Heritage At Longview Healthcare Center

F-F686- Failure to Provide Treatment/Services to Prevent/Heal Pressure Ulcer

Interventions:

Resident #1 no longer resides in the facility as of 2/18/25.

A head-to-toe assessment was completed on all residents as of 2/18/25 by the DON/ADON/MDS/Compliance Nurse. The MD was notified as of 2/18/25 on all residents with pressure wounds by the DON. Orders were received for treatment and implemented as of 2/18/25 by the Treatment and Charge Nurses.

Weekly ulcer assessments and non-ulcer assessments were completed as of 2/18/25 to include measurements by DON/ADON/MDS/Compliance Nurse.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 21 455569 Department of Health & Human Services Printed: 09/08/2025 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 455569 B. Wing 02/19/2025

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

Heritage at Longview Healthcare Center 112 Ruthlynn Dr Longview, TX 75605

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 0686 The Dietician was notified as of 2/18/25 of all residents with pressure wounds by the DON.

Level of Harm - Immediate All residents with pressure wounds have appropriate supplements in place to promote wound healing. jeopardy to resident health or Reviewed and completed by the DON and Compliance Nurse as of 2/18/25. safety

The Dietician and Physician will be notified for recommendations/orders when new or worsening pressure Residents Affected - Few wounds are identified by the DON and Treatment Nurse. This will start 2/18/25.

All wound care orders were reviewed as of 2/18/25 by DON, ADON, and Compliance Nurse to ensure pressure wound care recommendations are being followed appropriately for all residents.

Braden Scale assessments were completed on all residents as of 2/18/25 by the Regional Compliance Nurse and DON.

Resident care plans for pressure wounds and skin issues were reviewed and updated to include interventions promoting wound healing. This was completed by the Regional Compliance Nurse and DON as of 2/18/25.

The Medical Director was notified of immediate jeopardy on 2/18/25 by the Administrator.

An ADHOC QAPI meeting was held with the Administrator, DON, ADON, and Medical Director to discuss the immediate jeopardy and plan of removal as of 2/18/25.

Administrator, DON, and ADON were in-serviced 1:1 by the Regional Compliance Nurse as of 2/18/25 on the following topics.

o Pressure Injury Prevention, Assessment, staging, and Treatment Policy to include early prevention/treatment whenever a change in skin status occurs. Documentation to include measurements and staging/classifying pressure wounds appropriately with documentation of an accurate description in the weekly ulcer assessment. Completing Braden Scale assessments upon admission, readmission, and as needed to help identify when a resident might be at risk for skin breakdown.

o Skin Integrity management Policy to include identifying/documenting skin issues to include staging/classifying pressure wounds appropriately and initiating an appropriate treatment plan. Also to include interventions to help with pressure injury prevention and notifying the charge nurse when a new skin issue is identified or if a dressing is soiled or missing.

o Notification of a Change in Condition Policy-to include notifying the physician and family/RP when a new skin issue or pressure wound has been identified with documentation in the weekly skin assessment, weekly non-pressure assessment, weekly ulcer assessment, and care plan. Also including notifying the nurse when

a new skin issue has been identified.

o Skin Assessment policy to include completing head-to-toe assessments upon admission/readmission and weekly to help identify/document skin issues with physician and family/RP notification and treatment orders.

o Abuse and Neglect - failure to identify properly stage pressure wounds, classify skin issues, or provide treatments as ordered can be considered neglect.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 21 455569 Department of Health & Human Services Printed: 09/08/2025 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 455569 B. Wing 02/19/2025

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

Heritage at Longview Healthcare Center 112 Ruthlynn Dr Longview, TX 75605

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 0686 In-services:

Level of Harm - Immediate The following in-services were initiated by Regional Compliance Nurse, DON for all charge nurses. Any jeopardy to resident health or charge nurses not present or in-serviced as of 2/18/25 will not be allowed to assume their duties until safety in-serviced. All new hires will be in-serviced during orientation. All agency staff or staff on leave will in serviced prior to assuming their next assignment. Completion date 2/18/25. Residents Affected - Few o Pressure Injury Prevention, Assessment, staging, and Treatment Policy to include early prevention/treatment whenever a change in skin status occurs. Documentation to include measurements and staging/classifying pressure wounds appropriately with documentation of an accurate description in the weekly ulcer assessment. Completing Braden Scale assessments upon admission, readmission, and as needed to help identify when a resident might be at risk for skin breakdown.

