**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to ensure medications were secured/locked when not attended to for 1 (hall 200) of 2 medication/treatment carts observed for medication storage. The administrator identified 69 residents resided in the facility. Findings: On 04/15/25 at 10:19 a.m., a medication cart was observed unlocked on hall 200 in front of room [ROOM NUMBER]. There was no staff present. A policy titled Storage of Medications, dated 01/2022, read in part, Medications and biologicals are stored safely, securely .The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications .Medication carts and medication supplies are locked when not attended by persons with authorized access. On 04/15/25 at 10:20 a.m., ACMA #1 returned to the cart and was asked if the medication cart was locked. They looked and stated, No, I thought I locked it as the top drawer does not always lock. I just pushed it in and it must have popped open when I walked away. ACMA #1 was asked if it was reported to maintenance. They stated it had not been reported as it happened this morning. ACMA #1 stated they did not normally work on that cart and their pharmacy consultant was currently there and they were going to report it to them. On 04/15/25 at 10:23 a.m., ACMA #1 stated they alerted the pharmacy consultant immediately.

Based on record review, observation, and interview, the facility failed to ensure the physician prescribed about of formula was administered to one (#2) of two sampled resident reviewed for nutrition. The Resident Census and Conditions of Residents report, dated 12/06/22, documented two residents required tube feedings. Findings: Resident #2 had diagnoses which included aphasia and protein calorie malnutrition. A Resident Assessment, dated 09/12/22, documented the resident received tube feedings. A Physician's Order, dated 10/21/22, read in parts, .Enteral Feed .four times a day Give 1.5 cartons (350 cc) Glucerna 1.5 via peg tube Q 6hrs for PROTIEN [sic] -CALORIE MANLNUTRION [sic] . On 12/07/22 at 8:43 a.m., LPN #1 was observed to pour Glucerna 1.5 into a water pitcher that was marked in ounces and cc's. The amount of formula LPN #1 poured into the water pitcher measured halfway between the 300 cc mark and the 350 cc mark, and halfway between the 10 and 12 ounce mark. LPN #1 was observed to look at the formula and stated, 350, right? LPN #1 was observed to administer the 325 cc's of formula to Resident #2. On 12/07/22 at 9:12 a.m., the DON was asked how staff ensured they administered the physician ordered amount of formula. She stated by checking the orders and measuring the formula using a graduated measuring container. She was made aware of the above observation.

Based on observation and interview the facility failed to ensure clean plates and bowls were stored inverted or covered to prevent exposure to contamination. The Resident Census and Conditions of Residents report, dated 12/06/22, documented 74 residents resided in the facility and two residents received tube feedings. Findings: Title 310. Oklahoma State Department of Health, Chapter 257. Food Establishments, 310:257-7-105. Equipment, utensils, linens, and single-service and single-use articles, read in part, .(b) Clean equipment and utensils shall be stored .(2) Covered or inverted . On 12/07/22 at 10:44 a.m., clean plates were observed in the plate holder with the food surface side up. Additional clean plates and bowls were observed stacked along the side of the steam table with the food surface side up. On 12/07/22 at 10:45 a.m., the Dietary Manager was asked where clean dishes were stored after they were air dried. The Dietary Manager pointed out the clean serving plates uncovered and not inverted stored in the plate holder. They were asked if the dishes were stored properly. The Dietary Manager stated, Yes. They were informed that clean dishes are required to be stored inverted or covered. They stated, I will correct it right away.

