Complete Care at Inglemoor, LLC

Inspectors wroteComplaint #402154 (187228) Based on interviews, review of the closed medical records, and pertinent facility documents, it was determined that the facility failed to notify the Physician and Resident's Representative (RR) of resident's change in condition and status. This deficient practice was identified for 1 of 3 sampled residents (Resident #1), and was evidenced by the following: A review of the closed medical record for Resident #1 revealed: A review of the admission Record (AR) or face sheet (an admission summary) reflected that Resident #1 was admitted to the facility with a diagnoses that included but were not limited to; [...]

Inspectors wroteComplaint #NJ187551 (402155)Based on observation, interview, record review, and review of pertinent facility documents, it was determined that the facility failed to ensure a resident received care and services for weight monitoring consistent with a physician's order and professional standards of practice. This deficient practice was identified for 1 of 3 residents (Resident #1) reviewed for nutrition. This deficient practice was evidenced by the following:Reference: New Jersey Statutes, Annotated Title 45, Chapter 11. Nursing Board. The Nurse Practice Act for the state of New Jersey states: [...]

Inspectors wroteBased on interview and record review it was determined that the facility failed to maintain a complete record for 1 of 3 residents records reviewed (Residents #1). The deficient practice was evidenced by the following: A review of the closed medical record for Resident #1 revealed: A review of the admission record (AR) or face sheet (an admission summary) reflected that Resident #1 was admitted to the facility with a diagnoses that included but were not limited to; type 2 diabetes mellitus without complications, unspecified psychosis not due to a substance or known physiological condition, unspecified severe protein-calorie malnutrition, dementia in other diseases classified elsewhere, unspecified severity with agitation, and need for assistance with personal care. [...]

Inspectors wroteREPEAT DEFICIENCY Based on observation, interview, and review of pertinent facility documents it was determined that the facility failed to maintain sanitation in a safe and consistent manner to prevent food borne illness. This deficient practice was evidenced by the following: On 3/7/25 at 9:35 AM, the surveyor, in the presence of the Food Service Director (FSD), observed the following during the initial kitchen tour: 1. The surveyor observed the main stove-back splash with heavy, dry, thick brown substances. The FSD stated, It's grease .we clean it every two weeks sometimes a bit more with degreaser. The surveyor observed the FSD attempt to wipe off the thick brown substance on the back splash with his fingers, but the brown substance only smeared further. 2. [...]

Inspectors wroteBased on observation, interview, record review, and review of other pertinent facility provided documentation, the facility failed to; a.) clarify the physician orders for 2 of 18 residents, (Residents #6 and #159), b.) ensure as needed (PRN) medications were sequenced according to pain severity for 3 of 18 residents (Residents #6, #48, and #159), and c.) ensure that medications were available for 2 of 3 residents reviewed during medication pass observation, (Residents #15 and #21), according to the standard of clinical practice and facility policy. This deficient practice was evidenced by the following: Reference: New Jersey Statutes Annotated, Title 45. Chapter 11. Nursing Board. The Nurse Practice Act for the State of New Jersey states: [...]

Inspectors wroteBased on interviews and review of other facility documentation, the facility failed to ensure that the physician must include an evaluation of the resident's condition and total program of care, by signing orders that included medications and treatments, and a decision about the continued appropriateness of the resident's current medical regimen. The orders reflected that it was 982 days overdue for review. This deficient practice was identified for 1 of 18 residents, (Resident #159), reviewed for physician services. This deficient practice was evidenced by the following: On 3/7/25 at 10:47 AM, Surveyor #1 (S#1) observed Resident # 159 lying on bed with head of bed elevated approximately 45 degrees, eyes closed, with tube feeding (TF) formula of Glucerna 1.2 running via a pump at 50 ml/hr (milliliters/hour), with 159 ml fed, and remaining in the container was 500 ml. [...]

Inspectors wroteComplaint NJ #179968; NJ #181921 Based on interview, record review, and review of other pertinent documents, it was determined that the facility failed to maintain a complete, available, accurate, and readily accessible medical records. This deficient practice was identified for 5 of the 18 residents reviewed (Residents #3, #6, #24, #36, and #40). This deficient practice was evidenced by the following: 1. On 3/7/25 at 10:52 AM, Surveyor#1 (S#1) observed Resident #6 was seated in a wheelchair inside their room with Certified Nursing Aide #1 (CNA#1). S#1 also observed CNA#2 with hoyer lift machine and Staffing Coordinator came out of the resident's room. S#1 reviewed Resident #6's medical records and revealed: A review of the admission Record (AR, an admission summary) reflected that Resident #6 was admitted to the facility with medical diagnoses which included but not limited to; [...]