o Skin Integrity management Policy to include identifying/documenting skin issues to include staging/classifying pressure wounds appropriately and initiating an appropriate treatment plan. Also to include interventions to help with pressure injury prevention and notifying the charge nurse when a new skin issue is identified or if a dressing is soiled or missing.

o Notification of a Change in Condition Policy-to include notifying the physician and family/RP when a new skin issue or pressure wound has been identified with documentation in the weekly skin assessment, weekly non-pressure assessment, weekly ulcer assessment, and care plan. Also including notifying the nurse when

a new skin issue has been identified.

o Skin Assessment policy to include completing head-to-toe assessments upon admission/readmission and weekly to help identify/document skin issues with physician and family/RP notification and treatment orders.

o Abuse and Neglect - failure to identify properly stage pressure wounds, classify skin issues, or provide treatments as ordered can be considered neglect.

o

The following in-services were initiated by Regional Compliance Nurse, DON for all other nursing staff and therapy. Any staff not present or in-serviced will not be allowed to assume their duties until in-serviced. All new hires will be in-serviced during orientation. All agency staff or staff on leave will in serviced prior to assuming their next assignment. Completed as of 2/18/25.

o Notification of a Change in Condition Policy- to include notifying the nurse when a new skin issue has been identified.

o Skin integrity management and pressure injury prevention, assessment, and treatment. To include interventions to help with pressure injury prevention and notifying the charge nurse when a new skin issue is identified or if a dressing is soiled or missing.

The following in-services were initiated by Regional Compliance Nurse, DON for all staff. Any staff who are not present will not be allowed to assume their duties until in-serviced. All new hires will be in-serviced during orientation. All agency staff or staff on leave will in serviced prior to assuming their next assignment. Completed as of 2/18/25.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 21 455569 Department of Health & Human Services Printed: 09/08/2025 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 455569 B. Wing 02/19/2025

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

Heritage at Longview Healthcare Center 112 Ruthlynn Dr Longview, TX 75605

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 0686 o Abuse and Neglect - failure to identify skin issues or provide treatments can be considered neglect.

Level of Harm - Immediate On 2/19/2025 the Surveyor confirmed the facility implemented their plan of removal sufficiently to remove the jeopardy to resident health or IJ by: safety

Record review of Resident #1's electronic medical record confirmed Resident #1 discharged to the hospital Residents Affected - Few on 7/25/2024 and did not return to the facility.

Record review of electronic head to toe assessments date 2/13/2025 through 2/18/2025 with no concerns noted.

Record review of weekly ulcer and non-ulcer assessments completed 2/12/2025 through 2/18/2025 with no concerns noted.

Record review of attestation dated 2/18/2025 at 3:58 PM confirmed the Dietician was notified of all residents with pressure wounds.

Record review of attestation dated 2/18/2025 confirmed all residents with pressure wounds have appropriate supplements in place to promote wound healing.

Record review of attestation stating the Dietician and Physician will be notified for recommendations/orders when new or worsening pressure wounds were identified.

Record review of all wound care orders were reviewed by the DON, ADON, and Compliance Nurse on 2/18/2025 to ensure pressure wound care recommendations were being followed.

Record review of the electronic medical record confirmed all Braden scores had been updated on 2/13/2025.

Record review of the electronic medical record confirmed all resident care plans had been reviewed and updated as of 2/18/2025.

Record review of AdHoc QAPI meeting minutes confirmed to discuss plan of removal as of 2/18/2025 with

the following in attendance: Administrator, ADON, DON, Medical Director, HR, MDS, Dietary Manager, DOR, Activity Director, Housekeeping Supervisor, BOM, and Medical Records.

