Based on record review and interview it was determined that the facility failed to develop a Comprehensive Care Plan for 2 of 5 residents reviewed for unnecessary medications in a final sample of 13 residents (Resident Identifiers #9 and #8). Findings include Resident #9 Review on 3/6/24 of Resident #9's medical record revealed that Resident #9 was receiving Effexor (antidepressant medication) ER (extended release). Further review of the medical record revealed that there was not a care plan developed to address the resident's depression or Effexor ER. Interview on 3/7/24 at 2:20 pm with Staff C (Director of Nursing) confirmed the above findings. Resident #8 Review on 3/6/24 of Resident #8's medical record revealed that Resident #8 has a diagnosis of major depressive disorder and that Resident #8 was receiving Celexa (antidepressant medication). Further review of the medical record revealed that there was not a care plan developed to address the resident's depression or Celexa. Interview on 3/7/24 at 2:20 pm with Staff C confirmed the above findings Review on 03/07/24 of the facility's policy titled Utilization and Documentation of Psychotropic Medications dated 11/1/2017 revealed: .Psychotropic Drugs .Residents receiving any psychotropic medications will have: A care plan that describes awareness by the resident, and or responsible party, of the medication, the purpose, as well as potential side effects.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, it was determined that the facility failed to ensure that medications are administered following professional standards for 1 out of 33 medications observed during medication administration (Resident Identifier #23). Findings include: Standards: Review of Clinical Nursing Skills and Techniques, [NAME] A. [NAME] and [NAME], Mosby, 2018, 9th Edition, revealed the following: page 543 Administering Ophthalmic Medications .7a. Apply clean gloves. Observation on 3/7/24 at approximately 7:30 a.m. of Staff B (Licensed Practical Nurse) during medication administration revealed that Staff B administered eye drops into Resident #23's bilateral eyes without wearing gloves. Interview on 3/7/24 at approximately 7:30 a.m. with Staff B confirmed the above findings. Review on 3/7/24 of the facility policy titled Medication Administration Eye Drops dated 1/23 revealed: .Equipment . Gloves, per facility policy . Procedures . 8. With a gloved finger, gently pull down lower eyelid . 13. If administering to both eyes, use a different gloved finger to apply pressure to the inner tear duct .

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, it was determined that the facility failed to ensure that expired medication was removed from 1 of 2 medication carts observed and failed to ensure that opened multi-dose vials had the date of opening labeled on them in 1 of 1 medication rooms observed. Findings include: Lilac Unit Medication Cart Observation on [DATE] at approximately 8:00 a.m. of the Lilac Unit Medication Cart revealed a vial of Levemir insulin for Resident #25 with a handwritten date of [DATE]. The date did not specify if it was an open date or an expiration date. Interview on [DATE] at approximately 8:00 a.m. with Staff A (Licensed Practical Nurse (LPN)) confirmed the above finding. Medication Room Observation on [DATE] at approximately 8:20 a.m. of the facility's medication room revealed an opened and undated vial of Tuberculin Purified Protein Derivative (Mantoux) in the medication refrigerator. Interview on [DATE] at approximately 8:20 a.m. with Staff B (LPN) confirmed the above finding. Review on [DATE] of the facility's policy titled Medication Ordering and Receiving From Pharmacy Provider, Medications and Medication Labels dated 1/23 revealed: .2. Multi-dose vials shall be labeled to assure product integrity, considering the manufacturers' specifications. (Example: Modified expiration dates upon opening the multi-dose vial.). Nursing staff should document the date opened on multi-dose vials on the attached auxiliary label . Review on [DATE] of the manufacturer's instructions for Tuberculin Purified Protein Derivative (Mantoux), undated, revealed: .Storage . A vial of Tubersol which has been entered and in use for 30 days should be discarded . Review on [DATE] of the manufacturers instructions for Levemir insulin, dated 12/22, revealed: .After vials have been opened: .Throw away all opened Levemir vials after 42 days, even if they still have insulin in them .