Health inspection·January 31, 2025

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. Based on observation, interview, and record review the facility failed to ensure that drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable for one of four medication carts reviewed for medication storage. -The 300-hall nurse medication cart contained opened out of date liquid and medication not stored in the original packaging. The facility failed to keep resident medications in their original containers/packaging located in the medication cart assigned to LVN M. There were 35 pills that were multicolored/different shapes, 5 1/2 white pills of various shapes and 6 pieces multicolored pills loose at the bottom of one of the drawers belonging to unknown residents. This failure could affect residents receiving medications placing them at risk of receiving the wrong medication and adverse side effects. Findings included: During observation and interview on 01/29/2025 at 12:55 pm, of the Nurse medication cart for the memory unit, which was assigned to LVN M, it had 35 pills that were multicolored/different shapes, 5 1/2 white pills of various shapes and 6 pieces multicolored pills at the bottom of the second drawer on the left side of the cart. A 46-ounce bottle (with approximately 10 ounces remaining) of Thick It thickened water with manufacture expiration date of 07/21/2024 with an open date of 04/04/2024 was found in the bottom drawer on left side. The Manufacturer's instruction on the bottle was to refrigerate after opening and use within 14 days. The loose pills were underneath the medication blister cards that were tightly packed together. LVN M stated she was responsible to keep the medication cart clean and ensure there were no expired medications, liquids or loose pills in the cart. LVN M stated the potential issues were adverse side effects to a resident if loose pills fell out onto the floor and a resident took it or was given an expired medication or liquid. During an interview on 01/30/2025 at 3:15 pm the DON stated the nurses, and medication aide were responsible to clean, remove expired medications/liquid, remove loose pills from the med carts each shift. The DON stated the risks to having loose pills would be not knowing exactly what the pills were for and if a resident were to take a loose pill it could cause side effects, it could cause harm. The DON stated the medication supply could run out for that resident and a refill order would have to be placed. The DON reported her expectation regarding medication carts, was they should be cleaned (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: 676252 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 676252 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Capstone Healthcare Estates at Veterans Memorial 1424 Fallbrook Drive Houston, TX 77038 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)