**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, resident and staff interviews, record review, and review of the facility policies titled, Self -Administration of Drugs, the facility failed to ensure two of 25 residents (R) (R59 and R87) did not have unsecured, unauthorized medications stored at the bedside. This deficient practice had the potential to allow unauthorized access of medications to other residents and visitors in the facility. Finding include: Review of the facility policy titled, Self-Administration of Drugs dated 12/29/2023 under intent: It is the intent to promote safe medication administration practices for patients that choose to self-administer medications. Procedure: should the patient wish to self -administer his or her own drugs or medications, the patient should be permitted to do so; The care planning team should assess each patient's mental physical and visual ability to determine if the patient is capable of self-administration of drugs and medications. Record review for R59 revealed the following diagnoses but not limited to hypokalemia, hypertension, unspecified dementia, psychotic disturbance, and anxiety. The Quarterly Minimum Data Set (MDS) dated [DATE] assessed a Brief Interview for Mental Status Score (BIMS) of 13 indicating resident had little to no cognitive impairment. Observation on 3/5/2024 at 12:08 PM of R59's revealed an over the counter (OTC) medication (bottle) labeled cold Vicks for humidifier (at the bedside) positioned in a 2-tier plastic pulled out drawer container within view. At the time of observation, R59 reported using the medication last month for prior cold symptoms. She reported that her family brought the medication into the facility. An interview on 3/5/2024 at 12:10 PM, with Licensed Practical Nurse (LPN) AA confirmed the medication at the bedside and reported being unaware of medication at the bedside of R59. Further interview revealed LPN AA confirmed that R59 was not evaluated/ assessed to self-administer medications and She removed the medication from the room. LPN AA reported that the resident could possibly be at risk of an adverse drug reaction that would result from receiving duplicate cold medications from the nurse as well. Review of the clinical record for R59 did not reveal a completed assessment for Self-Administration of Medications. Record review for R87 revealed the following diagnoses but not limited to chronic obstructive pulmonary disease and cognitive communication deficit. The admission MDS dated [DATE] revealed a BIMS score of 15 indicating resident had little to no cognitive impairment. Review of physician order form (POF) documented the following medication of similar value: Ventolin HFA 90 mcg/actuation Aerosol Inhaler (albuterol sulfate) two HFA (hydrofluoroalkane) Aerosol Inhaler Inhalation every four hours as needed SOB (shortness of breath)/Wheezing. Observation on 3/5/2024 at 12:18 PM revealed an OTC medication labeled Equate Nasal Spray stored on R87s' bedside table in view. R87 reported occasionally taking the medication every now and then that she had purchased a month ago while being diagnosed with COVID. Observation and interview on 3/5/2024 at 12:25 PM, with Resident Care Coordinator (RCC) Register Nurse (RN) BB confirmed the medication at R87's bedside. She confirmed that the resident had not been evaluated/assessed to self-administer medications and was unaware of the medication being in the residents' room. RN BB further reported that in order for any resident to self-administer medications a physicians' order is required followed by a self-administration assessment evaluation. RN BB removed the med from the room. Review of the clinical record for R87 did not reveal a completed assessment for Self-Administration of Medications. Interview on 3/7/2024 at 3:29 PM, the Director of Nursing (DON) confirmed that both residents R59 and R87 were not assessed for self-administration of medications. She reported that resident admission package includes a form stating prohibited items in the facility. She reported that her expectation is that her nursing staff monitor the resident 's to ensure there are no medications stored at the bedside that they have not been assessed to have.

