Every finding on record at Epsom Healthcare Center

Based on observation, interview and record review, the facility failed to provide privacy of electronic medical records for 2 of 2 units observed (100 and 200 Halls) and during medication administration.Findings include:200 Hall Observation on 3/10/26 at 11:54 a.m. of Staff I (Licensed Nursing Assistant) was documenting on a laptop computer on a bench on [NAME] Wing short hall. Staff I set the computer down on a bench and walked away into a resident room. There was identifiable information observed on the computer screen. Interview on 3/10/26 at approximately 11:56 a.m. with Staff I confirmed the above. Staff I revealed that they had not closed the computer so that they did not have to log in again. Observation on 3/10/26 at 2:05 p.m. of the [NAME] Wing short hall revealed a computer on the above same bench that was open with a blank screen. When the keyboard was touched resident identifiable information could be seen. There were no staff members around this computer. 100 Hall Observation on 3/11/26 at 8:09 a.m. on the 100 hall [NAME] side there was a laptop computer open on a movable computer stand near the bench. When the keyboard was touched resident identifiable information could be seen, but then quickly went to a blank screen. There were no nursing staff nearby. Interview on 3/11/26 at 3:12 p.m. with Staff J (Staff Development) revealed that it is facility policy that staff click the walk away button to secure the electronic medical record when they walk away from the computer and are trained on this during orientation and annually. Interview on 3/12/26 at 8:07 a.m. with Staff K (Corporate Nurse) confirmed that it is facility policy that staff lock the screen when they are away from the computer to protect resident identifiable information. Staff K revealed that the facility's electronic medical record automatically locks after 15 minutes when idle. Resident #73 Observation on 3/11/26 at approximately 8:15 a.m. of the [NAME] Wing, East Hall medication cart with Staff A (Registered Nurse) revealed that while preparing medications for Resident #73, Staff A partially closed the laptop and walked away to go to the medication room, which was out of direct sight of the medication cart, with Resident #73's health information remaining on the screen. Further observation revealed that when Staff A returned to the medication cart to continue preparing medications for Resident #73. Staff A partially closed the computer screen leaving Resident #73's health information visible on the computer screen while administering medications to Resident #73. Resident # 36 Observation on 3/11/26 at approximately 8:30 a.m. of the [NAME] Wing, East Hall medication cart with Staff A revealed that after preparing medications for Resident #36 Staff A partially closed the computer screen and left to provide medications to Resident #36 which was out of the sight line of the laptop. Interview on 3/11/26 at approximately 8:35 a.m. with Staff A confirmed the above observations. Resident #42 Observation on 3/11/26 at approximately 8:45 a.m. of the [NAME] Wing North Hall medication cart with Staff B (Licensed Practical Nurse) revealed Staff B partially closed the computer screen walked away from the laptop to give medications to Resident #42. The laptop was out of sightline of Staff B. Interview on 3/12/26 with Staff B confirmed the above observation. Review on 3/12/26 of the facility's policy titled HIPAA [Health Insurance Portability and Accountability Act] Privacy and Security Policy reviewed on 10/3/25 revealed, .This policy establishes safeguards to prevent unauthorized access, viewing, or disclosure of PHI [Protected Health Information], including requirements for screen privacy, computer security, and automatic system timeouts . To protect resident confidentiality, the following safeguards must be followed . 4. Staff must immediately minimize or close resident records when not actively in use. 5. Staff must not leave a computer unattended while resident information is displayed . Staff are also required to . Lock their screen when stepping away from the computer .

Based on observation, interview, and record review, the facility failed to follow infection control policy regarding Enhanced Barrier Precautions (EBP) for 2 of 4 residents reviewed for EBP. (Resident identifiers are #65 and #90.)Findings include:Resident #65Observation on 3/10/2026 at approximately 10:44 a.m. in Resident #65's room revealed a EBP sign posted outside the room that indicated to wear gloves and gown (Personal Protective Equipment (PPE)) during high-contact resident care activities (e.g. dressing and transfers). Further observation revealed that Staff M (Certified Occupational Therapy Assistant) was with Resident #65 while wearing gloves and no gown for PPE. Interview on 3/10/2026 at approximately 10:55 a.m. with Staff M revealed that he/she was assisting Resident #65 with dressing. Staff M confirmed that he/she was not wearing a gown while assisting Resident #65 with dressing, which is a high-contact resident care activity.Review on 3/10/26 of Resident #65's medical record revealed a care plan and a physician order for EBP due to open wounds. Further review revealed that Resident #65 has pressure injury to the right scapula which was present on admission. Observation on 3/11/2026 at approximately 12:13 p.m. in Resident #65's room revealed an EBP sign posted outside the room. Further observation revealed Staff M assisting Resident #65 while seated in the wheelchair. Staff M was wearing gloves and no gown for PPE.Interview on 3/11/26 at approximately 12:18 p.m. with Staff revealed that he/she was assisting Resident #65 with dressing and transferring from bed to wheelchair. Staff confirmed that he/she was not wearing a gown for PPE while assisting Resident #65 with dressing and transferring.Resident #90Observation on 3/11/2026 at approximately 7:36 a.m. in Resident #90's room revealed a EBP signage posted outside of the room that indicated to wear gloves and gown during high-contact resident care activities (e.g. dressing, toileting, and changing linens). Observation revealed Staff N (Licensed Nursing Assistant) was in Resident #90s room changing the blue soak pads on Resident #90's bed wearing gloves and no gown for PPE then went in Resident #90's bathroom and appeared to be assisting Resident #90. Interview on 3/11/26 at approximately 9:48 a.m. with Staff N confirmed the above observation in Resident #90's room. Staff N revealed that he/she was assisting Resident #90 with dressing in the bathroom. Review on 3/11/2026 of Resident #90's care plan revealed that Resident #90 has a history of Extended Spectrum Beta Lactamase (ESBL) and an intervention in place for EBP.Review on 3/12/26 of the facility's policy titled, Enhanced Barrier Precautions (EBP), revised date 4/2025, revealed .Examples of high-contact resident care activities requiring the use of gown and gloves for EBPs include: a. dressing .c.transferring .e.changing linens .f. changing briefs or assisting with toileting .EBPS are indicated .for residents infected or colonized with the following: .g. ESBL .EBPs may be indicated.for residents with chronic wounds and/or indwelling medical devices regardless of MDRO colonization .

