Health inspection·April 18, 2023

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide pharmaceutical services including procedures to ensure the accurate acquiring, receiving, dispensing, administering of all drugs and biologicals for one (West unit 2) of two treatment carts reviewed for pharmacy services. The facility failed to ensure timely identification and removal of discontinued medications from a facility active treatment cart. This failure could place residents at risk for medication diversion and or accidental medication exposure. The findings were: Review of Resident #1's face sheet dated 04/18/23 revealed an [AGE] year-old male admitted to the facility 11/25/22 with diagnoses intrinsic eczema (an overactive immune system that causes the skin to become dry, inflamed and damaged), congestive heart failure, and diabetes. Review of Resident #1's face sheet revealed he discharged from the facility 12/21/22 to his home. Review of Resident #1's physician orders revealed the medication Silver Sulfadiazine Cream 1% prescribed related to his intrinsic eczema. Review of Resident #1's physician orders revealed the Silver Sulfadiazine Cream 1% was discontinued 12/21/22 noted Resident #1 was discharged . Review of Resident #2's face sheet dated 04/18/23 revealed a [AGE] year-old male admitted to the facility 12/12/22 with diagnoses diabetes, heart disease, and acquired absence of right toes. Resident #2 discharged from the facility 12/27/22 to the hospital. Review of Resident #2's physician orders revealed the medication Metronidazole 1% was ordered for wound treatment. Review of Resident #2's physician orders revealed the medication Metronidazole 1% was discontinued 12/27/22 noted resident discharged to the hospital. An observation on 04/18/23 at 9:02 AM of the [NAME] unit 2 hallway treatment cart revealed an unattended by staff treatment cart unlocked. The treatment cart and all 4 drawers were capable of being opened. Contained within the top drawer of the treatment cart were medicated ointments for Resident #1 two tubes of Silver Sulfadiazine 1% (an antibiotic medication used to treat wound infection) and Resident #2 one tube of Metronidazole 1% (a medicated gel used to treat inflammatory pimples or red bumps). Page 1 of 4 676395 676395 04/18/2023 The Healthcare Resort of Plano 3325 West Plano Parkway Plano, TX 75075

F 0755 Level of Harm - Minimal harm or potential for actual harm An interview on 04/18/23 at 11:56 AM with the DON revealed LVN B was responsible for auditing the treatment carts weekly for discontinued resident medications, which are promptly removed from active treatment carts upon a resident's discharge from the facility. The DON stated it was important to remove discharged resident medications to prevent inadvertent medication administration to a resident and potential medication errors. Residents Affected - Few In a telephone interview on 04/18/23 at 12:32 PM with LVN B revealed she had been the treatment nurse for two months. LVN B stated the [NAME] unit 2 treatment cart was kept stocked for treatments for each nurse in the facility to have access to and provide treatments when she was not in the facility. LVN B stated she was responsible for auditing the [NAME] unit 2 treatment cart weekly for medications that should be removed. LVN B stated the last time she audited the [NAME] unit 2 treatment cart was two weeks ago from 04/18/23. LVN B stated the medications for discharged residents if not being sent with the resident upon discharge should be removed from the active treatment cart. LVN B stated the risk of discontinued discharged resident medications being stored on an active treatment cart was the medication could be used on another resident leading to a medication error. LVN B stated the last time she audited the [NAME] unit 2 treatment cart two weeks ago she had not noticed Resident #1 or Resident #2's medicated ointments in the cart. Review of facility policy revised 11/13/18, titled; Disposal of Medications, Syringes, and Needles revealed, .3. Discontinued Medications. Policy: When medications are discontinued by physician order, a resident is transferred or discharged and does not take medications with him/her, or in the event of resident's death, the medications are marked as discontinued and destroyed. Procedures: a. Medications awaiting disposal are stored in a locked secure area designated for that purpose until destroyed. Medications are removed from the medication cart upon receipt of an order to discontinue (to avoid inadvertent administration). 676395 Page 2 of 4 676395 04/18/2023 The Healthcare Resort of Plano 3325 West Plano Parkway Plano, TX 75075

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 store all drugs and biologicals in locked compartments under proper temperature controls and permit only authorized personnel to have access to the keys for one (West unit 2) of two facility treatment carts reviewed. The facility failed to ensure the [NAME] unit 2 treatment cart was locked when unattended. This failure could place residents at risk of having access to unauthorized medications and/or lead to possible harm or drug diversions. Findings included: An observation on 04/18/23 at 9:02 AM of the west unit 2 hallway treatment cart revealed an unattended by staff treatment cart unlocked. The treatment cart and all 4 drawers were capable of being opened. Contained within the top drawer of the treatment cart were medicated ointments for Resident #1 two tubes of Silver Sulfadiazine 1% (an antibiotic medication used to treat wound infection) and Resident #2 one tube of Metronidazole 1% (a medicated gel used to treat inflammatory pimples or red bumps). Observed in the remaining three drawers were various wound care supplies to include wound dressings, normal saline, and absorbent wound dressings/coverings. In an interview on 04/18/23 at 9:15 AM with LVN A revealed she was the unit charge nurse for the west unit 2 hallway. LVN A stated she observed the west unit 2 treatment cart unsecured with all four of its drawers opened. LVN A stated she observed medicated ointments in the treatment cart for Resident #1 and Resident #2. LVN A stated the treatment cart should be always locked because residents and or family members passing by could have access to its contents. LVN A stated the risk of an unsecured treatment cart would be residents and or family members could gain access to its contents and take items to use on a resident. LVN A stated as a charge nurse on the west unit 2 hallway she was responsible to supervise the treatment carts on the unit to ensure each was locked. LVN A stated she had not noticed the treatment cart unlocked. An interview on 04/18/23 at 11:56 AM with the DON revealed LVN A the unit charge nurse was responsible to ensure treatment carts were locked. The DON stated treatment carts should be locked to prevent anyone passing the cart from having access to the medications and prevent potential medication errors from occurring. In a telephone interview on 04/18/23 at 12:32 PM with LVN B revealed she had been the treatment nurse for 2 months. She stated treatment carts in the facility should be locked when not in use to prevent resident access to its contents. LVN B stated the west unit 2 treatment cart is kept stocked for treatments for each nurse in the facility to have access to provide treatments when she was not in the facility. Review of facility policy revised November 2022, titled; Policy/Procedure-Nursing Clinical revealed, Policy: It is the policy of this facility to store all drugs and biological in locked compartments under proper temperature controls. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications .2. Only licensed nurses, the consultant pharmacist and those lawfully authorized to administer medications 676395 Page 3 of 4 676395 04/18/2023 The Healthcare Resort of Plano 3325 West Plano Parkway Plano, TX 75075

F 0761 (e.g., medication aides) are allowed access to medications. Medication rooms, carts, and medication supplies are locked or attended by persons with authorized access. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 676395 Page 4 of 4