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F0658
D

Medications Left at Bedside Without Supervision

Durham, North Carolina Survey Completed on 04-10-2025

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

A nurse entered the room of a resident with multiple active diagnoses, including osteoarthritis, muscle weakness, lymphedema, major depressive disorder, hypertension, and other chronic conditions. The resident was assessed as cognitively intact. During medication administration, the nurse brought a cup containing several medications, water, and eyedrops to the resident's bedside. Instead of observing the resident take the medications as required, the nurse left the medications at the bedside and told the resident she would return later to check on her. The resident did not take the medications during this time and left them on her bedside table. Record review revealed there was no physician's order or assessment for the resident to self-administer medications. During interviews, the nurse acknowledged that the resident was not permitted to self-administer medications and stated she should have removed the medications from the room when the resident was not ready to take them. The DON confirmed that the resident was not ordered to self-administer medications and that the nurse should not have left the medications at the bedside.

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