Health inspection·October 5, 2022

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that the medication error rate was not five percent or greater for when the facility had a medication error rate of 9.38% based on 3 of 32 opportunities, which involved 2 of 6 residents (Resident #7 and Resident #24) observed during medication administration. Residents Affected - Few 1) The facility failed to ensure MA A administered Resident #24's physician's orders for Pataday solution 0.2% (olopatadine HCL) and artificial tears solution 1%. 2)The facility failed to ensure MA A administered Resident #7's physician's order for Patanol solution 0.1% (olopatadine HCL). These deficient practices could place residents at risk of not receiving therapeutic dosage of medications. Findings Include: Review of Resident #24's face sheet, dated 10/05/2022, reflected a [AGE] year-old male admitted to the facility on [DATE] and readmitted on [DATE] with the following diagnoses schizoaffective disorder bipolar type (is a mental health disorder that is marked by a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania.), dry eye syndrome, and allergic rhinitis (A disorder caused by allergy-causing substance, called allergens.) Review of Resident #24's quarterly MDS assessment, dated 08/15/2022, reflected Resident #24 was assessed to have a BIMS score of 11 indicating moderate cognitive impairment. Resident #24 was assessed to not have vision impairment. Review of Resident #24's comprehensive care plan reflected a focus area, dated 06/09/2022, of Allergic Rhinitis .med use ongoing. Interventions included administer related medication as ordered . Review of Resident 24's consolidated physician orders, dated 10/05/2022, reflected orders dated 08/19/2021 for Pataday solution 0.2% (olopatadine HCL) instill one drop in both eyes two times a day for allergic rhinitis and an order dated 09/29/2022 for artificial tears solution 1% instill one drop in both eyes three times a day for dry eye syndrome. Review of Resident #24's MAR, dated October 2022, reflected both eye drops were to be given at 9:00 AM. (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: 676316 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 676316 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE High Hope Care Center of Brenham 401 East Blue Bell Road Brenham, TX 77833 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)