Failure to Ensure Proper Witnessing During Drug Destruction
Penalty
Summary
The facility failed to provide pharmaceutical services that ensured the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals to meet the needs of each resident during May 2025. Specifically, on May 22, 2025, the facility did not have a licensed pharmacist and two facility staff witnesses sign the drug destruction log during a drug destruction event. Record review showed that the controlled substances destruction record was initialed only by the consultant pharmacist, with no witness signatures present. The facility's policy required the consultant pharmacist to arrange for proper witnesses to be present for the destruction and to destroy the medications in accordance with federal regulations. This failure was confirmed during an interview with the DON, who acknowledged the lack of required witness signatures.