Based on observation, interview, and record review, the facility failed to ensure equipment was clean for 1 of 1 kitchen and 1 of 2 kitchenette observed. Findings include:Observation on 3/10/26 at approximately at 8:14 a.m. during the kitchen tour with Staff G (Food Service Director) revealed a fryolator with yellow brown, food-like debris on the top surface. The oil inside the fryolator appeared cloudy, dark in color, and contained visible crumbs. Further observation revealed a thick layer of yellow brown, grease like grime on the upper portion of the fryolator, including the basket and the top area of the tank. Interview on 3/10/26 at approximately at 8:14 a.m. with Staff G confirmed the above observation. Staff G revealed that the fryolator was last cleaned two weeks ago and gets cleaned every two weeks. Review on 3/11/26 of the fryolator cleaning log revealed the fryolator was last cleaned on 2/28/26. Review on 3/11/26 of the fryolator manufacturer's instructions revealed .DAILY PREVENTATIVE MAINTENANCE .DAILY PREVENTATIVE MAINTENANCE Performing the preventative maintenance steps below on a daily basis will keep your equipment safe and at peak performance. During the cooking process, oil/shortening may spill and splatter and requires immediate attention. Furthermore, during the cooking process, particles, crumbs and crackling collect inside the cooker tank reducing product quality and decreasing oil/shortening life. If you are producing high quantities of fried food and/or frying heavily battered food, it may be necessary to perform these steps more then once a day. DAILY CLEANING At least daily, filtering the oil is required. Make sure a clean filter is use every day. Using the cleaning brush, crumb scoop, and clean out rod, remove all the loose debris .CLEANING THE COOK TANK Recommended at least once a week .CLEANING THE CABINET 1. Wipe any spilled oil/shortening, dust and lint from the cabinet exterior with a clean damp cloth and a mild food grade detergent. Be careful not to get any water or detergent in the oil/shortening. Use a nonabrasive pad for tougher stains if needed. 2. Remove detergent from all surfaces. 3. Cleaning the interior cabinet requires a clean cloth to remove any oil/shortening, dust, lint or filter powder (i.e.: Magnesol) from the interior of the cabinet WEEKLY PREVENTATIVE MAINTENANCE Performing the preventative maintenance steps above on a daily basis will keep your equipment clean and safe . Observation on 3/10/26 at approximately 8:47 a.m. with Staff G of the second floor kitchenette microwave revealed multiple dried food particles scattered across the interior surfaces, including the bottom, side walls, and top interior area of the microwave. Interview on 3/10/26 at approximately 8:47 a.m. with Staff G confirmed the above observation of the second floor kitchenette microwave. Review on 3/12/26 of the FDA 2022 Food Code revealed . Cleaning of Equipment and Utensils (A) EQUIPMENT FOOD-CONTACT SURFACES and UTENSILS shall be clean to sight and touch. (B) The FOOD-CONTACT SURFACES of cooking EQUIPMENT and pans shall be kept free of encrusted grease deposits and other soil accumulations. (C) NonFOOD-CONTACT SURFACES of EQUIPMENT shall be kept free of an accumulation of dust, dirt, FOOD residue, and other debris .

Based on interview and record review, the facility failed to hold routine interdisciplinary care plan meetings and include the resident in the meeting for 1 of 1 resident reviewed for care planning in a final sample of 22 residents (Resident identifier is #27).Findings include:Interview on 3/10/26 at 11:54 a.m. with Resident #27 revealed that he/she had not been invited to attend their care plan meetings. Review on 3/12/26 of Resident #27's quarterly comprehensive Minimum Data Set (MDS) assessments revealed that Resident #27 had been assessed by the facility on 8/13/25, 11/5/25 and 1/22/26. Review on 3/12/26 of Resident #27's Care Conference Report revealed that the most recent care plan meeting was held on 8/19/25 and that Resident #27 was their own decision maker. Resident #27 was not listed as attending this meeting and there was no documentation that he/she had been invited. There were no documented care plan meetings held after the 11/5/25 and 1/22/26 assessments. Interview on 3/12/26 at 9:12 a.m. with Staff L (Social Service Specialist) confirmed that Resident #27's most recent care plan meeting held was on 8/19/25 and that Resident #27 was not documented as attending/declining this meeting. Staff L revealed that the facility will hold care plan meetings after the MDS assessments and that Resident #27's care plan meetings were missed for 11/5/25 and 1/22/26 quarterly comprehensive MDS assessments. Review on 3/12/26 of the facility's policy titled Resident Participation in Care Planning revised 10/15/25 revealed, . The resident and his or her legal representative are encouraged to attend and participate in the resident's assessment and in the development of the resident's person-centered care plan . 9. The social services director of designee is responsible for notifying the resident/representative and for maintaining records of such notices .

Based on observation, interview, and record review, the facility failed to ensure self-administered medications were properly secured for 1 of 1 resident reviewed for choices in a final sample of 22 residents. (Resident identifier is #53.)Findings include:Observation on 3/10/26 at approximately 9:32 a.m. in Resident #53's room revealed three prescription medication boxes with pharmacy labels on the bedside table. These medications were not secured in a locked storage area. Further observation revealed that Resident #53 was in bed sleeping and these prescription medications were Breztri inhaler (corticosteroid), Albuterol Sulfate inhaler (short-acting bronchodilator), and Ipratropium Bromide nasal spray (treat allergies). Review on 3/10/26 of Resident #53's care plan for self administration of medications revealed that Resident #53's medications (i.e. inhalers and nasal sprays) may be kept in Resident #53's room. Review on 3/10/26 of Resident #53's active physician orders revealed that the above medications had orders that indicated that the above medications may be kept at bedside. Observation on 3/11/26 at approximately between 12:25 p.m. in Resident #53's room revealed that the Breztri inhaler and Ipratropium Bromide nasal spray were on the bedside table and the Albuterol Sulfate inhaler was on top of Resident #53's bedside dresser. These three medications were not secured in a lock storage area. Interview on 3/11/26 at approximately 12:27 p.m. with Staff D (Licensed Practical Nurse (LPN)) confirmed that the above mentioned medications were not locked. Interview on 3/12/26 at 8:10 a.m. with Staff H (LPN) revealed that there was a resident on the unit that had a history of wandering in other resident's room. Observation on 3/12/26 at approximately between 8:12 a.m. in Resident #53's room revealed that Resident #53 was not in the room and the Breztri inhaler and Ipratropium Bromide nasal spray were on the bedside table. Review on 3/12/26 of the facility's policy titled, Self-Administration of Medications, review date 10/2/25, revealed .Self-administered medications are stores in a safe and secure place, which is not accessible by other residents . Review on 3/12/26 of the facility's policy titled, Medication Storage, review date 10/5/25, revealed .The facility stores all drugs and biologicals in a safe, secure, and orderly manner .Drugs and biologicals used in the facility are stored in lock compartments .Only authorized to prepare and administer medications have access to lock medications .Compartments (including, but not limited to, drawers, cabinets, rooms, refrigerators, carts, and boxes) containing drugs and biologicals are locked when not in use .

