Golden Age Care Center
Inspection Findings
F-Tag F0761
F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, staff interviews, record review and the facility policy review the facility failed to keep all medications in a locked medication cart, inaccessible to unauthorized staff and residents. The facility reported a census of 40 residents. Findings include: The Minimum Data Set (MDS) dated [DATE REDACTED] documented Resident #1 entered the facility on 7/22/22. The MDS also documented a Brief Interview of Mental Status (BIMS) of 09 indicating moderate cognitive impairment. The MDS documented diagnoses of non-Alzheimer's dementia, diabetes, and depression. Review of Resident #1 physician orders revealed Hydrocodone-Acetaminophen (pain medication) tablet 5-325 mg. Give 1 tablet by mouth at bedtime for pain dated 9/5/24. The Care Plan for Resident #1 documented a focus area for pain related to history of back and leg pain at times and usually takes medication at bedtime, date Initiated 11/10/22.Review of document titled Controlled Drug Receipt/Record Disposition Form for Resident #1 for Hydrocodone-Acetaminophen tablet 5-325 mg revealed count of -1 tablet entry on 10/11/25 at 8:05 pm with a signature of Staff A, Licensed Practical Nurse (LPN). A review of the facility reported incident revealed Director of Nursing (DON) was notified an incident at the facility that occurred on 10/11/25 around 9 pm, Staff A reported leaving Hydrocodone medication for Resident #1 unattended in her room on the bedside table then stepping out of the room to attend to another task prior to observing Resident #1 swallowing the medication. While Staff A was out of Resident's #1 room she observed Staff B, Certified Nursing Assistant leaving Resident's #1 room. Staff A, LPN went back to Resident's #1 room but the Hydrocodone that was left in a pill cup on the bedside table was not there. After searching the room and trash bins, the medication was not recovered.In an interview with the Director of Nursing on 10/20/25 at 2:35 pm, she stated her expectations were that Staff A should have administered Resident's #1 Hydrocodone right after removing it from a locked medication storage. In an interview with Staff A, LPN, 10/21/25 at 1:31 pm, she stated she was supposed to administer the medication to Resident #1 and observe the medication being taken and not left unattended. In an interview with Staff B, CNA on 10/21/25 at 10:50 am, she denied seeing any medications in Resident's #1 room when she was observed leaving the room. A review of the facility provided policy titled Medication Administration Times updated 09/2025 documented the following: The policy of the facility is to provide medications to residents as ordered by the physician. The following medication administration times will be observed unless specifically ordered otherwise by the physician.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
Golden Age Care Center in Centerville, IA inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in Centerville, IA, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Golden Age Care Center or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.