Based on observation, interview and record review it was determined that the facility did not provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident. Specifically, the facility did not have a process in place to destroy narcotics when not administered to the residents. Resident identifiers: 129 and 130. Findings included: On 3/13/24 at 8:30 AM, an observation was made of the facility medication cart located on the South hallway with Licensed Practical Nurse (LPN) 1. The following medications were observed inside: a. A multi dose medication card which held Oxycodone 5 mg (milligram) had the back of pocket number 23 was opened with tape now closing it, there was no medications observed in the pocket. The bottom of the narcotic card, under the waste section, had a note written by a staff member that documented, the Oxycodone had been taped closed back into pocket number 23 after the resident refused it. b. A multi dose medication card which held Hydrocodone - APAP (Acetaminophen) 5-325 mg had the back of pocket number 2 was opened with tape now closing it, there was no medication observed in the pocket. No information was documented under the waste section of the form to explain what happened to the narcotic. c. A multi dose medication card which held Oxycodone 10 mg had the back of pocket number 25 was opened with tape now closing it, there was no medication observed in the pocket. No information was documented under the waste section of the form to explain what happened to the narcotic. On 3/13/24 at 8:30 AM, an interview was conducted with LPN 1. LPN 1 stated when a narcotic needed to be discarded it was done by two nursing staff, if available. And the narcotic was put in the sharps container. If two staff were not available LPN 1 stated they had been told that it was okay to tape the narcotic back in the the medication card for future use. LPN 1 stated the staff would circle the number on the narcotic sheet of the pill that was taped back in. LPN 1 stated the medication would then be used when the resident needed that medication again. LPN 1 stated she was unsure how future staff would know if the correct medication had been placed back into the medication card or if the medication was kept clean by the previous nurse. LPN 1 stated she was unsure what the correct process was. On 3/13/24 at 9:00 AM, an interview was conducted with Registered Nurse (RN) 1. RN 1 stated two nurses would dispose of a narcotic and sign it out in the narcotic book. RN 1 stated she did not know what to do if there was only one nurse on duty and a narcotic needed to be wasted. RN 1 stated, you would need to keep it right, and put it back in? RN 1 then stated she just did not know because she had not been faced with that or been told what to do in that situation. On 3/13/24 at 10:16 AM, an interview was conducted with the Director of Nursing (DON). The DON stated the staff were expected to sign out a narcotic when they get it from the cart. The DON stated when the nurses waste a narcotic they were supposed to waste it with another nurse, if another nurse is not available then the nurse could place the narcotic in a cup and save it to waste when the next nurse came on shift. The DON stated a wasted medication would be one that was dropped, the nurse popped out the wrong medication, or refused by the resident. The DON stated it would be a nursing judgement call whether the medication needed to be discarded. The DON stated she was unsure if the facility had a procedure for disposing of medications. The DON stated the medications could be taped back into the medication card and used again. The DON stated the nurses would have to trust the previous nurse who put the medication in the card that it was the correct medication and that is was kept clean. The DON stated the nurses were not expected to write anything on the narcotic sheet under the waste section if they taped it back into the card, only if they wasted the medication.