St Clare Manor

F 0761 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 Level of Harm - Minimal harm or locked, compartments for controlled drugs. potential for actual harm 48333 Residents Affected - Few Based on observations, interviews and record review the facility failed to ensure all drugs and biologicals were stored in accordance with currently accepted professional principles. The facility failed to ensure a multi dose vial of insulin was dated upon opening. This deficient practice had the ability to affect any of the 129 residents who received medications in the facility.

Findings:

Review of the facility's policy titled, Medication Labeling and Storage with a revised date of February 2023, revealed the following, in part:

Medication Labeling: 5. Multi-dose vials that have been opened or accessed are dated.

An observation and interview was conducted on 05/27/2025 at 10:34 a.m., of refrigerator in Med Room A with S9LPN. Observed was an opened and undated multi-dose vial of Lispro Insulin for subcutaneous injection. S9LPN confirmed the insulin multi-dose vial was opened and undated, and stated it should have been dated upon opening.

An interview was conducted on 05/28/2025 at 1:45 p.m., with S2DON and S1AA. S2DON and S1AA confirmed multi-dose insulin vials should be dated as soon as they are opened. S2DON confirmed the insulin

in Med Room A refrigerator was not dated upon opening, and should have been.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 4 of 10 195590 Department of Health & Human Services Printed: 08/26/2025 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 195590 B. Wing 05/29/2025

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

St Clare Manor Nursing and Rehabilitation 7435 Bishop Ott Drive Baton Rouge, LA 70806

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 0880 An interview was conducted on 05/28/2025 at 1:30 p.m. with S2DON. S2DON confirmed Resident #63 was

on EBP due to colostomy. S2DON confirmed staff should wear a gown when bathing a resident on EBP. Level of Harm - Minimal harm or potential for actual harm

Residents Affected - Few

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 9 of 10 195590 Department of Health & Human Services Printed: 08/26/2025 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 195590 B. Wing 05/29/2025

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

St Clare Manor Nursing and Rehabilitation 7435 Bishop Ott Drive Baton Rouge, LA 70806

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)