Montereau Inc: Care Quality Deficiencies Found - OK
On October 27, inspectors watched LPN #2 walk away from an unlocked cart on the second floor, leaving it unattended for minutes. The cart contained insulin, Narcan opioid reversal medication, lidocaine pain patches, antiseptics, and wound cleaners.
When questioned, LPN #2 admitted keeping the key hidden under trash bags in an open compartment on the cart's side "for easy access." They acknowledged medications were stored in the cart and said the protocol required keeping carts locked, but couldn't explain why it remained open and unattended.
"They stated they left the keys in the side compartment for easy access to the cart," inspectors wrote. After the interview, LPN #2 walked away again without locking the cart.
Another nurse, LPN #3, eventually secured the cart and told LPN #2 to "Keep that cart locked."
The next day, inspectors found a second treatment cart unlocked on the first floor. This cart sat around the corner from the nurses' station with its lock facing away from staff view. The Director of Nursing walked directly past the unsecured cart without acknowledging it.
A nursing assistant stopped at the unlocked cart to grab gloves before entering a resident's room. When confronted, LPN #1 admitted responsibility, saying "they forgot to lock the cart."
The Director of Nursing told inspectors that carts should be locked when out of sight and keys kept on nursing staff. They claimed to monitor cart security through facility rounds.
Federal regulations require all medications to be stored in locked compartments. The facility operates six treatment carts and six medication carts throughout the building.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Montereau, Inc. from 2025-11-21 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 20, 2026 · Our methodology
Montereau, Inc. in Tulsa, OK was cited for violations during a health inspection on November 21, 2025.
On October 27, inspectors watched LPN #2 walk away from an unlocked cart on the second floor, leaving it unattended for minutes.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.