Based on interview, and record review, the facility failed to follow professional standards for 2 of 3 residents reviewed for nutrition, 1 of 1 resident reviewed for choices, and 1 of 6 residents reviewed for unnecessary medications in a final sample of 22 residents. (Resident identifiers are #5, #8, #24, and #65.)Findings include:Standard: [NAME], [NAME] A., and [NAME]. Fundamentals of Nursing. 10th edition St. Louis, Missouri: Elsevier, 2021. Page 614 .It is essential to verify the accuracy of every medication you give to your patients with the patient's order. If the medication order is incomplete, incorrect, or inappropriate, or if there is a discrepancy between the original order and the information on the MAR [Medication Administration Record]. consult with the health care provider. Do not give a medication until you are certain that you can follow the seven rights of medication administration . Page 672 .seven rights of medication administration include right medication, right dose, right patient, right route, right time, right documentation and right indication . Resident #8 Review on 3/11/26 of Resident #8's progress note dated 2/26/26 revealed that the nurse practitioner would like to decrease Resident #8's Eliquis (a blood thinner) from 5 milligrams (mg) twice daily to 5 mg once daily. This note was written by Staff D (Licensed Practical Nurse (LPN)). Review on 3/11/26 of Resident #8's February 2026 Medication Administration Record (MAR) revealed a physician's order for Eliquis (blood thinner) 5 mg (milligram) twice daily for the treatment of a cerebrovascular accident (CVA). Further review revealed that on 2/26/26, Resident #8 received the morning dose of Eliquis 5 mg, after which the medication was discontinued without a new physician's order to restart Eliquis. Review on 3/11/26 of Resident #8's March 2026 MAR revealed that there was no order for Eliquis from 3/1/26 to 3/11/26. Review on 3/11/26 of Resident #8's physician progress note dated 3/6/26 revealed . Chronic atrial fibrillation . continue Eliquis Review on 3/11/26 of Resident #8's Nurse Practitioner note dated 3/11/26 revealed .Chronic atrial fibrillation . Continue . Eliquis . This was written by Staff E (Advanced Practical Registered Nurse). Interview on 3/11/26 at 1:19 p.m. with Staff E revealed that Resident #8 should be on Eliquis 5 mg daily and confirmed that this was not in Resident #8's physician's orders. Interview on 3/11/26 at 1:24 p.m. with Staff D confirmed that they had received a verbal order from Staff E on 2/26/26 to change Resident #8's Eliquis dosage from 5 mg twice daily to 5 mg once daily. Staff D further confirmed that instead of updating the order, the Eliquis was discontinued. Review on 3/11/26 of Resident #8's Anticoagulant Care Plan revealed an intervention to administer medication as ordered. Review on 3/11/26 of the facility's policy titled Physician's Orders and revised on 10/3/25 revealed, . Verbal orders must be recorded immediately in the resident's chart by the person receiving the order . Resident #24 Review on 3/11/26 of Resident #24's outside Cardiology visit progress note dated 2/26/26 revealed the provider recommended to consider starting Pyridostigmine at 30 mg twice daily for autonomic hypotension with medication induced hypertension. Review on 3/11/26 of Resident #24's March 2026 MAR revealed a physician's order for Pyridostigmine Bromide tablet 30 mg twice daily for orthostatic hypertension with a start date of 2/27/26. Review also revealed that the Pyridostigmine Bromide 30 mg order did not have parameters to hold the medication. Further review revealed the Pyridostigmine Bromide 30 mg was not administered for the following dates and reasons: On 3/5/26, due to condition (no documentation of what the condition was to not administer the medication); On 3/9/26, due to condition with a comment that indicated 217/97; On 3/10/26, due to condition with a comment that indicated elevated blood pressure; and On 3/11/26, due to condition with a comment that indicated blood pressure of 189/82. Interview on 3/12/26 at 1:48 p.m. with Staff D confirmed that the Pyridostigmine Bromide 30 mg medication was not administered as ordered and that there was no parameters that indicated to hold the medication. Staff D also revealed that there was no documentation the provider had been notified that the Pyridostigmine medication was not administered on the above mentioned dates and reasons. Interview on 3/12/26 at 2:08 p.m. with Staff E revealed that they were not aware that Resident #24 did not get the Pyridostigmine medication on the above mentioned dates. Resident #5 Review on 3/12/26 of the facility's policy titled, Weight Policy and Procedure, revised date 1/6/25, revealed .Weight should be recorded in the computer under vitals by the dietician, LNA's [Licensed Nursing Assistant] and nursing. If there is a weight gain or loss of 3 pounds or more nursing/dietician are to be notified. A reweight is to be obtained for accuracy . Review on 3/11/26 of Resident #5's Weights Vital Reports revealed the that nn 2/26/26, Resident #5 weight was 135.4 pounds (lbs.) and on 3/5/26, Resident #5 weight was 148 lbs.,which is a 12.6 lbs. weight gain in 7 days. Further review revealed that a re-weigh was not done to check the accuracy of the weight. Interview on 3/12/26 with Staff C (Dietician) revealed that confirmed the above and was not notified of the weight gain. Resident #65 Review on 3/11/26 of Resident #65's weight record revealed that on 2/25/26, Resident #65 weight was 123.8 lbs. and on 3/8/26, Resident #65 weight was 108 lbs., which is 15.8 lbs. weight loss in 11 days. Further review of the weight record revealed no other weights were recorded after 3/8/26. Review on 3/11/26 of Resident #65's progress notes revealed no documentation verifying the accuracy of the above weight loss. Interview on 3/12/26 at approximately 10:20 a.m. with Staff D confirmed the above findings. Interview on 3/12/26 at approximately 10:20 a.m. with Staff E revealed that there were no documentation that Resident #65 was reweighed to verify the above weight loss. Staff E also revealed that Resident #65 should have been reweighed immediately to verify the weight loss and that he/she was aware of the above weight loss on 3/8/26. Interview on 3/12/26 at approximately 10:27 a.m. with Staff C revealed that he/she was unaware of the above weight loss on 3/8/26. Interview on 3/12/26 at approximately 12:27 p.m. with Staff D revealed that they obtained Resident #65's weight, and the current weight was 104 lbs. Interview on 3/12/26 at approximately 12:27 p.m. with Staff F (Medical Director) revealed that he/she was unaware of Resident #65's weight loss on 3/8/26. Staff F also revealed that there might have been a discrepancy of obtaining Resident #65's weight on 2/25/26 rather than a weight loss. Review on 3/12/26 of Resident #65's medical record revealed that Resident #65 was admitted to the facility with a diagnosis of severe protein-calorie malnutrition. Further review revealed Resident #65's nutritional care plan interventions in place prior to 3/8/26 were therapeutic diet, honor preferences, encourage intake of diet, offer snacks between meals, Megace medication (appetite stimulant), and house supplements twice a day. Further review also revealed a dietary assessment by Staff C completed on 3/1/26.

