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F0761
D

Failure to Secure Medications in Locked Storage

San Rafael, California Survey Completed on 05-16-2025

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

The facility failed to implement safe medication storage practices for three residents. For one resident with dementia, a jar of triamcinolone acetonide cream with a pharmacy label was found on the bedside table. A CNA mistook the medication for a non-prescription ointment and returned it to the bedside. The LVN confirmed that the resident was forgetful and should not have unsupervised access to medications. The DON and Consultant Pharmacist both stated that medications should not be kept at the bedside and must be stored in locked compartments, as per facility policy. In two other cases, one resident had a large container of powdered magnesium, a bottle of sleep aid, and a bottle of PM leg cramp medication on the dresser at bedside, while another resident had a bottle of multivitamins on the bedside table. Both the DON and Consultant Pharmacist confirmed that these medications should not be accessible at bedside and should be dispensed from the pharmacy or kept in the medication cart. The facility's policy requires all medications and biologicals to be stored in locked compartments, which was not followed in these instances.

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