**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations and staff interviews, the facility failed to discard an expired Novolog insulin flex pen from 1 of 4 medication carts observed. (300-hall medication cart) Findings included: A review of the Resident #33's Medication Administration Records (MAR) for [DATE] and [DATE] revealed she received Novolog Insulin flex pen for sliding scale coverage of blood sugars readings. She received one dose of Novolog Insulin on [DATE] and received twenty-two doses of Novolog Insulin in January: [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE] and [DATE]. An observation of the 300-hall medication cart was conducted on [DATE] at 11:23 a.m. in the presence of Medication Aide #1 who was assigned to the 300-hall medication cart. Resident #33's Novolog Insulin flex pen (100 units per milliliter) label was observed with [DATE] written as the date opened and the expiration date written as [DATE]. The label indicated the medication was to be discarded twenty days after opening. In an interview with Medication Aide #1 on [DATE] at 11:23 a.m., she stated the Infection Preventionist was responsible for checking the 300-hall medication cart, and nurses administered insulin to her residents. She said Resident #33 received Novolog Insulin as needed for elevated blood sugars and read the expiration date as [DATE] on the Novolog Insulin flex pen. On [DATE] at 11:27 a.m. the Director of Nursing (DON) observed Resident #33's Novolog Insulin flex pen from the 300-hall medication cart. She stated she could not tell if the open date was written as [DATE] or [DATE], and the expiration date written looked like [DATE]. Medication Aide #1 re-examined the Novolog flex pen and stated the open date written on the label looked like [DATE], and the expiration date written looked like [DATE]. She said she did not think Resident #33 had received Novolog Insulin on [DATE]. The DON disposed of Resident #33's Novolog Insulin Flex pen in a sharp container. In an interview with the DON on [DATE] at 11:32 a.m., she said the pharmacy checked the medication carts monthly, the Infection Preventionist (IP) checked the medication carts weekly, and the nursing staff checked the medication carts each shift and before administering medications to residents for expirations. She further stated the IP was to check the medication carts and medication rooms daily during the survey that week. An interview with the Infection Preventionist (IP) on [DATE] at 2:51 p.m., she stated she was responsible for checking the medications carts and medication rooms monthly, and she had checked the 300-hall medication cart on [DATE] and did not recall Resident #33's Novolog Insulin flex pen on the 300-hall medication cart. She disclosed medication carts and medication rooms should be checked weekly, and she had not been checking the medication carts and medication rooms weekly. She said she checked the medication rooms on Monday ([DATE]) and had not checked the medication carts that week as directed by the DON. On [DATE] at 3:00 p.m. in an interview with Nurse #1, she stated she administered Resident #33 her Novolog Insulin per sliding scale on [DATE] and could not recall using the Novolog Insulin flex pen dated with an expiration date of [DATE] and checking the expiration date on the label of the Novolog Insulin. She stated when a new insulin vials or flex pens were opened, the date opened and the expiration date which was 28-30 days after opening depending on the type of insulin was written on the label. She further stated the expirations date on insulin should be checked before administering insulin to Resident #33. A written statement dated [DATE] from Nurse #1 to the Director of Nursing revealed Nurse #1 wrote she could not specifically remember checking Resident #33's Novolog Insulin expiration date on [DATE] and she always checked the expiration dates. When she was done with the Novolog Insulin pen, she returned the Novolog Insulin pen to Medication Aide #1 who disposed of the Novolog Insulin Flex pen in the sharp container because it was empty. Therefore, the Novolog Insulin flex pen found on the 300-hall medication cart on [DATE] expired could not have been the Novolog Insulin flex pen used on [DATE]. A written statement not dated from Medication Aide #1 to the Director of Nursing revealed Nurse #1 returned Resident #33's Novolog Insulin flex pen to Medication Aide #1 on [DATE]. There was no more insulin in Resident #33's Novolog Insulin flex pen, and Medication Aide #1 discarded the Novolog Insulin flex pen into a sharp container on [DATE]. Medication Aide #1 wrote the Novolog Insulin flex pen found on 300-medication cart on [DATE] was not the one used for Resident #33 on the evening of [DATE]. On [DATE] at 10:03 a.m. in a phone interview with Pharmacist #1, she stated she randomly checked the contents of one medication cart and one medication room for expirations monthly. The last pharmacy medication cart check was performed on [DATE], and she checked the 100-hall medication cart. On [DATE] at 9:53 a.m. in a phone interview with Pharmacist #2, she disclosed pharmacy records showed Resident #33 was dispensed a Novolog Insulin Flex Pen 100 units per milliliter on [DATE] and [DATE] to the facility. She stated the Novolog Insulin flex pen expired after 28 days of removing from the refrigerator and opened.