Based on interview and record review, the facility failed to provide routine medications to meet the needs of 1 of 1 resident reviewed for choices. (Resident identifier is #24). Findings include:Review on 3/11/25 of Resident #24's outside Cardiology visit progress note dated 2/26/26 revealed the provider recommended to consider starting Pyridostigmine at 30 milligrams (mg) twice daily for autonomic hypotension with medication induced hypertension. Review on 3/11/26 of Resident #24's March 2026 Medication Administration Records revealed a physician's order for Pyridostigmine Bromide tablet 30 mg twice daily for orthostatic hypertension with a start date of 2/27/26. Further review revealed that the Pyridostigmine Bromide 30 mg was not administered on the following dates as the medication was not available: 2/27/26, and 2/28/26, 3/2/26, 3/3/26, 3/6/26, and 3/7/26. There was no documentation indicating that the provider was notified on 2/27/26 or 2/28/26 that Pyridostigmine Bromide 30 mg was unavailable.Review on 3/12/26 of the facility's pharmacy delivery form revealed that the above medication for Resident #24 was delivered on 2/28/26 at 10:44 p.m.Interview on 3/12/26 at 1:48 p.m. with Staff D (Licensed Practical Nurse) confirmed the above findings and and that the medication should have been administered on the above mentioned dates, as it was available in the facility.Interview on 3/12/26 at 2:08 p.m. with Staff E (Advanced Practical Registered Nurse) revealed that he/she was not aware that Resident #24 had missed the medication doses on the above mentioned dates, whether the medication was available or unavailable at the facility.

Based on interview and record review, the facility failed to act upon a provider approved recommendation that were identified by the pharmacist during the Pharmacy Medication Regimen Review (MRR) for 1 of 6 residents reviewed for unnecessary medications in a final sample of 22 residents. (Resident Identifier is #95).Findings include:Review on 3/12/26 of Resident #95's pharmacy review titled Consultant Pharmacist MRR (Medication Regimen Review) Recommendation to the Prescriber, dated 2/16/26, revealed a recommendation to the physician/prescriber to Suggest considering change of lisinopril to losartan. Further review revealed that Staff E (Advanced Practical Registered Nurse) agreed to the recommendation and signed the form.Review on 3/12/26 of Resident #95's physician orders revealed that there was no change in Resident #95's order for lisinopril.Interview on 3/12/26 at approximately 12:15 p.m. with Staff E confirmed that he/she agreed with the above mentioned MRR recommendation but did not update Resident #95's electronic health record to reflect the recommended change to the orders.Review on 3/12/26 of the facility's policy titled Pharmacy Consultant Policy reviewed 4/1/2025 revealed .A written or electronic report of findings and recommendations is given to the attending physician, director of nursing, medical director, and others as may be appropriate .to ensure that the findings are acted upon.

Based on interview and policy review, it was determined that the facility failed to develop and implement a water management program to prevent the growth of waterborne pathogens in their building with a census of 102 residents. Findings include: Review on 2/3/25 of the facility's water management program, not dated, revealed the following: 1. There was no detailed description and/or diagram of the facility's water system; 2. There was no identification of areas in the water system where legionella and other opportunistic pathogens could grow and spread; 3. Legionella testing was to be done January 2024 and June 2024. Legionella testing was done on January 2024 and there was no second Legionella testing performed in 2024; 4. There was no control measures for areas identified in the facility's water system where legionella and other opportunistic pathogens could grow and spread besides Legionella testing; 5. There was no procedure of monitoring of control measures; and 6. There was no procedure to intervene when control limits are not met. Interview on 2/3/25 at approximately 1:00 p.m. with Staff C (Director of Maintenance and Environmental Services) confirmed the above findings. Further interview with Staff C revealed that Staff C oversees the water management program at the facility. Staff C was unable to describe detailed description of the facility's water system and he/she was unable to identify areas in the facility's water system that could encourage growth and spread of legionella and other opportunistic pathogens. Staff C also stated Staff C did not know when the water management program had been updated. Interview on 2/3/25 at approximately 2:30 p.m. with Staff B (Director of Nursing) and Staff D (Infection Preventionist) revealed that they started working at the facility November 2024. Staff B and Staff D stated that they reviewed the water management program last December 2024. Staff B and Staff D was unable to explain the facility's water management program that included measures to minimize the risk of Legionella and other opportunistic pathogens as mentioned in the facility's legionella water management program. Interview on 2/3/25 at approximately 3:20 p.m. with Staff A (Administrator) revealed that they reviewed the facility's water management program last December 2024. Staff A was unable to explain the facility's water management program that included measures to minimize the risk of Legionella and other opportunistic pathogens as mentioned in the facility's legionella water management program.