Based on observations, staff interviews, record review, and review of the facility policy, titled, Patient's Plan of Care the facility failed to follow the care plan for one of 20 Residents (R) R85 that required assistance with Activities of Daily Living (ADL). Findings include: Review of the facility policy titled, Patient's Plan of Care, dated 12/29/2023 revealed under Intent: to promote person-centered comprehensive care plan. Under Guideline: Each patient will have a person-centered comprehensive care plan developed and implemented to meet his or her other preferences and goals, and address the patient's medical, physical, mental, and psychosocial needs. Record review revealed in Quarterly Minimum Data Set (MDS) Section C - Brief Interview for Mental Status (BIMS) was a 15 indicating resident had little no cognitive impairment; section GG - Functional Limitation in Range of Motion - impairment both sides upper extremity; impairment on one side lower extremity; uses wheelchair; needs set up or clean up assistance with eating; she is dependent on staff for oral hygiene, toileting hygiene, shower/bath, upper and lower body dressing, and personal hygiene. Medical Diagnosis include Chronic obstructive pulmonary disease, Heart failure, Pain, Restless legs syndrome, Need for assistance with personal care, Muscle weakness (generalized, osteoarthritis, Contracture of muscle, right lower leg. Review of the resident care plan revealed a problem noted as Self care deficit with Goal og Patient will accept assistance with ADL's and needs will be met during review period. Interventions Assist with ADL's as needed. Observation and interview on 3/5/2024 at 10:15 am with R85, she was observed lying in bed; right leg contracted towards chest; her hands are contracted, and she states she cannot open them; on the right hand the nails are digging into her hand and the skin is broken; she tried to put a towel in her hand, but it was too big. The towel is laying in the bed. Interview on 3/6/2024 at 9:01 am with Licensed Practical Nurse (LPN) JJ revealed she confirmed the Resident's right hand was contracted and her fingernails were digging into her hand. The nurse looked at the hand and stated she needs something in her hand to prevent injury to her skin. During an interview with R85 on 3/7/2024 at 10:13 am She confirmed her nails were cut on yesterday. Interview on 3/7/2024 at 2:48 PM with Director of nursing (DON) revealed the bath sheet for R85 was reviewed, and it did not indicate if nail care was provided; the DON says CNAs are educated to provide nail care as needed and the care is expected to be provided. Further interview revealed there is no documentation on the bath sheets for nail care specifically.

Based on observations, resident interview, staff interviews, and review of the facility policy titled, Care of fingernails/Toenails, the facility failed to ensure that nail care was provided for one of 20 residents (R) R85 with contractures. Findings include: Review of the facility policy titled, Care of fingernails/Toenails, dated12/29/2023 under Intent: It is the intent of this center to provide appropriate nail care to patients. Record review revealed the Quarterly Minimum Data Set (MDS) Section C - Brief Interview for Mental Status (BIMS) was a 15 indicating resident had little to no cognitive impairment; section GG - Functional Limitation in Range of Motion - impairment both sides upper extremity; impairment on one side lower extremity; uses wheelchair; needs set up or clean up assistance with eating; she is dependent on staff for oral hygiene, toileting hygiene, shower/bath, upper and lower body dressing, and personal hygiene. Medical Diagnosis include Chronic obstructive pulmonary disease, Heart failure, Pain, Restless legs syndrome, Need for assistance with personal care, Muscle weakness (generalized, osteoarthritis, Contracture of muscle, right lower leg. Observation and interview on 3/5/2024 at 10:15 am with R85, she was observed lying in bed; right leg contracted towards chest; her hands are contracted, and she states she cannot open them; on the right hand the nails are digging into her hand and the skin is broken; she tried to put a towel in her hand, but it was too big. The towel is laying in the bed. There is no splint or other device in her hands. Interview on 3/6/2024 at 9:01 am with Licensed Practical Nurse (LPN) JJ revealed she confirmed the Resident's right hand was contracted and her fingernails were digging into her hand. The nurse looked at the hand and stated she needs something in her hand to prevent injury to her skin. Interview on 3/7/2024 at 9:14 am with Certified Medication Aide (CMA) HH revealed the resident can make her needs known, she is total care, she can feed herself; nail care is with every bath and as needed. Further interview revealed that R85 gets her bath at night and would usually get her nails done at that time. During an interview with R85 on 3/7/2024 at 10:13 am She confirmed her nails were cut on yesterday. Interview on 3/7/2024 at 2:48 PM with Director of nursing (DON) revealed the bath sheet for R85 was reviewed, and it did not indicate if nail care was provided; the DON says CNAs are educated to provide nail care as needed and the care is expected to be provided. Further interview revealed there is no documentation on the bath sheets for nail care specifically.