Health inspection·June 1, 2023

F 0755 - chlorhexidine gluconate 0.12% oral rinse (dispensed 4/13/2023), and Level of Harm - Minimal harm or potential for actual harm - diclofenac sodium 1% topical gel (dispense date unknown) Residents Affected - Few Resident #6 stated he got these medications himself from a local pharmacy store while being out after a doctor's appointment. He stated he never brought those medications to the nursing staff, nor did he know to bring it to them, he just kept it at his bedside. He stated the powder was Nystatin powder prescribed by his doctor for jock itch and was given to him by the LVN G. He stated it had been there for over a day or so and the nurse left it there for him to apply it himself. Resident #6 said it was his own fault for forgetting to apply it on himself. Observations and an interview with LVN R, on 05/31/2023 at 3:54PM, she stated she worked with Resident #6 and was not aware Resident #6 was keeping medications at his bedside. She was observed confiscating all three medications from the bedside. In an interview with the DON on 06/01/2023 at 8:33AM, she stated Resident #6 had behaviors of acquiring medications on his own in the past and has been educated on the importance of turning in all prescriptions to the nursing department, but he was very noncompliant. She stated the resident was not capable of administering medications to himself due to memory issues and uncertainty in his capability to read fine prints of doses and instructions. She stated the medications should not have been at his bedside due to the risk of not receiving treatment as prescribed. The DON also stated LVN G was not supposed to leave Nystatin powder in the possession of the Resident #6 but instead mark it as not administered because it was not administered. She said she talked with LVN G and the reason he gave for not administering it was because Resident #6 insisted in doing it himself. She stated the risk of leaving medication with a resident who was not permitted to self-administer was the medication not being administered correctly as prescribed, and the rash not being treated. In a phone interview with LVN G 06/01/2023 at 9:28AM, he stated he last worked with Resident #6 on Sunday 05/27/2023. LVN G stated he did not pass any prescribed medications that day except for Nystatin powder that described as an off-white colored powder. He said he was going to apply the powder to the resident #6's groin but the resident stated that he wanted to wait and apply it to himself after his shower so that it would not get washed away. LVN G stated typically he passed the medication to him and watched the resident apply it on himself. He stated the standard was for the nurse to apply powders themselves, but since the resident was so alert and wishes to do it himself he allowed him to do it. He stated he did niether noticed any creams or medicated mouthwash in the resident's possession nor was made aware of the resident's behavior of acquiring and keeping medications for himself. He stated the risk was that the resident might not get his medication and the diagnosis of jock itch may continue on without being effectively treated, and also there was risk of overdosing or incorrect administration of the medication. In a phone interview with LVN B on 06/01/2023 at 10:45AM, she stated Resident #6 had orders for Nystatin and Ketocanazole for jock itch. She stated she went in and out because he can be inappropriate at times. She stated his bedside was cluttered but did not notice anything out of the ordinary. She said she was not aware of medications being kept at bedside and the resident often went out a lot on appointments he set himself. She stated any resident who acquire medications outside from other pharmacies should turn those medications in to them. In an interview with the Executive Director on 06/10/2023 at 11:30AM, she stated she did not know that Resident #6 went to the pharmacy but was aware that he went out for his appointments at his (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676362 If continuation sheet Page 2 of 3 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 676362 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgecrest Rehabilitation Suites 14100 Karissa Court Houston, TX 77049 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)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few physician's office, where he was capable of receiving prescriptions directly. She stated what typicially should have occurred is that all changes be communicated to the charge nurse who then would communicate new prescriptions to the physician, who would confirm or disagree to the change. She stated LVN G should have at least stayed to watch the resident apply it on himself and the risk was exactly what happened, which was that he did not apply it, which could cause further decline of the condition being treatment. Record review of the facility's policy on medication administration, dated 05/05/2023, stated, . person authorized medical or licensed person prepares, administers and records the medication . and . A resident choosing to self-administer medications will be assessed and evaluated . to determine if its safe for him/her to self-administer medication . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676362 If continuation sheet Page 3 of 3