Based on observation, interview, and record review, it was determined that the facility failed to follow the seven rights of medication administration for 2 of 5 residents observed for medication administration. (Resident identifiers are #6 and #37). Findings include: Standards: [NAME], [NAME] A., and [NAME] [NAME]. Fundamentals of Nursing. 10th ed. St. Louis, Missouri: Mosby Elsevier, 2021. Page 672 .seven rights of medication administration include right medication, right dose, right patient, right route, right time, right documentation, and right indication . .Before administering medications, perform physical assessment, which will reveal physical findings for any indications or contraindications for medication therapy . Resident #6 Observation on 2/3/25 at approximately 8:25 a.m. with Staff E (Medication Nursing Assistant) during medication administration revealed that Staff E administered 1/2 tablet of Calcium Extra Strength 750 milligram (antacid) (dose administered: 375 mg) for Resident #6. Review on 2/3/25 of Resident #6 active physician's orders revealed an order for chewable Calcium 200 mg 1 tablet by mouth twice a day with a start date of 12/20/24. Interview on 2/3/25 at approximately 8:25 a.m. with Staff E confirmed the above findings. Resident #37 Observation on 2/3/25 at approximately 8:45 a.m. with Staff F (Licensed Practical Nurse) during medication administration observation revealed that Staff F placed a pulse oximeter on Resident #37's finger to take his/her pulse. Further observation revealed that Staff F did not utilized their stethoscope to take an apical pulse via the chest. Review on 2/3/25 of Resident #37's active physician's orders revealed an order for Metoprolol Succinate 100 mg extended release with instructions to hold the medication for an apical pulse less than 60. Interview on 2/3/25 at approximately 8:55 a.m. with Staff F confirmed that they did not check Resident #37's apical pulse. Review on 2/3/25 of the facility's policy titled Apical Pulse Monitoring, dated 9/1/22, revealed The purpose of this procedure is to determine the resident's heart rate and rhythm .Steps in the Procedure .5. Locate the apex of the resident's heart by placing the diaphragm of the stethoscope under the resident's left breast (at the fourth to fifth intercostal space). 6. Count the resident's pulse rate for one full minute (60 seconds) .

Based on observation, interview, and record review it was determined that the facility failed to revise care plans for 2 of 2 residents reviewed for care planning in a final sample of 24 (Resident Identifiers #31 and #63). Findings Include: Resident #63 Review on 3/7/24 of Resident #63's medical record revealed a provider order, with a start date of 12/22/23, for Eliquis [anticoagulant] 5 mg [milligram] Oral Twice Daily for atrial fibrillation. Further review on 3/7/24 of Resident #63's medical record revealed no care plan interventions for monitoring adverse drug reactions of the anticoagulant medication. Interview on 3/7/24 at approximately 7:50 a.m. with Staff E (Director of Nursing) confirmed the above finding. Review on 3/8/24 of the facility's policy titled Anticoagulant Medications dated 9/1/22, revealed the following: .a. Assess for any signs or symptoms related to adverse drug reactions due to the medication alone or in combination with other medications . 48515 Resident #31 Review on 3/6/24 of Resident #31's nurse's note dated 3/4/24 revealed that on 2/27/24 Resident #31 fell asleep while sitting in his/her wheelchair and fell forward to the floor. Note further stated that Resident #31's care plan was updated to include the intervention that if Resident #31 falls asleep in his/her wheelchair then staff should encourage Resident # 31 to go to bed. Review on 3/6/24 of Resident # 31's care plan revealed no intervention to encourage Resident #31 to go to bed if he/she falls asleep in his/her wheelchair. The care plan for falls was last updated on on 1/18/24. Interview on 3/7/24 at approximately 9:45 a.m. with Staff D (Licensed Practical Nurse) confirmed the above findings. Review on 3/8/24 of the facility's policy titled Comprehensive Care Planning dated 9/1/22, revealed the following: .11. Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' condition change .

Based on observation, record review, and interview the facility failed to follow professional medication administration standards for 1 medication administered out of 29 medications (Resident Identifier is #16). Findings include: Review on 3/7/24 of professional nursing standard: Fundamentals of Nursing, [NAME], [NAME] A., and [NAME] [NAME]. 7th ed. St. Louis, Missouri: Mosby Elsevier, 2009 revealed: Page 336- Physicians' Orders The physician is responsible for directing medical treatment. Nurses follow physician ' s orders unless they believe the orders are in error or harm clients. Therefore you need to assess all orders, and if you find one to be erroneous or harmful, further clarification from the physician is necessary . Observation on 3/6/24 at approximately 8:20 a.m. of Staff A (Registered Nurse) administering Resident #16's medications revealed that Staff A did not instruct the resident to rinse his/her mouth after inhaling corticosteroid medicine. Review on 3/6/24 of Resident #16's Physician Orders for this inhaler revealed instructions to Rinse mouth after use. Review on 3/7/24 of the manufacturer warnings and precautions for this corticosteroid inhaler, revealed Candida albicans infections of the mouth and pharynx may occur. Advise the patient to rinse his/her mouth with water without swallowing after inhalation to help reduce risk. Interview on 3/7/24 at approximately 8:45 a.m. with Staff E (Director of Nursing) confirmed the above findings.