Inspectors wroteBased on observation, interview, and record review it was determined that the facility failed to keep the call bell within reach for a resident who required assistance from staff and who was able to use a call bell. This deficient practice was identified for 1 of 17 residents reviewed, Resident #48, and evidenced by the following: On 3/10/25 at 9:22 AM, the surveyor observed Resident #48's door closed. The Certified Nursing Assistant (CNA) was inside the room providing morning hygiene (AM) care to the resident. On 3/10/25 at 9:50 AM, the surveyor entered the resident's room after the CNA was done with AM care. The surveyor observed the resident lying in their bed and the resident's call bell on the floor at the right side of the bed. The surveyor asked Resident #48 how they called for assistance. [...]

Inspectors wroteBased on observation, interview, record review, and review of other facility documents, it was determined the facility failed to ensure accurate documentation and review of a resident's advance directives for 1 of 3 residents, (Resident #13) reviewed. This deficient practice was evidenced by the following: 1. On [DATE] at 12:09 PM, the surveyor reviewed the Electronic Medical Record (EMR) of Resident #13. According to the admission Record (admission summary) Resident #13 had diagnoses that included but were not limited to; respiratory failure, chronic obstructive pulmonary disease (a lung condition that blocks airflow and makes it difficult to breathe), and heart failure. [...]

Inspectors wroteComplaint NJ#161311 Based on observation, interview, record review and review of pertinent facility documents, it was determined that the facility failed to conduct a thorough investigation to address an allegation of abuse. This deficient practice was identified for 1 of 7 residents, Resident #310, reviewed for alleged abuse and was evidenced by the following: On 3/7/25 at 10:02 AM, during the entrance conference, the surveyor requested from the Licensed Nursing Home Administrator (LNHA), the Director of Nursing (DON), the regional LNHA, and the Regional [NAME] President of Clinical Services (RVPCS) for reportable event investigations from February 2023. On 3/10/25 at 9:00 AM, the surveyor requested from the LNHA for Facility Reportable Event (FRE) investigations from February 2023 for Resident #310. [...]

Inspectors wroteBased on interview, record review, and review of other pertinent facility documents, it was determined that the facility failed to provide the Resident and the Resident's Representative a written notification of the reason for transfer to the hospital, and also send a copy to a representative of the Office of the State Long-Term Care Ombudsman (LTCO) for 1 of 1 resident (Resident #159) reviewed for hospitalization. This deficient practice was evidenced by the following: On 3/7/25 at 10:47 AM, the surveyor observed Resident #159 lying on bed with head of bed elevated approximately 45 degrees, eyes closed, with tube feeding (TF) formula of Glucerna 1.2 running via a pump at 50 ml/hr (milliliters/hour), with 159 ml fed, and remaining in the container was 500 ml. The surveyor reviewed Resident #159's medical records and revealed: [...]

Inspectors wroteBased on interview and record review it was determined that the facility failed to accurately code the Minimum Data Set (MDS), an assessment tool used to facilitate the management of care, in accordance with federal guidelines for 1 of 18 residents, (Resident #6), reviewed for accuracy for MDS coding. This deficient practice was evidenced by the following: On 3/7/25 at 10:52 AM, the surveyor observed Resident #6 was seated in a wheelchair inside their room with Certified Nursing Aide #1 (CNA#1). S#1 also observed CNA#2 with hoyer lift machine and Staffing Coordinator came out of the resident's room. The surveyor reviewed Resident #6's medical records and revealed: A review of the admission Record (an admission summary) reflected that Resident #6 was admitted to the facility with medical diagnoses which included but not limited to; [...]