Record review of inservices provided to the Administrator, DON, and ADON dated 2/12/2025 consisted of: Pressure Injury Prevention, Skin Integrity Management Policy, Skin Assessment Policy, and Abuse and Neglect.

Record review of inservices provided to Charge Nurses dated 2/12/2025 and consisted of: Pressure Injury Prevention, Skin Integrity Management Policy, Notification of a Change in Condition Policy, Skin Assessment Policy, and Abuse and Neglect.

Record review of inservices provided to all staff dated 2/12/2025 and consisted of: Notification of a Change

in Condition Policy, Skin Integrity Management, and Abuse and Neglect.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 16 of 21 455569 Department of Health & Human Services Printed: 09/08/2025 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 455569 B. Wing 02/19/2025

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

Heritage at Longview Healthcare Center 112 Ruthlynn Dr Longview, TX 75605

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 0686 During an interview on 2/19/2025 at 12:10 PM CNA E said some wound prevention interventions consisted of: turning and repositioning every 2 hours, elevating legs, changing positions, wedges, pillows to offset Level of Harm - Immediate pressure points, wheelchair cushions, and movement. She said she would immediately notify the charge jeopardy to resident health or nurse and DON of any new wounds or wounds without dressings. She said it could be considered abuse or safety neglect for not preventing and treating wounds.

Residents Affected - Few During an interview on 2/19/2025 at 12:18 PM CNA G said some wound prevention interventions consisted of: turning and repositioning every 2 hours, elevating legs, changing positions, wedges, pillows to offset pressure points, wheelchair cushions, and movement. She said she would immediately notify the charge nurse and DON of any new wounds or wounds without dressings. She said it could be considered abuse or neglect for not preventing and treating wounds.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 17 of 21 455569 Department of Health & Human Services Printed: 09/08/2025 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 455569 B. Wing 02/19/2025

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

Heritage at Longview Healthcare Center 112 Ruthlynn Dr Longview, TX 75605

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** 47339

Residents Affected - Some Based on interview and record review, the facility failed to provide pharmaceutical services, including procedures that assures the accurate acquiring, receiving, dispensing, and administering of medications for 3 of 5 residents (Resident #3, Resident #4 and Resident #5) and reviewed for pharmacy services.

The facility failed to remove discontinued controlled medications from the medication cart for Resident #3, Resident #4 and Resident #5 who had expired.

The facility failed to ensure proper destruction of 71 Hydrocodone ,d+[DATE REDACTED]mg, 103 Lorazepam 1mg, 17 Lorazepam 0.5mg, and 94.75ml Morphine Sulfate 100mg/5ml that were controlled medications for Resident #3, Resident #4 and Resident #5 who had expired.

These failures could place residents who received medications, including narcotics at risk for not receiving

the intended therapeutic effects of their prescribed medications and experiencing unintended and harmful effects of medications prescribed to others and place the facility at risk for drug diversion.

Findings included:

1.Record review of facility electronic face sheet indicated Resident # 3 was an [AGE] year-old female admitted to facility on [DATE REDACTED]. Resident #3's diagnoses included: malignant neoplasm of liver (liver cancer), and secondary malignant neoplasm of bone (bone cancer).

Record review of Quarterly MDS dated [DATE REDACTED] indicated Resident #3 had a BIMS of 14 indicating no cognitive impairment.

Record review of discharge MDS dated [DATE REDACTED] indicated Resident #3 had expired in the facility on [DATE REDACTED].

Record Review of comprehensive care plan dated [DATE REDACTED] indicated Resident # 3 had a terminal prognosis of malignant neoplasm of liver and had received hospice services with interventions that included: .Observe resident closely for signs of pain, administer pain medications as ordered, and notify physician immediately is there is breakthrough pain .

Record review of physician orders for [DATE REDACTED] indicated Resident #3 had an order for Hydrocodone , d+[DATE REDACTED]mg give 1 tablet every 6 hours as needed, Lorazepam 1mg give 1 tablet every 6 hours as needed, and Morphine Sulfate 100mg/5ml give 0.25ml-0.5ml every 2 hours as needed.