Based on interview and record review it was determined that the facility failed to provide adequate supervision to prevent a resident from eloping from the facility and to ensure safety measures were in place for a resident who was at risk for elopement for 2 of 3 residents reviewed for accident hazards (Resident Identifiers are #1 and #2). Findings include: Resident #1 Review on 6/1/23 of Resident #1's medical record revealed that he/she was admitted to the facility on [DATE] with a diagnosis of unspecified symptoms and signs involving cognitive functions and awareness-memory, cognitive impairment. Review on 6/1/23 of Resident #1s Minimum Data Set (MDS) with an assessment reference date of 2/27/23 revealed Resident #1 had a Basic Interview for Mental Status (BIMS) score of 9 out of 15. Review on 6/1/23 of Resident #'1's Elopement Assessment, dated 4/10/23 revealed: . Elopement Risk 1. Prior to admission, did patient have a history of elopement or exit seeking behavior? No 2. Has patient exhibited wandering or exit seeking behavior in the last 90 days? Yes . 8. Has there been a change in patient's living arrangements within the last 30 days, including room change? Yes 9. Is patient cognitively impaired with poor decision making skills? Yes . Elopement Risk (Score of 1) Level (The patient is at risk for elopement). Proceed with appropriate safety intervention. Comment (Wander guard re-applied to walker). Review of 6/1/23 of Resident #1's Progress Notes revealed the following: 3/1/23 at 11:27 a.m. Resident noted to be exit seeking and wandering. Wander guard and care plan in place. DPOA [Durable Power of Attorney] in agreement and gave verbal consent. Wander guard placed to resident's LLE [Lower Left Extremity]. 4/11/23 at 12:43 a.m. Resident wandering and exit seeking throughout the shift. 4/15/23 at 8:34 p.m. Noted with exit seeking behavior this AM [morning] X1 [one time]. 4/19/23 at 11:38 a.m. Resident wandering and exit seeking throughout the shift. 4/20/23 at 2:35 a.m. Resident attempting to exit building multiple times today. Stating he is signing himself out and borrowing someone's car. Going to door and trying to leave. 4/20/23 at 11:30 p.m. Reported to this writer that resident frequently exit seeking . Resident continues to remove wander guards from person or walker and dispose of them so wander guard discontinued. Resident on 15 minute checks for safety. 4/21/23 at 5:59 a.m. Reported to this writer that resident was exit seeking. Resident called 911 on 4/20 at 11:30 attempting to get out of facility. 4/22/23 at 9:48 p.m.exit seeking x1 . 5/13/23 at 2:13 p.m.resident was found outside the facility, a staff member saw the resident and brought back to the facility safety . Interview on 6/1/23 at 11:30 a.m. with Staff A (Director of Nursing) revealed that Resident #1 was let out of the facility by a visitor. Resident #1 told the visitor that his/her ride was outside. The visitor observed Resident #1 asking for a ride so the visitor told a staff member. Interview further revealed that Resident #1 was brought back inside the building within minutes by a staff member. Review on 6/1/23 of Resident #1's current care plan revised 4/14/23 revealed the following problem, goal, and approach: .Problem: .Exit seeking behavior as evidenced by: Wandering and exit seeking behaviors. No wander guard in place. 15 min checks in place .Goal: . Will be safe and secure in their environment .Approach: .15 mins checks in place related to exit seeking. No wander guard in place, Resident noted to cut off wander guard . Review on 6/1/23 of Resident #1's 15 Minute Check Log dated 5/13/23 revealed that no 15 minute checks were documented between 12:00 a.m. and 3:00 p.m. Interview on 6/1/23 at 1:15 p.m. with Staff A revealed that there were no 15 minute checks documented prior to the resident eloping the facility on 5/13/23. Review on 6/1/23 of facility policy titled Elopement Prevention Procedure revised on 9/2022, revealed .Procedure: . C. Communication and monitoring of Patient Response to Invention: . 2. Individualized monitoring based on assessed risk level and interventions planned . Resident #2 Review on 6/1/23 of Resident #2's medical record revealed that he/she was admitted to the facility on [DATE]. Review on 6/1/23 of Resident #2's Elopement Assessment, dated 12/12/22 revealed: . Elopement Risk 1. Prior to admission, did patient have a history of elopement or exit seeking behavior? Yes 2. Has patient exhibited wandering or exit seeking behavior in the last 90 days? Yes . 5. Was or is resident patient resistive to Nursing Home placement? Yes 6. Does patient verbally express desire to leave center or go home? Yes . 9. Is patient cognitively impaired with poor decision making skills? Yes . Elopement Risk (Score of 4) Level (The patient is at risk for elopement). Proceed with appropriate safety intervention. Review on 6/1/23 of Resident #2's nursing notes revealed: 12/24/22: 12:37 a.m.Was wandering on unit this evening. Stated [pronoun omitted] was going home. 1/4/23: 10:39 p.m. Was wandering throughout the shift stating [pronoun omitted] wanted to go home. 1/9/23: 12:25 p.m. Exit seeking multiple times this shift, . 1/10/23 11:27 a.m. [pronoun omitted] continues to exit seek . 1/11/23 7:20 a.m. Exit seeking at times . 1/12/23 9:55 a.m. Resident wandering this shift, exit seeking and searching for wife . Review on 6/1/23 of Resident #2's care plans revealed the following: Problem Start Date, 1/16/23 Exit seeking behavior as evidenced by: Resident noted to exit seek and wander at times Interview at approximately 1:00 p.m. with Staff A revealed that there were no elopement interventions put into place for Resident #2 from 12/12/22 to 1/16/23. Review on 6/1/23 of the facility policy titled, Elopement Prevention Procedure, Revision Date 9/22 revealed: Purpose: To identify patients who are at risk for elopement and to develop and implement the lease restrictive appropriate intervention to reduce the probability of elopement. Procedure: All patients will receive a comprehensive nursing assessment within 24 hours from admission. All patients who identify at risk or we feel poses a risk for elopement will have a care plan with appropriate interventions. 47129

Based on interview and record review the facility failed to ensure that residents who were diagnosed with a mental disorder or have a history of trauma and/or Post-Traumatic Stress Disorder (PTSD) received appropriate treatment and services for 2 of 3 residents reviewed for behaviors and emotions in a final survey sample of 21 (Resident identifiers are #50 and #75). Findings include: Resident #50 Review on 2/17/23 at approximately 8:40 a.m. of Resident #50's medical record revealed that Resident #50 was admitted to the facility on [DATE] with diagnosis of anxiety, depression, and PTSD. Further review of Resident #50's medical record revealed that on 11/2/21 Resident #50 completed the Post Traumatic Stress Disorder Checklist-Civilian Version (PCL-C) with a score of 8.0 on the 2 item version. An individual is considered to have screened positive if the sum of the items is 4.0 or greater. Review on 2/17/23 at approximately 9:00 a.m. of Resident #50's physician orders revealed that Resident #50 is taking Sertraline 25 milligrams (mg) 1 time a day, and Trazadone 150 mg give 50 mg at bedtime for depression. Interview on 2/17/23 at with Staff C (Social Services Director) who revealed that if a resident has a positive score on the PCL-C then the resident is offered psychological services and psychiatric services which is contracted through two different providers. Staff C also revealed that Staff C is responsible for referrals for psychological services and that Staff B (Minimum Data Set Nurse) was responsible for referrals to psychiatric services. Interview on 2/17/23 at approximately 9:20 a.m. with Staff B (MDS Nurse) confirmed that Resident #50 had not been offered psychiatric services. Review on 2/17/23 of the facility policy titled Post-Traumatic Stress Disorder Screening Policy Statement: The facility will complete the PCL-C screen upon admission. Policy Interpretation and Implementation: Residents who indicate a positive score on the PCL-C screening will be care planned and offered additional mental health services once consent is obtained. 43408 Resident #75 Review on 2/16/23 at approximately 9:22 a.m. of Resident #75's medical record revealed that they had admitted to the facility on [DATE] with diagnosis of Bipolar disorder, Obsessive Compulsive Disorder (OCD), personal history of Traumatic Brain Injury (TBI) and PTSD. Further review of Resident #75's medial record revealed an active order for Clozapine [Antipsychotic] 350 mg at night time for Bipolar, with a start date of 11/15/22. Review on 2/17/23 at approximately 8:50 a.m. of Resident#75's medial record revealed no PCL-C was completed for Resident #75. Review on 2/17/23 at approximately 9:10 a.m. of Resident #75's medical record revealed no indication that psychiatric or psychological services had been initiated. Interview on 2/17/23 at approximately 9:15 a.m. with Staff C (Assistant Director of Nursing) confirmed the above information. Interview on 2/17/23 at approximately 9:20 a.m. with Staff B (MDS nurse) stated that they are responsible for psychiatric services referrals and that they had sent one over on Resident #75 a few weeks ago, but Resident #75 had not been seen yet as the provider wanted to know more about their extensive psychiatric and medication history. Review on 2/17/23 at approximately 9:30 a.m. of Resident #75's care plan revealed no identified behaviors or PTSD triggers. Interview on 2/17/23 at approximately 9:30 a.m. with Staff D (Social Services) confirmed that no referral had been made for Psychological services for Resident #75 and that no behaviors are identified on care plan or PTSD triggers.

