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F0761
E

Medications Improperly Stored in Unlocked Office Accessible to Unauthorized Staff

Rochester, New York Survey Completed on 12-08-2025

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

Surveyors observed that medications, including blister packs and injectable vials prescribed for multiple residents, were left unsupervised on an office desk in an unlocked office on one of the residential units. The medications had been removed from medication carts and were intended to be returned to the pharmacy, but instead were stored in the office for approximately a week. During this time, the office door was open, and unlicensed personnel, including certified nursing assistants, were present in the office and had access to the medications. The Registered Nurse Manager acknowledged that medications were not supposed to be stored in the office and that the Director of Nursing was aware of their presence. Facility policy requires all medications to be stored in locked rooms or medication carts, inaccessible to residents and visitors, and only accessible to authorized personnel. The Director of Nursing confirmed that medications awaiting return to the pharmacy should be secured in a locked medication room and that certified nursing assistants should not have access to medications. The observed practice of storing medications in an unlocked office with access by unauthorized staff was not in accordance with facility policy or regulatory requirements.

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