the lock in when she left the cart. LVN A opened the medication cart and inside the medication cart Drawer #1 contained glucometer strips and glucometers, OTC aspirin, vitamins, minerals, and eye drops. In Drawer #2 there was a locked compartment attached to the cart with controlled substances, and multiple resident's individual medication bubble-blister packets. During an interview on 1/10/24 at 4:30 p.m., the DON said he expected the nurses to follow the facility policy and procedure when it came to the medication carts during a medication pass and drug (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: 676218 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 676218 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Jefferson Nursing and Rehabilitation Center 3840 Pointe Parkway Beaumont, TX 77706 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)