Health inspection·January 27, 2024

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 drugs and biologicals used in the facility were stored and labeled in accordance with currently accepted professional principles, for 2 of 6 (Hall 600 & Hall 700) Medication Carts. 1.) The facility failed to ensure medication cart #1 was locked when unattended by nurse. 2.) The facility failed to ensure that all medications stored in Hall 600 & 700 medication carts were properly stored/labeled. These failures placed all residents at risk of harm or decline in health due to lack of potency of medications/biologicals or misappropriation of medications. The findings included: During an observation and interview on 01/26/2024 at 11:27 a.m., of 700 hall medication cart, revealed RN A stored 10 loose pills in the top drawer under one lock in a clear medication cup with no label. RN A stated she had attempted to administer the medications earlier and the resident would not take them so she stored it in the top of medication cart to attempt to give again. She stated she knew what the resident's medications were for due to it was the only medication cup with medications in the top of her cart. She stated medications were for Resident #2 which included 5 supplements, 1 thyroid medication, 1 blood thinner, 1 proton pump inhibitor, 1 constipation medication, 1 diuretic, and 1 blood pressure medication. RN 1 did not state any negative outcome when asked if there could be a negative outcome from storing medication outside of their original medication packages. During an observation and interview on 01/26/2024 at 12:04 p.m. of the 600 hall medication cart, revealed RN B stored loose medications in 3 medication cups in the top drawer under one lock 1 medication cup had Resident #3's last name written on it and one capsule in a medication cup. 2 medication cups had Resident #4's last name written on them with 7 pills in them. RN B stated the medications were for Resident #3 and Resident #4 which included: 1 antibiotic, 1 heart arrythmia medication, 4 supplements, 1 steroid, and 1 blood thinner. RN B stated she attempted to give medications earlier and both residents would not take. She stated she had stored them in the top drawer to attempt to administer the medications later and then would dispose of them if residents continued to refuse. RN B stated she did not know if the facility had a policy on medication storage regarding loose medication in cups. During an interview on 01/26/2024 at 12:08 p.m., the DON stated she was not aware if the facility Page 1 of 3 676376 676376 01/27/2024 Silver Spring 1690 N. Treadway Blvd. Abilene, TX 79601

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some had policy on medication storage. She stated she felt it was better to store medications loose in medication cups than to dispose of the medications right away when resident refused to take and not attempt to give the medications again. During an observation on 01/27/2024 at 8:12 p.m., revealed the medication cart #1 was unlocked and unsupervised on the 700 hall. Residents were observed near the medication cart and no staff were visible. On top of the medication cart there were 7 medication cups labeled with resident last name on some and room number on others for Residents #2, #5, #6, #7, #8, #9, and #10 stacked on top of each other with medications pre-popped inside of the cups. There were 2 additional medication cups that had a crushed medication inside of them. 1 medication cup has 4 pills, 2 medication cups had 5 pills, 1 medication cup had 6 pills, and 1 medication cup had 11 pills. The loose medications included: Crestor a cholesterol lowering medication; Melatonin a supplement to help induce sleep; Mirtazapine an anti-depressant; Eliquis a blood thinner (medication that interferes with blood clotting); Metoclopramide a medication that increases the speed the stomach empties into the intestines. Lyrica a medication used to treat nerve pain; Calcium / Magnesium / Zinc supplement; Atorvastatin a cholesterol lowering medication; Trazodone an antidepressant that can help with sleeplessness; Baclofen a medication that helps reduce muscle spasms; Carvedilol a medication that is used to help heart and circulation of blood; Famotidine a medication that decreases the amount of acid in the stomach; Keflex an antibiotic for infection; Seroquel an anti-psychotic medication used to treat psychosis; Senna-S a medication used to treat constipation; Buspirone an anti-anxiety medication; Sertraline an anti-depressant; Metoprolol a medication used to treat high blood pressure or elevated heart rate; Potassium chloride a supplement; 676376 Page 2 of 3 676376 01/27/2024 Silver Spring 1690 N. Treadway Blvd. Abilene, TX 79601

F 0761 Ticagrelor a medication that lowers risk for heart attack and helps lower risk of blood clots; Level of Harm - Minimal harm or potential for actual harm Carisoprodol a medication to help relax muscles and reduce nerve pain; Amitriptyline a medication that helps lower depression; Residents Affected - Some Metformin a medication used to help lower blood sugars in Type 2 diabetics; Gabapentin a medication used to help reduce nerve pain; Omeprazole a medication used to lower stomach acid; Donepezil a medication used to treat dementia. The medication names were gathered from the MARs of each of these residents. During an interview on 01/27/2024 at 8:17 p.m., RN C stated the medication cart was her cart and that she had not left the cart unattended for very long. RN C stated that she had pre-popped medications for resident #5, #6, #7, #8, #9, and #10 that were to be administered at nighttime. RN C stated the medication cart should have been locked and that medications should not have been on top of the cart. RN C stated it was not appropriate to pre-pop the medications, but she lived in the real world and that was the only way she would have time to administer all her medications to residents. During an interview on 01/27/2024 at 8:35 p.m., the DON stated she and the ADONs were responsible for monitoring medication storage and administration by performing rounds. She stated an in-service was performed with staff that handle medications earlier today. The DON stated pre-popping medications increases the chance of medication errors. The DON was unsure of why medications were pre-popped but felt the nurse pre-popped to make her medication pass faster. During an interview on 01/27/2024 at 8:45 PM RN C stated she had signed an in-service when she started her shift informing her about not pre-popping medications. Review of an in-Service document provided by the facility to CMAs and nurses on 01/27/2024 titled Medication Administration revealed RN C had signed the in-service document prior to observation. The in-service document revealed: It is not best practice to leave medications in the cart for any reason. If the resident won't take their medications, and you have already popped them out of the card, then you will need to waste the pills that were popped with another nurse. Record review of the facility policy titled Storage of Medications revised date of April 2007 revealed: The facility shall store all drugs and biologicals in a safe, secure, and orderly manner .Drugs and biologicals shall be stored in the packaging, containers or other dispensing systems in which they are received. Only the issuing pharmacy is authorized to transfer medications between containers .The nursing staff shall be responsible for maintaining medication storage AND preparation areas in a clean, safe, and sanitary manner .Compartments (including, but not limited to, drawers, cabinets, rooms, refrigerators, carts, and boxes.) containing drugs and biologicals shall be locked when not in use, and trays or carts used to transport such items shall not be left unattended if open or otherwise potentially available to others. 676376 Page 3 of 3