Record review of narcotic count sheets indicated Resident #3 had 31 Hydrocodone ,d+[DATE REDACTED]mg, 56 Lorazepam 1mg, and 26.75ml of Morphine Sulfate remaining at the time of Resident #3's expiration.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 18 of 21 455569 Department of Health & Human Services Printed: 09/08/2025 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 455569 B. Wing 02/19/2025

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

Heritage at Longview Healthcare Center 112 Ruthlynn Dr Longview, TX 75605

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 2.Record review of facility electronic face sheet indicated Resident #4 was an [AGE] year-old male admitted to facility on [DATE REDACTED]. Resident #4's diagnoses included: metabolic encephalopathy (brain does not function Level of Harm - Minimal harm or properly), malignant neoplasm of lower lobe, right bronchus or lung (lung cancer), and hypertension (high potential for actual harm blood pressure).

Residents Affected - Some Record review of admission MDS dated [DATE REDACTED] indicated Resident #4 had a BIMS of 10 indicating moderate cognitive impairment.

Record review of discharge MDS dated [DATE REDACTED] indicated Resident #4 had expired in the facility on [DATE REDACTED].

Record Review of comprehensive care plan dated [DATE REDACTED] indicated Resident #4 had a terminal prognosis of squamous cell carcinoma and had received hospice services with interventions that included: .work with nursing staff to provide maximum comfort for the resident .

Record review of physician orders for [DATE REDACTED] indicated Resident #4 had an order for Hydrocodone , d+[DATE REDACTED]mg give 1 tablet every 4 hours as needed, Lorazepam 1mg give 1 tablet every 2 hours as needed, and Morphine Sulfate 100mg/5ml give 1ml every hour as needed.

Record review of narcotic count sheets indicated Resident #4 had 40 Hydrocodone ,d+[DATE REDACTED]mg, 30 Lorazepam 1mg, 17 Lorazepam 0.5mg, and 44ml of Morphine Sulfate remaining at the time of Resident #4's expiration.

3.Record review of facility electronic face sheet indicated Resident #5 was an [AGE] year-old male admitted to facility on [DATE REDACTED]. Resident #5's diagnoses included: atrial fibrillation (irregular heartbeat), malignant neoplasm of prostate (prostate cancer), and dementia (decline in mental ability).

Record review of admission MDS dated [DATE REDACTED] indicated Resident #5 had a BIMS of 04 indicating severe cognitive impairment.

Record review of discharge MDS dated [DATE REDACTED] indicated Resident #5 had expired in the facility on [DATE REDACTED].

Record Review of comprehensive care plan dated [DATE REDACTED] indicated Resident #4 had a terminal prognosis and had received hospice services with interventions that included: .if receiving hospice services, work cooperatively with hospice team to ensure the resident's spiritual, emotional, intellectual, physical and social needs are met .

Record review of physician orders for [DATE REDACTED] indicated Resident #3 had an order for Lorazepam 1mg give 1 tablet every 6 hours as needed, Morphine Sulfate 20mg/ml give 0.25ml every 2 hours as needed, and Morphine Sulfate 20mg/ml give 0.5ml every 2 hours as needed.

Record review of narcotic count sheets indicated Resident #5 had 17 Lorazepam 1mg, and 24ml of Morphine Sulfate remaining at the time of Resident #5's expiration.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 19 of 21 455569 Department of Health & Human Services Printed: 09/08/2025 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 455569 B. Wing 02/19/2025

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

Heritage at Longview Healthcare Center 112 Ruthlynn Dr Longview, TX 75605

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 During an interview on [DATE REDACTED] at 12:21 PM LVN H said when a resident had expired, they count the residents remaining narcotics with the hospice nurse. She said she counted the remaining narcotics the night Level of Harm - Minimal harm or Resident #3 and Resident #4 expired with the hospice nurse and then locked the medications in the cart to potential for actual harm give to the DON. She said the next evening on [DATE REDACTED] when she came in to work and counted the cart with LVN A he told her he had thinned out the cart and turned the medication in with the count sheets to the DON. Residents Affected - Some She said the hospice sheets were still on the cart in the back of the book, but the narcotic count sheets were missing from the book. She said the following day [DATE REDACTED] the DON called her and woke her up asking where

the narcotics where and she told her that LVN A had said he had thinned the cart out and turned them in to

the DON.

