The Health Center At Research Park

F-F867 for Resident's #334 and #335 and all current residents

in the facility have the potential to be affected. The Medical Director agreed with the current action plan and had no new recommendations

6. This Behavior Communication binder is brought to morning QA by a member of the Behavior Committee and reviewed during QA to determine any new or changes in behaviors, intervention implementation, and appropriateness and will be revised as necessary.

7. Upon return from a transfer when ER deems resident appropriate for return for residents sent out related to abuse, aggressive, distress, and combative behavior, and suicidal/homicidal ideations a Resident Return from Transfer Behavior assessment will be conducted. This will help us determine if behaviors are present and require interventions upon return to the facility after a transfer related to abuse, aggressive, distress, and combative behavior, and suicidal/homicidal ideations. For any resident discharged and readmitted a readmission assessment already part of the readmission process is completed to include an abuse and behavior section. On 6/18/2024 Nursing Staff educated that upon return from a transfer when ER deems residents appropriate for return for residents sent out related to abuse, aggressive, distress, and combative behavior, and suicidal/homicidal ideations a behavioral assessment should be conducted using the Resident Return from Transfer Behavior assessment form. This form will help us determine if behaviors are present and require interventions upon return to the facility after a transfer related to abuse, aggressive, distress, and combative behavior, and suicidal/homicidal ideations. Nursing Staff unavailable to receive education will not be permitted to work until the required education is completed. 20 out of 22 Nurses have been educated.

Facility implemented all corrective actions by 6/18/2024.

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After review of documentation supporting the above corrective actions, including the facility's investigation file, in-service/education records, QAPI documentation, and staff intervention, the survey team verified the facility implemented corrective actions including ongoing monitoring on 06/18/2024.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 30 of 33 015458 Department of Health & Human Services Printed: 09/23/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 015458 B. Wing 06/18/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

The Health Center at Research Park 5275 Millennium Drive Huntsville, AL 35806

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 33739

Residents Affected - Few Based on record review, interview, a review of Facility Reported Incidents, the facility's investigative files, and

review of a facility policies Medication Administration, and AMPharm Delivery Service, the facility failed to ensure controlled medications records were maintained and able to be reconciled when licensed staff failed to add medication to the control sheets and failed to place the controlled medications in the narcotic drawer

after receiving from the pharmacy for Resident Identifier (RI) #57 and RI #47.

This affected RI #47 and RI #57 and was cited as a result of the investigation of complaint/report AL00045923.

Findings Include:

A review of a facility policy AMPharm Delivery Services with an effective date of 11/2021 documented Policy: Nightly delivery is provided to each facility on a preset schedule.

Procedure: .

c. The delivery person shall present the nurse with a delivery manifest for signature . For narcotic deliveries,

the receiving nurse shall verify the medications and counts with the delivery person prior to signing the manifest.

1. Immediately upon receipt scheduled medications shall be secured in the medication cart .

RI #47 was admitted to the facility on [DATE REDACTED].

RI #57 was admitted to the facility on [DATE REDACTED].

The Facility Reported Incident submitted on 10/18/2023 at 7:06 PM indicated Registered Nurse (RN) #5 identified RI #47 and RI #57 had missing oxycodone tablets.

The facility's investigative summary indicated .

Incident type: Misappropriation of resident property

Suspected Offender: Unknown

10/18/23 it was found that (RI #47) had Oxycodone/APAP 5/325 tablets 60 pills were unaccounted for.

10/18/23 it was found that (RI #57) had Oxycodone 5 milligram tablets 30 pills were unaccounted for.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 31 of 33 015458 Department of Health & Human Services Printed: 09/23/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 015458 B. Wing 06/18/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

The Health Center at Research Park 5275 Millennium Drive Huntsville, AL 35806

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 It is substantiated that the pills are missing. But we don't know for sure what happened to them at this point.

Level of Harm - Minimal harm or On October 18th at approximately 12:45 PM 100 hall charge nurse (RN #5) reported to the DON (Former potential for actual harm Director of Nursing (FDON)) that she called the pharmacy . to inquire about oxycodone for (RI #57's room number). The (pharmacy) reported that the medication had been delivered the night before and was signed Residents Affected - Few off by two individuals. Nurse managers initiated search . No Oxycodone was found that belonged to (RI #57).

On October 18th at approximately 4:30 PM . (RN #5) notified (pharmacy) that (RI #47) was completely out of oxycodone despite (RN #5) faxing the script (prescription) to (pharmacy) the previous day. (Pharmacy) informed (RN #5) the last oxycodone script was filled and delivered . on 10/13/23 of 60 tablets.After a thorough search of the building no medications were found.

An order to (pharmacy) was called in requesting to replace the residents missing medications - replacement provided by Millennium.

Multiple attempts via phone calls and text messages to contact (RN #7) the charge nurse that signed for both cards of oxycodone were left unanswered.

(RN #7) was scheduled to work night shift on October 18th . She arrived late . stated her phone was dead . (RN #7) provided a statement . but denied any involvement in the missing medications. However, she did agree that she was the only nurse that signed for the medications that were delivered .

During an interview with RN #5 on 06/12/2024 at 11:58 AM, she said she had ordered RI #57's oxycodone

on 10/17/2023. RN #5 said on 10/18/2023 she checked the cart to confirm delivery and did not find it. RN #5 said she called the pharmacy and was told it had been delivered the night before and signed by RN #7. She said she and other nurses searched and did not find the medication, so she reported to the Director of Nursing (DON). She said she told the DON she counted with the RN #18, because RN #7 had left early. RN #5 said the counts were accurate. She said later the same day when RI #47 asked for pain medication, she went to the cart for oxycodone and there was none there, she again called the pharmacy and was told the medication delivered on 10/13/2023 and was also signed by RN #7. RN #5 said the facility was unsure about what happened to the medications and that neither resident missed a dose of the pain medication.

An unsuccessful attempt was made to contact RN #7 on 06/12/2024 at 12:15 PM.

On 06/12/2024 at 12:20 PM an interview was conducted with RN #18. RN #18 said she worked the same night as RN #7 but worked the other side of facility. RN #18 said when medications were delivered RN #7 received them and signed for them. RN #18 said she went over and got the medications for her hall later in

the shift. RN #18 said RN #7 left before her shift was over and RN #7 and herself counted the medications and the count was accurate. RN #18 said she became aware of the missing medications when she did her statement.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 32 of 33 015458 Department of Health & Human Services Printed: 09/23/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 015458 B. Wing 06/18/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

The Health Center at Research Park 5275 Millennium Drive Huntsville, AL 35806

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 On 06/14/2024 at 6:44 PM during an interview with the Regional Nurse Manager (RNM), he said RN #5 identified that RI #47 and RI #57's oxycodone was missing. The RNM said RI #47's was delivered and Level of Harm - Minimal harm or signed by RN #7 on 10/13/2023 and RI #57's was delivered and signed also by RN #7 on 10/17/2023. When potential for actual harm asked what happened to the medications, he said they did not have evidence other than RN #7 signed the delivery sheet. The RNM said RN #7 failed to follow the pharmacy processes of documenting and recording Residents Affected - Few the medication when received. The RNM said RN #7 said she left the medications unattended and was terminated.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 33 of 33 015458