Based on observation, interviews and policy review, the facility failed to properly store medications for 1 of 6 patients sampled for medication storage (Resident 195). The findings include: On 08/16/22 at approximately 10:32 AM, an observation was made of a hard plastic bin attached to the wall in Resident 195's room. Inside the bin was noted 4 insulin pens. The bin did not lock and was held closed by a magnetic latch. (Photographic evidence obtained). On 08/16/22 at approximately 10:38 AM, an interview was conducted with Staff A, a Registered Nurse (RN). Staff A, RN, stated she left the insulin pens inside Resident 195's room because Resident 195 was on isolation. On 08/16/22 at approximately 11:09 AM, an interview was conducted with Staff B, RN, who stated she did not leave insulins inside patient's rooms. She further stated facility nursing staff stored the insulins inside bins assigned to each specific patient inside the medication room while not in use. On 08/16/22 at approximately 12:42 PM, an interview was conducted with the Director of Nursing (DON) who stated that after the observation of the insulin pens the facility had conducted an in-service, with staff in the building, educating everyone on proper medication storage and that this education. The DON further stated there was not a facility procedure or policy to store insulin pens inside isolation rooms. Facility Policy and Procedure Drug Storage Security dated 06/02/2008, revised 09/09/2021, was reviewed. Procedure stated if not administered or used, the drug should be returned to the return bin for non-controls and waste for controls within 30 minutes.

Based on observations, staff interviews, record review, and facility's policy review, the facility failed to ensure a resident (Resident # 35) receiving enteral feeding received appropriate care and services to prevent complications of enteral feeding on 1 of 1 resident sampled. The findings are: On 6/7/2021 at approximately 11:21 AM, resident # 35's enteral feeding tubing and bag were dated 6/6/21 at 6:57 AM, while feeding pump was in use at 40 mililiters per hour (ml/hr). On 6/8/2021, at approximately 11:23 AM, resident # 35's enteral feeding tubing and bag were dated 6/6/2021 at 6:57 AM, while feeding pump was in use at 40 ml/hr. On 6/8/2021 at approximately 4:40 PM, an interviewed was conducted with Staff A, a Licensed Practical Nurse (LPN), who stated that the enteral feeding tube and bags were changed every 24 hours and that resident # 35's feeding tubing and bag should have been changed on 6/7/2021. On 6/9/2021 at approximately 9:41 AM, an interview was conducted with the Director of Nursing (DON), who revealed that facility's enteral feeding tubing and bags were changed every 24-48 hours depending the system and resident #35's enteral feeding tubing and bag were supposed to be changed every 24 hours. A review of resident # 35's medical record revealed that the resident had a gastrostomy tube (a surgically inserted tube through the wall of the abdomen directly into the stomach to allow medications and liquids including liquid foods) placed on 5/28/2021 and feedings via gastrostomy tube were initiated on 6/4/2021. A review of the clinical progress notes dated 6/5/2021 at 6:45 AM, revealed that feeding tube was not flushing and needed to be de-clogged. A review was conducted of Facility's policy on Enteral Nutrition dated 8/2004 and revised on 1/15/2021 read: enteral nutrition bags, bottles, tubing, irrigation set or syringes will be changed every 24 hours. On 6/10/2021 at approximately 10:04 AM, an interview was conducted with Staff B, LPN, who revealed that feeding tubes could clog if they were not changed every 24 hours.