The facility failed to properly store medications in medication rooms and a medication cart. An unlocked medication refrigerator contained expired and undated sodium chloride vials, a controlled substance box that was not permanently affixed, and expired daptomycin devices that had not been discarded after the order was discontinued. A medication cart also contained suppositories that were not in their original packaging.
Medication labeling and storage were deficient in multiple med carts. An LPN and the infection preventionist found morphine sulfate oral solution, insulin lispro, and inhalers stored in medication boxes, but the individual containers were not labeled with the resident’s name and, when applicable, the date opened. One resident’s discontinued narcotic medications also remained in the cart after the resident expired, and the DON stated the handwritten label on the insulin vial was not appropriate.
Improper medication labeling, expired drugs, and unsecured storage were found in the facility. Surveyors observed expired diphenhydramine and milk of magnesia, eye drops and insulin pens without open dates, and multiple bottles of latanoprost and Refresh Tears without required labeling on a medication cart. Surveyors also found a medication closet and a storage room left unlocked, with heparin syringes, IV fluids, and other supplies stored in areas accessible from resident hallways.
Medication Storage and Labeling Deficiencies: The facility failed to properly store and label medications in a medication cart and medication room. Surveyors found an expired bottle of latanoprost in the med room, several opened meds in the cart without open dates, one fluticasone bottle without a resident name or open date, and 33 unidentified loose pills in the cart drawers. RN and DON interviews confirmed that staff were expected to date opened meds, check for expirations, and clean the carts.
Surveyors found multiple medications in medication carts and medication rooms that were not properly labeled with the resident’s name and open date, including a nasal spray, oxycodone suspension, Ozempic pen, Dulera inhaler, and an accessed TB vial. Staff also found loose or uncovered medications in a narcotic drawer and medication room, including a Dilaudid pill, a clonazepam tablet, and uncovered Tylenol tablets without an open or expiration date. RN, LPN, and DON interviews confirmed the items were not stored or labeled correctly.
Medication storage carts contained multiple expired drugs and biologicals, unlabeled opened medications, improperly stored insulin and eye drops, and unidentified pills with no resident or medication labels. Surveyors found these issues across several carts, while an LPN and the DON confirmed staff were responsible for checking expiration dates, labeling opened products, and discarding expired medications.
Medication carts contained multiple labeling and storage errors, including Lantus and NovoLog pens without open dates, an expired NovoLog pen, and an Ozempic pen stored without its cap and with a needle attached. An RN stated she had administered the Ozempic dose and placed the pen back in the cart while looking for the cap, and another RN was unsure what the date on the NovoLog pen meant. The DON stated that the nurse who opened the insulin or Ozempic pen was responsible for labeling it and that cart drawers should be organized by route.
Expired and discontinued meds were found in a medication cart and expired IV antibiotics were stored in the med room. An LPN, RN, and ADON confirmed the meds should have been removed, including gabapentin for a resident whose order had been discontinued and oxycodone for a resident who had already been discharged.
Medication storage and labeling were deficient in multiple med carts and med storage areas. Surveyors found opened ophthalmic drops, an opened insulin vial, and an opened lorazepam vial without date-opened labels, along with loose pills left in cart drawers without containers or labels. An LPN, RN, and DON stated nurses were responsible for cleaning carts, labeling opened meds, and removing dropped pills from drawers.
Improper storage and labeling of medications and biologicals were found in a medication cart and two medication rooms. An expired bisacodyl bottle remained in stock, an opened Spiriva inhaler for a resident was not dated, an RSV vaccine kit for a discharged resident was still stored in the refrigerator, and two opened Tubersol PPD vials remained in use beyond the allowed time after opening.
Self-audit
Pick a level of detail and, optionally, what to focus on — then generate a survey-ready checklist distilled from the most recent citations.
Beta · AI-generated — for reference only, not professional advice. Verify against current CMS guidance before relying on it. Assisto accepts no responsibility for how this checklist is used.
Citations used to create this checklist
Trusted data from CMS and state health departments
Every citation, penalty and Plan of Correction is sourced from public CMS records (latest release October 8, 2026) and official state health department websites — never guesswork.
In your survey window? See what surveyors are citing.
The Survey-Prep Report maps your facility's risk from 12 months of CMS and state citation data — what's being cited around you and what to check first. $129 one-time.