Health inspection·November 13, 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 all drugs and biologicals were stored in locked compartments under proper temperature controls and permitted only authorized personnel to have access to the keys (the Medication Cart) for 1 medication cart out of 3 medication cart's reviewed for medication storage. The facility failed to ensure medications were secured on medication cart # 2 The non-compliance was identified as past non-compliance. The noncompliance began on 10/3/2024 and ended on 10/5/23. The facility had corrected the non-compliance before the survey began. This deficient practice could place residents at risk of medication misuse or drug diversion. The findings were: Record review of Resident # 1 face sheet dated 11/13/24 , revealed an [AGE] year old male admitted to the facility on [DATE] with diagnosis that included: Congestive heart failure,(is a long-term condition in which your heart can't pump blood well enough to meet your body's needs) , Osteoarthritis (condition in which the cushions at the ends of the bones wears down over time and type II diabetes (condition that happens because of a problem in the way body regulates and uses sugar as fuel). Record review of Resident's # 1 Quarterly MDS assessment dated [DATE] reflected a BIMS score left blank which indicated Resident # 1 was unable to complete the interview. Record review of Resident's # 1 monthly physician orders for November 2024, revealed an order for Norco oral tablet 10-325 mg administer one tablet by mouth three times a day at 0500, 1300 and 2000. Record review of Resident # 1 pain assessment for 10/3/24, revealed he was not in any pain and was given Tylenol 325 mg two tabs at 0515 a.m. In an interview with Resident # 1 on 11/13/24 at 8:35 a.m., revealed he was not in any pain on 10/3/24 when his medication Norco 10-325 mg went missing and he was glad that the facility was able to get replacement pain medication promptly on 10/3/2024 for his 1300 dose. In an interview with RN A on November 13, 2024, at 9:10 AM, she reported that the Norco oral tablet (10-325 mg) count for Resident #1 was accurate when she started her shift on October 3, 2024, at (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: 676274 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 676274 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River Bend Healthcare 1339 Eastwood Dr Seguin, TX 78155 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)