Based on interview and record review, it was determined that the facility failed to offer and provide education to the risks and benefits of the COVID-19 vaccination for 4 of 5 residents reviewed for COVID-19 immunizations (Resident identifiers are #2, #48, #69 and #94). Findings include: Resident #2 Review on 2/17/23 at approximately 10:30 a.m. of Resident #2's medical record revealed their admission to the facility was on 6/17/16. Further review of Resident #2's medical record revealed they had not received the COVID-19 vaccination, and there was no information regarding the education and offering of the COVID-19 vaccination or declination of the COVID-19 vaccination. Resident #48 Review on 2/17/23 at approximately 10:30 a.m. of Resident #48's medical record revealed their admission to the facility was on 3/5/20. Further review of Resident #48's medical record revealed they had not received the COVID-19 vaccination, and there was no information regarding the education and offering of the COVID-19 vaccination or declination of the COVID-19 vaccination. Resident #69 Review on 2/17/23 at approximately 10:30 a.m. of Resident #69's medical record revealed their admission to the facility was on 1/24/23. Further review of Resident #69's medical record revealed they had not received the COVID-19 vaccination, and there was no information regarding the education and offering of the COVID-19 vaccination or declination of the COVID-19 vaccination. Resident #94 Review on 2/17/23 at approximately 10:30 a.m. of Resident #94's medical record revealed their admission to the facility was on 12/23/22. Further review of Resident #94's medical record revealed they had not received the COVID-19 vaccination, and there was no information regarding the education or offering of the COVID-19 vaccination. Interview on 2/17/23 at approximately 12:22 p.m. with Staff C (Assistant Director of Nursing) confirmed that no proof of education or declination could be provided for the COVID-19 vaccination for the above residents. Review on 2/17/23 of the facility policy titled COVID-19 Immunization, revised on 11/12/22, revealed .the patient's medical record will include that they were provided education regarding the benefits and potential risks associated with the COVID-19 vaccine, each dose of the COVID-19 vaccine administered, and if they did not receive the vaccine due to medial contraindication or refusal .

Based on interview and record review, it was determined that the facility failed to ensure a resident was provided with education on the risks and benefits of the Pneumococcal vaccination for 5 of 5 residents reviewed for Pneumococcal immunizations (Resident identifiers are #2, #48, #69, #85 and #94). Findings include: Resident #2 Review on 2/17/23 at approximately 10:30 a.m. of Resident #2's medical record revealed their admission to the facility was on 6/17/16. Further review of Resident #2's medical record revealed they had received the Pneumococcal vaccination on 9/15/17. Review on 2/17/23 at approximately 10:45 a.m. of Resident #2's medical record revealed no consent for Pneumococcal vaccination and no indication that further vaccination was offered or that education was provided on the Pneumococcal vaccination. Resident #48 Review on 2/17/23 at approximately 10:30 a.m. of Resident #48's medical record revealed their admission to the facility was on 3/5/20. Further review of Resident #2's medical record revealed they had received the Pneumococcal vaccination on 6/10/16. Review on 2/17/23 at approximately 10:45 a.m. of Resident #48's medical record revealed no consent for vaccination and no indication that further vaccination was offered or that education was provided on the Pneumococcal vaccination. Resident #69 Review on 2/17/23 at approximately 10:30 a.m. of Resident #69's medical record revealed their admission to the facility was on 1/24/23. Further review of Resident #69's medical record revealed no information regarding Pneumococcal vaccination or consent for Pneumococcal vaccination. Resident #85 Review on 2/17/23 at approximately 10:30 a.m. of Resident #85's medical record revealed their admission to the facility was on 9/15/22. Further review of Resident #85's medical record revealed no information regarding Pneumococcal vaccination or consent for Pneumococcal vaccination. Resident #94 Review on 2/17/23 at approximately 10:30 a.m. of Resident #94's medical record revealed their admission to the facility was on 12/23/22. Further review of Resident #94's medical record revealed no information regarding Pneumococcal vaccination or consent for Pneumococcal vaccination. Interview on 2/17/23 at approximately 10:45 a.m. with Staff A (Infection Preventionist) confirmed the facility could not provide evidence that education was provided to each of the above listed residents regarding the risks and benefits of the Pneumococcal vaccination or that Pneumococcal vaccination was offered. Review on 2/17/23 of the facility policy titled Pneumococcal Vaccine Policy, with no initiation date, revealed .the resident or responsible party will receive information and education regarding benefits and potential side effects of vaccine .Vaccinations will be administered and offered in accordance with current recommendations from the CDC [Centers for Disease Control and Prevention]. Review of the CDC website titled Pneumococcal Vaccination: Summary of Who and When to Vaccinate, effective 01/28/22, indicated . CDC recommends pneumococcal vaccination for all adults [AGE] years or older . For adults [AGE] years or older who have not previously received any pneumococcal vaccine, CDC recommends you . Give 1 dose of PCV [Pneumococcal Conjugate Vaccine] 15 or PCV20 . If PCV15 is used, this should be followed by a dose of PPSV [Pneumococcal Polysaccharide Vaccine] 23 at least one year later. The minimum interval is 8 weeks and can be considered in adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak . If PCV20 is used, a dose of PPSV23 is NOT indicated . For adults [AGE] years or older who have only received a PPSV23, CDC recommends you . May give 1 dose of PCV15 or PCV20 . The PCV15 or PCV20 dose should be administered at least one year after the most recent PPSV23 vaccination. Regardless of if PCV15 or PCV20 is given, an additional dose of PPSV23 is not recommended since they already received it. For adults [AGE] years or older who have only received PCV13, CDC recommends you . Give PPSV23 as previously recommended . For adults who have received PCV13 but have not completed their recommended pneumococcal vaccine series with PPSV23, one dose of PCV20 may be used if PPSV23 is not available. If PCV20 is used, their pneumococcal vaccinations are complete .