Inspectors wroteBased on the interview, record review, and review of pertinent documents, it was determined that the facility failed to ensure residents who were discharged to the community had a discharge summary that was completed by the physician in accordance to the regulation and facility's policy and procedure. This deficient practice was identified for 1 of 1 resident, (Resident #58), reviewed for discharge. This deficient practice was evidenced by the following: Surveyor #1 (S#1) reviewed the medical records of Resident #58, and revealed: A review of the admission Record (an admission summary) reflected that the resident was admitted to the facility with diagnoses that included but were not limited to, sepsis (serious condition in which the body responds improperly to an infection), unspecified organism and low back pain unspecified. [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent facility documents, it was determined that the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice, by failing to ensure; a.) that the physician order was clarified, b.) care plan (CP) intervention was revised, and c.) the fall investigation included the statement of the staff to complete the investigation, and in order to determine root cause analysis. This deficient practice was identified for 1 of 2 residents, (Resident #6), reviewed for accidents and was evidenced by the following: Reference: New Jersey Statutes, Annotated Title 45, Chapter 11. Nursing Board. The Nurse Practice Act for the state of New Jersey states: [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent facility documents, it was determined that the facility failed to: a) obtain weights for a resident according to the physician's orders and facility policy for 1 of 2 residents (Resident #13) reviewed for nutrition; and b) monitor and document the fluid intake for a resident with a physician's order for fluid restrictions for 1 of 2 residents (Resident #28) reviewed for nutrition. This deficient practice was evidenced by the following: 1. On 3/7/25 at 10:50 AM, the surveyor observed Resident #13 sitting in a wheelchair in their room, being provided care by staff. On 3/12/25 at 9:06 AM, the surveyor reviewed the paper chart and the Electronic Medical Record (EMR) of Resident #13. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to ensure appropriate storage of a nebulizer treatment equipment in accordance with facility protocol and infection control. This deficient practice was identified in 1 of 1 resident (Resident #55), reviewed for respiratory care. The deficient practice was evidenced by the following: On 3/7/25 at 1:40 PM, the surveyor interviewed Licensed Practical Nurse (LPN) #1 about the changing of nebulizer (neb) tubing and mask equipment. LPN #1 was not sure of the facility's policy regarding changing of oxygen (O2) tubing and neb tubing equipment. LPN #1 accompanied the surveyor to the Resident #55's room to observe the resident's neb machine equipment. Resident #55 was sitting on their bed, alert and verbally responsive. [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to properly store medications and medical supplies safely and per standards of practice. This deficient practice was identified in 1 of 2 medication storage areas observed on the 2nd floor of the facility. This deficient practice was evidenced by the following: Reference: New Jersey Statutes Annotated, Title 45, Chapter 11. Nursing Board. The Nurse Practice Act for the State of New Jersey states: The practice of nursing as a licensed practical nurse is defined as performing tasks and responsibilities within the framework of case finding; [...]

Inspectors wroteBased on interview, review of medical record, and review of other pertinent facility documents, it was determined that the facility failed to offer residents a pneumococcal and influenza vaccines or document the refusal and reason for ineligibility for the vaccines for 1 of 5 residents reviewed for unnecessary medications (Resident #55). The deficient practice was evidenced by the following: Reference: According to the Centers for Disease Control (CDC) and Prevention, recommends pneumococcal vaccination (PCV) for many adults based on age, having certain risk conditions, and pneumococcal vaccines already received . CDC recommends PCV15, PCV20, or PCV21 for adults who never received a PCV and are Ages 65 years or older Ages 19 through 64 years with certain risk conditions. [...]

Inspectors wroteBased on interview, medical record review, and review of other pertinent facility documents, it was determined that the facility failed to offer a resident a COVID-19 Immunization. This deficient practice was identified for 1 of 5 residents reviewed for unnecessary medications (Resident #55). The deficient practice was evidenced by the following: The surveyor reviewed the Resident's #55's medical record which revealed the following information: A review of the admission Record (an admission summary) revealed that Resident #55 had been admitted to the facility with diagnoses which included but not limited to type 2 diabetes mellitus with hyperglycemia (is characterized by elevated glucose levels in the blood, typically above 180 to 200 mg/dL [milligrams per deciliter]) and moderate protein-calorie malnutrition. [...]

Inspectors wroteComplaint # NJ00180296 Based on interviews, record review, and review of pertinent facility documents on 12/03/2024, it was determined that the facility failed to ensure that a resident (Resident #1) was free from involuntary confinement when on 09/18/2024 a nurse on duty in night shift attached a hospital gown on the Resident's doorknob and looped it to the handrail in the hallway outside of Resident's room after the Resident in her/his wheelchair was brought back to her/his room from another resident's room. The deficient practice was observed in one of three residents and was evidenced as follows: [...]

Inspectors wroteBased on observation, interview, record review, and review of the facility provided documentation, it was determined that the facility failed to: a) establish, assess, and maintain record measures to minimize the risk of Legionella and other opportunistic pathogens in building water systems, this deficient practice had the potential to affect all 54 residents; b) properly doffed (remove) and discard the PPE (personal protective equipment) for one of three staff observed; c) perform handwashing appropriately for one (Certified Nursing Aide) of six staff observed for hand hygiene; [...]

Inspectors wroteBased on observation, interview, and review of medical records, it was determined that the facility failed to develop a person-centered comprehensive care plan to address: a) the use of antipsychotic medication for one of five residents (Resident #27) from August 2022 through January 23, 2023 reviewed for unnecessary medications, for a total of five months and b) activities of daily living (ADL) of one of seventeen residents (Resident#44), reviewed for comprehensive care plan. This deficient practice was evidenced by the following: 1. On 01/22/23 at 11:20 AM, Surveyor#1 observed Resident #27 laying on the bed with their eyes closed. Surveyor#1 reviewed Resident #27's medical records. The admission Record (AR or face sheet; [...]

