Expired medications were found in the Main Medication Stock Room, including multiple bottles of Mylanta, Melatonin, Aspirin, multivitamins, and vitamin B12. An LPN confirmed the medications were expired and said they should not have been in stock, and the DON stated expired meds should not be in the medication rotation.
Improper Storage and Labeling of Insulin: Surveyors found insulin stored outside required temperature ranges in a medication refrigerator and observed multiple insulin vials and pens on medication carts that were open but not dated, expired, or not properly labeled with a resident name. The facility’s policy required refrigeration temperatures to be maintained within set limits and medications to include open and expiration dates when applicable.
Controlled substances were not stored in a locked container separate from non-controlled medications. During a tour of the locked med room, a medication refrigerator without a lock was found to contain unopened liquid oral lorazepam and IV lorazepam. The RN said the lorazepam was an emergency supply not prescribed for a specific resident, and the DON stated she was unaware of the requirement for a separate locked compartment.
Medication storage was deficient when surveyors found multiple unlabeled or improperly labeled meds on several med carts. An RN and ADON observed an open insulin pen, GLP-1 pens without resident identifiers, an inhaler with an illegible open date, and open, undated ophthalmic solution, inhaler, and insulin pen items. The DON stated open meds should be dated and dates should be legible.
Improper Storage and Labeling of Medications: A surveyor observed a resident's liquid morphine on a unit E med cart with no open date label after it had been opened, and also found lorazepam stored in a refrigerator inside a locked cabinet with other medications rather than in a separately locked compartment. The RN was unsure about the storage requirement, and the ADON stated the controlled medication should have been locked separately.
Expired COVID-19 antigen tests were found in the only med storage room during an observation with the IP. Surveyors saw three boxes of iHealth COVID-19 tests past expiration, including one opened box with three tests already used; the IP confirmed the tests were expired and said three tests from the expired box had been used the prior day. The facility policy required checking open dates and expiration before administration, and the IP stated she expected no expired meds or biologicals in the facility.
Unlocked Medication Cart Left Unattended: Surveyors observed an LPN leaving a vent unit med cart unlocked and unattended during med pass, and the cart was also later observed unlocked and unattended in a public area. The facility policy required medication compartments to be locked when not in use, but 1 of 5 med carts was found unsecured, affecting medications for 10 residents.
Medication storage was not maintained according to policy because LTC and rehab medication refrigerators were observed unlocked and temperature logs were incomplete. Staff stated temperatures should be checked every shift or at least daily, but multiple dates had no documentation. Temperature-sensitive items, including insulin pens, vaccines, ophthalmic drops, suppositories, and lorazepam solution, were stored in the refrigerators, and an expired lorazepam vial was found in a lock box. A scheduled medication was also stored in an unlocked refrigerator.
Unsecured medication carts and expired medications were found in multiple areas of the facility. Surveyors observed several medication carts unlocked and unattended while licensed staff were away, and found an insulin vial without an open/use-by date, expired dressings, expired inhalers, and other expired supplies in medication carts and a medication storage room. An RN, MT, LPN, and DON verified the findings and confirmed carts should be locked when unattended.
Unsecured medication cabinets outside resident rooms contained prescribed creams, dressings, a prescription bottle, and an unknown white powder, and 6 of 26 observed cabinets were left unlocked when unattended and out of view of staff. Facility policy required medication storage to be locked when unattended, and an RN and the NHA both stated the cabinets should be locked when prescribed meds were present.
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