Unattended and Unlocked Medication Cart Found During Survey
Penalty
Summary
A deficiency was identified when a medication cart (MC #1) on the 300-hall was found unattended and unlocked, containing both prescribed and over-the-counter medications. The medication aide (MA A) responsible for the cart was observed at the nurses station, away from the cart, which was positioned by the dining room entrance. The state surveyor was able to open the drawers and take pictures without being noticed by MA A. During interviews, MA A confirmed she had been trained on medication storage and acknowledged the policy required the cart to be locked when not in use, admitting she forgot to lock it due to being distracted. Further interviews with the Director of Nursing (DON) and the Administrator (ADM) revealed that while staff had been trained on medication storage, the DON was unfamiliar with the specific policy details, and both the DON and ADM stated that the person using the cart was responsible for ensuring it was locked. The facility's policy, last revised in 2019, specifies that only licensed nurses or certified medical aides may carry keys and that the cart must be locked at all times when not in use. The failure to secure the medication cart was attributed to staff distraction and lack of adherence to established procedures.