Failure to Secure and Properly Label Medications
Penalty
Summary
Surveyors identified that medications were left unattended at a resident's bedside, contrary to facility policy and professional standards. Specifically, a cognitively intact resident with multiple chronic conditions, including rheumatoid arthritis, osteoporosis, and cardiomegaly, was observed with a cup containing seven pills, identified as vitamins, on her over-bed table without nursing staff present. The resident stated she was in the process of taking the medications after breakfast when the surveyor entered. There was no documentation of a self-administration assessment for this resident, and the facility's policy requires residents to be observed after medication administration to ensure ingestion. Additionally, during a review of medication storage, surveyors found a Lantus Solostar insulin pen and a bottle of lubricating eye drops on a medication cart that were not labeled or dated as required. The LPN confirmed the lack of labeling and dating, and the DON later discarded the insulin pen, unable to determine its intended resident. Facility policy mandates that certain medications, once opened, must be dated to ensure potency and safety, but this was not followed in the observed instances.