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F0761
D

Expired Insulin Pens Not Discarded per Policy

La Crescenta, California Survey Completed on 04-25-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

Facility staff failed to follow established policies and procedures for medication storage and disposal when two insulin pens belonging to a resident were found in a medication cart past their 28-day expiration from the opened date. Observation and interviews confirmed that both an Insulin Glargine pen and an Insulin Lispro pen, each labeled with their respective opened dates, had not been discarded as required. The Insulin Glargine pen should have been discarded before its expiration, and the Insulin Lispro pen should have been discarded both due to expiration and because the order for it had been discontinued and replaced with another medication. The resident involved had a history of diabetes mellitus and hyperlipidemia, with severely impaired cognition and no capacity to make decisions, as documented in their medical records. Facility policy, as reviewed with the DON, clearly stated that insulin pens must be discarded within 28 days of first use or removal from refrigeration. Staff interviews confirmed awareness of this policy, yet the expired insulin pens remained accessible in the medication cart, contrary to facility procedures.

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