NeuroRestorative: Expired Meds, Missing CPR Certs - NV

Federal inspectors discovered expired medications stored alongside active supplies in every medication storage area they examined during a February inspection of the specialized care facility on Lake Placid Drive. The violations put residents at risk of receiving ineffective or potentially harmful treatments.

The most glaring example occurred on the 400 unit, where inspectors found a bottle of Diphenhydramine Hydrochloride oral solution that had expired in January 2025 sitting in a medication cart with active medications. The Licensed Practical Nurse confirmed the medication had expired at the end of January but remained accessible to staff preparing resident doses.

In the same unit's medication storage room, inspectors discovered three bottles of iron supplement liquid that expired in December 2024 and a bottle of Geri-Tussin cough medicine that expired in October 2024. All remained in cabinets designated for active medications.

The pattern repeated throughout the facility. On the 300 unit, a bubble pack containing 12 tablets of Ondansetron, an anti-nausea medication, sat expired since January in another medication cart. The Registered Nurse acknowledged the tablets had expired and explained that facility protocol required removing expired medications and placing them in a designated disposal bin.

But the protocol clearly wasn't working.

In the 200 unit medication storage room, inspectors found two boxes of Bisacodyl suppositories, both expired in January 2025. One box contained 36 remaining suppositories, the other had 100. A Registered Nurse confirmed both boxes had expired but remained stored with active medications instead of being moved to the disposal area.

The Director of Nursing acknowledged that expired medications could be administered to residents by mistake if not properly removed from active storage areas. The facility's own policy, revised in August 2024, required medications with expired dates to be stored separately from active supplies until destroyed or returned to the pharmacy.

The medication safety violations weren't the only staffing problems inspectors uncovered.

Two direct care employees worked at the facility without current CPR certification, despite the facility's own assessment stating all staff would be Basic Life Support certified. Employee 14, a Licensed Practical Nurse, had CPR certification that expired before the inspection. Employee 16, a Certified Nursing Assistant, also worked with expired CPR credentials.

The Office Manager confirmed both employees lacked current CPR certification, acknowledging it was required for all direct care staff. The deficiency could result in delayed or inadequate life-saving care if a resident required CPR while awaiting emergency medical personnel.

NeuroRestorative's problems extended beyond immediate safety concerns to fundamental care delivery failures.

A resident with spastic quadriplegic cerebral palsy and muscle weakness missed two weeks of ordered physical therapy in February due to staffing shortages in the rehabilitation department. The resident required weekly hour-long physical therapy sessions to improve strength, endurance, and balance, according to a physician's order from January.

Progress notes showed the resident received physical therapy on January 16, 21, and 30, and February 19. But from February 2 through February 15, no therapy occurred despite the continuing physician's order.

The Regional Support Director of Nursing confirmed the rehabilitation department had been short-staffed and acknowledged the resident should have received weekly therapy sessions as ordered. The resident's care plan emphasized the importance of physical therapy for someone at high fall risk due to cerebral palsy and muscle weakness.

The facility also failed basic assessment accuracy requirements. Inspectors found an admission assessment that incorrectly documented significant weight loss for a resident who had actually maintained stable weight. The MDS coordinator confirmed the resident showed no weight loss by the assessment date, but the error remained in the official record used for care planning.

Perhaps most troubling, the facility violated its own policies regarding psychiatric medications without implementing required safeguards.

Five residents received antidepressants, anti-anxiety medications, or other psychiatric drugs without the pre-restraining assessments required by facility policy. These assessments help ensure psychiatric medications aren't used inappropriately as chemical restraints.

One resident received Sertraline for anxiety without proper consent documentation, violating facility policy that prohibits administering psychiatric medications without prior written consent. The Regional Support Director of Nursing admitted the facility hadn't conducted pre-restraining assessments for any residents receiving psychiatric medications.

The facility's Quality Assurance and Performance Improvement committee failed to address infection control deficiencies related to Enhanced Barrier Precautions for residents with chronic wounds or indwelling medical devices. The Administrator acknowledged no Enhanced Barrier Precautions were implemented despite identifying the concern in January.

NeuroRestorative's annual facility assessment contained another significant gap. Despite caring for both pediatric and adult residents, the assessment only addressed the pediatric population and omitted any consideration of ethnic, cultural, or religious factors that could affect care delivery.

The Administrator acknowledged the assessment should have included all resident populations and cultural considerations but confirmed these elements were missing from the January 2025 assessment.

The inspection revealed a facility struggling with basic operational requirements across multiple departments. From expired medications sitting alongside active drugs to missing CPR certifications among direct care staff, the violations suggest systemic problems with oversight and quality assurance at the specialized care facility.

Full Inspection Report

The details above represent a summary of key findings. View the complete inspection report for Caremeridian LLC, Dba Neurorestorative from 2025-02-21 including all violations, facility responses, and corrective action plans.

Additional Resources

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