F0761

D

Unlocked and Unattended Medication Carts with Open MAR Screens

Dobbs Ferry, New York Survey Completed on 01-29-2026

Penalty

No penalty information released

Summary

Surveyors identified a deficiency related to the facility’s failure to ensure medications and biologicals were stored securely and accessible only to authorized personnel, as required by facility policy and 10 NYCRR 415.18(e)(1-4). During an abbreviated survey on 1/29/2026, multiple observations were made of unattended, unlocked medication carts with open computer screens displaying medication administration records. On Unit 3 North at 10:42 a.m., a medication cart was observed left in the hallway unlocked and unattended; a unit manager later walked past, noticed it was unlocked, and then locked the cart and computer screen. At 10:46 a.m. on the same unit, another medication cart near the nurse’s station was observed unlocked and unattended while the assigned nurse was in the dining area obtaining vitals and administering medications to a resident.

On Unit 2 South, similar issues were observed. At 11:00 a.m., a medication cart was found in front of a resident’s room with the cart unlocked and the computer screen open to that resident’s medication administration record while the nurse was inside the room with the resident. At 11:03 a.m., another medication cart was observed unlocked on one side of the nurse’s station while the assigned nurse was on the opposite side of the station obtaining vitals from a resident. In subsequent interviews, the involved LPNs acknowledged that they had not locked the carts, stated they typically do lock them, and attributed the lapses to being busy or believing the carts were locked. These observations and statements occurred despite a written facility policy stating that medications and biologicals are to be stored safely and securely, with access limited to licensed nursing, pharmacy personnel, or other lawfully authorized staff.