Based on observation, interview, and record review, it was determined that the facility failed to assess residents' ability to self-administer medications for 2 of 2 residents reviewed for self-administration of medication in a final survey sample of 21 residents (Resident identifiers are #46 and #150). Findings include: Resident #150 Observation on 2/15/23 at 10:28 a.m. and on 2/16/23 at 9:05 a.m. in Resident #150's room revealed an opened tube of Dibucaine topical anesthetic on his/her night stand. Interview on 2/5/23 at 10:28 a.m. with Resident #150 revealed that he/she used the ointment whenever he/she wanted to and at times needed staff assistance. Interview on 2/16/23 at 9:10 a.m. with Staff E (Licensed Practical Nurse) confirmed Resident #150 did not have an order for self-administration of the topical anesthetic. Resident #46 Observation on 2/15/23 at 10:40 a.m. in Resident #46's room revealed 3 loose pills (2 tablets and 1 capsule) on his/her night stand. Interview on 2/15/23 at 10:40 a.m. with Resident #46 revealed staff had left the pills for him/her at approximately 8:30 a.m. Interview on 2/16/23 at 9:10 a.m. with Staff E (Licensed Practical Nurse) confirmed Resident #46 did not have an order for self-administration of medication. Review on 2/16/23 of the facility policy titled, Self-Administration of Medications revealed: 1. Residents who wish to self-administer medications are assessed by the licensed nurse to determine cognitive and physical abilities initially; then quarterly thereafter to determine whether self-administrating medications is safe and clinically appropriate for the resident.

Based on interview and record review, it was determined that the facility failed to retain the daily nurse staffing data for a minimum of 18 months. Findings include: Review on 2/17/23 of the facility's daily staffing postings requested for July - September 2022 revealed that the facility did not have the daily postings for July and August 2022. Interview on 2/17/23 at 1:42 p.m. with Staff F (Administrator) and Staff G (Staffing Coordinator) confirmed that the facility did not have the daily nurse staff postings for July and August 2022.

Based on interview and record review, it was determined that the facility failed to ensure that staff were competent to provide services for wound care for 1 out of 2 residents reviewed for pressure ulcer care in a survey sample of 23 residents. (Resident identifier is #283.) Findings include: Review on 3/3/22 at approximately 8:30 a.m. of Resident #283's wound management report from admitted d 12/14/21, competed by Staff D (Licensed Practical Nurse), revealed a stage 2 wound to sacrum described as having slough present on wound bed. Review on 3/3/22 at approximately 8:30 a.m. of Resident #283's wound management report dated 1/6/22, completed by Staff D, revealed the following description .wound healing status: improving .Stage 2 pressure ulcer to sacrum .Slough noted on entire wound bed . Interview on 3/3/22 at approximately 11:15 a.m. with Staff D revealed that they had been the facility wound nurse since approximately November/December 2021. Staff D confirmed that they assessed Resident #283's pressure ulcer on admission and weekly. Staff D stated that they staged Resident #283's pressure ulcer as a stage 2 on admission as it was not covered with slough. Staff D stated that they had not completed any competencies for wounds or wound care. Staff D stated that they are the only wound care nurse and will have the provider come in to see the wounds if they have questions or concerns. Review on 3/3/22 of the NPUAP (National Pressure Ulcer Advisory Panel) Pressure Injury Stages found at, https://cdn.ymaws.com/npiap.com/resource/resmgr/npuap_pressure_injury_stages.pdf, revealed Stage 2 Pressure Injury: Partial-thickness skin loss with exposed dermis Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister. Adipose (fat) is not visible and deeper tissues are not visible. Granulation tissue, slough and eschar are not present . Review on 3/3/22 at approximately 12:00 p.m. of Staff D's completed competency file revealed no wound care competencies had been completed to date. Interview on 3/3/22 at approximately 12:00 p.m. with Staff E (Staff Education) confirmed that Staff D had not completed any wound care competencies.

1. Based on observation, interview, and policy review, it was determined that the facility failed to ensure that medications were disposed of properly for 1 out of 30 medications observed. Findings include: Observation on [DATE] at approximately 10:15 a.m. during the observation of medication administration with Staff A (Licensed Practical Nurse) revealed Staff A dropped a [MEDICATION(S)] capsule on the top of the medication cart while preparing Resident #53's medication. Staff A disposed of the [MEDICATION(S)] capsule in a sharps container attached to the medication cart. Interview on [DATE] at approximately 10:15 a.m. with Staff A revealed that this is Staff A's practice for disposing of medication. Review on [DATE] of the facility policy titled, Disposal of Medications, Syringes and Needles, Section 5.5, dated ,d+[DATE] revealed: .Procedures .1. a. The nursing care center should maintain approved containers to separate and securely store different types of pharmaceutical waste until it is scheduled for pick up if applicable by law. .4. Medications not listed in Schedules II, III, IV and V (non controlled medications) shall be destroyed by the nursing care center as outlined below. .Transfer medication to trash receptacle following destruction to unusable consistency *Mixing medication with a commercially available undesirable substance made for medication destruction, such as RxDestroyer, DisposeRx, etc. Or, mixing medications with an undesirable substance, such as kitty litter, and putting them in impermeable, non-descript containers, such as empty cans or sealable bags; will further ensure the drugs are not diverted 2. Based on observation, interview, and manufacturer instructions review, it was determined that the facility failed to remove an expired vial of [MEDICATION(S)] used for [CONDITION(S)] testing from 1 of 1 refrigerators observed in the facility medication room. Findings include: Observation on [DATE] at approximately 9:00 a.m. in the East Wing medication room refrigerator revealed: 1 opened vial of [MEDICATION(S)] with a labeled opening date of [DATE]. Interview on [DATE] at approximately 9:00 a.m. with Staff B (Licensed Practical Nurse) confirmed the [MEDICATION(S)] vial was opened and labeled with an opening date of [DATE]. Review on [DATE] of the manufacturer's instructions for [MEDICATION(S)], dated [DATE] revealed: .Storage .Vials in use more than 30 days should be discarded due to possible oxidation and degradation which may affect potency.