Health inspection·December 8, 2022

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, interviews, and record review the facility failed to ensure in accordance with State and Federal laws, all drugs and biologicals were stored securely in locked compartments under proper temperature controls and the medications provided (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to [NAME] the needs of medications stored in 1 Medication Cart (600 hall) of 3 reviwed for medication storage. -The facility failed to ensure Nurse cart medication cart 600 hall did not store medications with punctured or torn backs. This failure could place residents at risk for loss of prescribed medications, resident's safety, and drug diversion. Findings included: Observation on 12/07/2022 at 8:36 AM, MA A removed medications from medication aide medication cart 400/500/600 halls and walked into room [ROOM NUMBER]. The medication cart was parked in the hall in front of room [ROOM NUMBER] unlocked and unattended. MA A walked into the resident room with her back to the medication cart administered medication to the resident. No visitors, staff or residents were in the hall. Observation on 12/08/2022 at 10:38 AM of nurse medication cart 600 hall revealed narcotic storage of Hydrocodone 5/325 Mg tablet #8 of 26 tablets with a small puncture on the back of the individual medication container. In an interview at the time of the observation, LVN B stated the backs of the medications were checked every shift during narcotic count. The risk of an opened back would be a pill could fall out and cause a discrepancy with the count. The person working the cart was the one responsible for checking the medication backs. In an interview on 12/08/2022 at 11:20 AM, the DON said when the back of the resident medication bubble packs had a noticeable tear it needed to be wasted by two nurses. The DON said the risk of an opening in the back of a medication packet was an infection control issue. Possible contaminated of the medications, a liquid could have gotten into the medication, the shelf life of the medication could be decreased, the pill may not be safe to administer. If the opening was big enough the pill could be removed and exchanged with something else. The nurse was responsible for making sure the integrity of the medication was in place. The medications were checked every shift during narcotic count. (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 6 Event ID: 676412 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 676412 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fall Creek Rehabilitation and Healthcare Center 14949 Mesa Dr Humble, TX 77396 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)