During a phone interview on [DATE REDACTED] at 11:58 AM LVN A said he had been passing pills and was tired and frustrated that day, so he decided to lighten his load by destroying the expired residents' medications. He said he wasted the medication in the 100-hall guest room bathroom. LVN A said he poured the medications

in a cup and then flushed them in the toilet. LVN A said he had been a nurse for [AGE] years and knew he was supposed to give the medication to the DON and the Pharmacist was supposed to destroy them. He said in hindsight he knew it was not his best idea. Said he was suspended and terminated. He said he had worked for the facility on and off for ,d+[DATE REDACTED] years and had never destroyed medications before. He said

the facility had in the past educated him on the proper way to destroy medications.

During an interview on [DATE REDACTED] at 1:23 PM the DON said on Tuesday [DATE REDACTED], she went to get the expired residents narcotics out the medication cart. She said LVN H told her they were not on the cart and LVN A had said he gave them to the DON to destroy. She said she did not remember LVN A giving her the medications but went and checked her locked medication cabinets for medications in case she had forgotten but did not find the medications. She said she called LVN A he told her that he had destroyed the medications by flushing them down the toilet in the family room bathroom because he needed space on the cart. The DON said LVN A told her he had the count sheets in his personal bag and needed to find someone to sign with him that he had destroyed the medications. She said she told LVN A he was not going to find anyone to sign with him if they had not witnessed the destruction. She said LVN A did return the count sheets to the facility. She said LVN A told her he just was not thinking straight. The DON said she called and reported the incident to the Administrator immediately and LVN A was suspended and ultimately terminated.

She said her expectation was for the nurses to turn in medications to her to be destroyed with the pharmacy consultant.

During an interview on [DATE REDACTED] at 2:02 PM the Administrator said his expectation was for nurses to turn in all discontinued narcotic medications to the DON for destruction with the pharmacy consultant.

During an interview on [DATE REDACTED] at 2:02 PM the Administrator said when he spoke with LVN A he asked him to take a drug test. He said when the results of the drug test where positive LVN A told him he had prescriptions for the positives on the drug test. He said he asked LVN A to provide the prescriptions to the facility, but LVN A never provided any prescriptions. He said LVN A was suspended and ultimately terminated. The Administrator said the expectation for drug destruction would be for the nurses to hand over discontinued narcotics to the DON. He said the DON and the pharmacy consultant should reconcile the drugs and then destroy them according to facility policy.

Record review of a urine drug screen dated [DATE REDACTED] for LVN A indicated positive for cocaine, opiates, codeine, and hydrocodone.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 20 of 21 455569 Department of Health & Human Services Printed: 09/08/2025 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 455569 B. Wing 02/19/2025

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

Heritage at Longview Healthcare Center 112 Ruthlynn Dr Longview, TX 75605

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 Record review of facility policy Discontinued Medications undated indicated: 1. The nurse that received the order to discontinue a medication is responsible for: .Removing the medication from the medication storage, Level of Harm - Minimal harm or filling out the form to be attached to the medication that discontinued, if applicable, personally giving the form potential for actual harm and medication to the DON or ADON .

Residents Affected - Some Record review of facility policy Drug Destruction Policy dated [DATE REDACTED], indicated: It is the policy of this facility to destroy dangerous and controlled medications according to the State of Texas law . 2. Drugs to be destroyed will be destroyed under the supervision of a consultant pharmacist and at least one of the following: Director of Nursing, Assistant Director of Nursing, or Administrator. 3. Nursing staff will submit to Director of Nursing any medication and any applicable log that has expired, been discontinued by physician or that had been prescribed to a resident who no longer resides at the facility. 4. The nurse submitting the discontinued medication, will verify along with the Director of Nursing that the amount of medication remaining matches the log. After verification, both the nurse and the Director of Nursing will sign the log. 5.

The nurse will make a copy of the signed log and provide to the administrator. The Director of Nursing will maintain the original log and medication .

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 21 of 21 455569