Based on observation and interview, the facility failed to ensure the laundry room was maintained in safe operating conditions by not cleaning out the lint traps for two of two dryers observed. The Resident Census and Conditions of Residents report, dated 12/06/22, documented 74 residents resided in the facility. Findings: On 12/08/22 at 11:59 a.m., a tour of the laundry room was conducted. An observation was made of two dryers in the laundry room. There was a build up of half an inch to one inch of lint observed on the floor once the lids to the lint traps were opened. Housekeeper #1, who was present during the observation, stated that they weren't sure when the lint traps were last cleaned. They were asked to provide the cleaning log for the lint traps and were unable to locate the log. The dryer vent lid had a sticker that read it was to be cleaned every day. On 12/08/22 at 12:10 p.m., the Maintenance Supervisor stated there used to be a cleaning schedule posted in the laundry room. A cleaning log was not located. The Maintenance Supervisor stated they cleaned the lint traps every Friday. He was asked how often the lint traps should be cleaned. The Maintenance Supervisor stated they were unsure. On 12/08/22 at 1:26 p.m., the Administrator stated there was not a policy on cleaning the lint traps.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, and interview, the facility failed to provide maintenance services necessary to ensure the following: a. a sanitary and comfortable interior for one (#20) of 24 sampled residents reviewed for homelike environment, and b. odors did not linger on one unit (Route 66- Hall 300) of three units observed for odors. The Resident Census and Conditions of Residents report, dated 12/06/22, documented there were 74 residents residing in the facility. There were 27 residents residing on Route 66 - Hall 300. Findings: A Maintenance policy, dated 06/27/06, read in parts, .This facility shall provide a safe, functional, sanitary and comfortable environment for residents .and assure the good repair of the entire facility . 1. Resident #20 had diagnoses which included hypertension and heart disease. A Comprehensive Resident Assessment, dated 06/16/22, documented Resident #20's cognition was moderately impaired. On 12/06/22 at 1:37 p.m., Resident #20 was observed in their room. There was a blanket observed to be rolled up on the floor between the toilet and the wall in their bathroom. The base board was pulled away from the wall and the drywall was wet and deteriorated behind the base board. Resident #20 was asked why the blanket was on the bathroom floor. They stated there had been a leak next to the toilet for about two to three weeks. Resident #20 was asked if staff were aware of the issue. They stated they must be, because they were the ones putting the blankets down. A Completed Work Orders log, dated January 2022 through November 2022, had no documentation of the water leak in Resident #20's bathroom. On 12/07/22 at 12:49 p.m., the Maintenance Supervisor was shown Resident #20's room and asked why the blanket was on the floor. He stated he didn't know why the blanket was there, but the wall looked wet. He was asked if anyone had reported this issue to him. He stated, No, but it looks like I need to get on it. On 12/07/22 at 12:55 p.m., the Administrator was shown Resident #20's bathroom with the rolled up blanket between the toilet and the wall, baseboard pulled away from the wall, and the drywall wet and deteriorated. The Administrator stated she was not aware of the issue and would call the plumber. 2. On 12/06/22 at 10:00 a.m., upon arriving on hall 300, a strong urine odor was noted in the hallway at the nurses' station. On 12/06/22 at 12:00 p.m., a strong urine odor was noted when passing 300 hall nursing station and in the sitting area on hall 300. A strong urine odor could be smelled in the hall outside of room [ROOM NUMBER]. On 12/07/22 at 8:07 a.m., a strong urine odor was noticed in the 300 hall at the nurses' station. RN #1 was observed at nurses' station on hall 300. RN #1 was asked if they smelled an odor in the hallway. They stated, That urine smell may be coming from room [ROOM NUMBER]. I see the housekeepers are in there two to three times a day. That gentleman has a dog and he's not a very clean person. On 12/07/22 at 8:10 a.m., the floor tech was observed cleaning the floor around the nurses' station on hall 300. They were asked if they smelled an odor in the hallway. The floor tech stated, I do not smell anything, but I will check around for a possible cause. On 12/07/22 at 8:46 a.m., there was a very strong urine odor on hall 300 between rooms [ROOM NUMBERS]. On 12/07/22 at 11:07 a.m., the DON was asked about the strong urine odor present around the nurses' station on hall 300. The DON stated they were aware of the lingering odor on Route 66 [hall 300] near the nurses' station. They were asked what the facility policy was on maintaining an odor-free environment. The DON stated, Housekeeping should address problems with odors immediately when present. They were asked what was causing the strong urine odor around the nurses' station on hall 300. The DON stated, There are two residents on that unit that urinate on the floor. When we see the problem we try to address it immediately. All the rooms have individual heaters and that makes it worse. She was asked what was being done to eliminate the problem. The DON stated, We try to educate and investigate as much as we can. We have increased cleaning and changing of residents there. We have increased housekeeping hours on that unit during the week and on the weekends. We moved the DON office to that hall to help monitor and improve opportunities for education. On 12/08/22 at 8:17 a.m., the Administrator stated the tile in rooms [ROOM NUMBERS] had odors trapped in them from the lift station backing up into the rooms the through the toilets. She stated the lift station has been repaired multiple times, but the tile continued to have the odors trapped in it. She stated they had increased housekeeping in those rooms, but due to the smell being trapped in the tile, they were unable to get rid of the odor.