Inspectors wroteBased on interview, record review, and review of facility provided documents, it was determined that the facility failed to follow up on the Consultant Pharmacist's (CP) recommendations of a medication irregularity for one of five residents (Resident #27) reviewed for unnecessary medications for a total of five months from August 2022 through January 2023. This deficient practice was evidenced by the following: On 01/22/23 at 11:20 AM, the surveyor observed Resident #27 laying on the bed with their eyes closed. The surveyor reviewed Resident #27's medical records. The admission Record (or face sheet; [...]

Inspectors wroteBased on observation, interview, record review, and review of the facility provided documents, it was determined that the facility failed to consistently monitor, document, and evaluate the ongoing benefit use of Seroquel, an antipsychotic medication (used to treat bipolar disorder- depressive and manic episodes and schizophrenia-mental disorder interpret reality abnormally). This deficient practice was identified for one of three residents (Resident #27) reviewed for antipsychotic use for a total of five months from August 2022 through January 2023. This deficient practice was evidenced by the following: On 01/22/23 at 11:20 AM, the surveyor observed Resident #27 laying on the bed with their eyes closed. The surveyor reviewed Resident #27's medical records. The admission Record (or face sheet; [...]

Inspectors wroteBased on the observation, interview, record review, and other pertinent facility documentation it was determined that the facility failed to: a) conduct testing in a manner that is consistent with current standards of practice for conducting COVID-19 tests and b) perform COVID-19 testing for three of six residents (Resident #6, #17, and #32) reviewed for PUI (person under investigation) and one of three staff members reviewed for COVID-19 testing in accordance with the facility policy and Centers for Disease Control and Prevention guidelines (CDC) for infection control and to mitigate the spread of COVID-19 (A highly contagious respiratory disease caused by the SARS-CoV-2 virus). This deficient practice was evidenced by the following: According to the U.S. [...]

Inspectors wroteBased on observation, interview, and review of the facility provided documents, it was determined that the facility failed to ensure that a nurse aide had the skills and techniques necessary prior to providing care to residents. This deficient practice occurred for one (1) of four (4) newly hired employees and was evidenced by the following: On [DATE] at 9:59 AM, the surveyor interviewed Registered Nurse#1 (RN#1) and a Licensed Practical Nurse (LPN) who stated that they were the two nurses assigned to the second floor for that day. RN#1 and LPN stated that they had a resident census of 30 residents and that there were four Certified Nurses Aides (CNA) working on the second floor. At that time, RN#1 provided the surveyor with a CNA assignment sheet for the second floor. [...]

Inspectors wroteBased on observation, interview, and review of facility provided documents, it was determined that the facility failed to routinely and accurately post the nurse staffing information on four of six days during the survey period in a place within the facility readily accessible to the residents and the visitors. This deficient practice was evidenced by the following: On 01/22/23 at 9:14 AM, upon entry into the facility, the surveyor observed that the Nursing Home Resident Care Staffing Report (NHRCSR) that was posted in the reception area of the lobby showed a staffing report dated 01/20/23 with the census (total number of residents) of 57 for Day Shift, shift hours of 7 AM - 3 PM. [...]

Inspectors wroteBased on interview, record review, and other pertinent facility documentation, it was determined that the facility failed to ensure a medication used for moderate to severe pain (Oxycodone) was available and administered as ordered for a resident with a history of chronic pain (Resident #458). This deficient practice was identified during the Medication Storage Task for one of one resident reviewed for pain management. The evidence was as follows: On 01/ 26/23 at 10:42 AM, while performing the Medication Storage Task the surveyor interviewed the Director of Nursing (DON). The surveyor asked if the facility had any unresolved narcotic discrepancies with their automated medication dispensing machine and the DON responded no, but they did have an incident last month with a nurse. [...]

Inspectors wroteBased on observation, interview, record review, and facility provided documentation, it was determined that the facility failed to ensure that all medications were administered without error of 5% or more. During the medication observation performed on 01/24/23, the surveyor observed two (2) nurses administered medications to five (5) residents. There were 27 opportunities, and two (2) errors were observed, which calculated to a medication administration error rate of 7.41 %. This deficient practice was identified for two (2) of five (5) residents, (Resident #31 and #42), that were administered medications by one (1) of two (2) nurses. The deficient practice was evidenced by the following: 1. On 01/24/22 at 8:34 AM, during the medication administration observation, the surveyor observed the Licensed Practical Nurse (LPN) in the room of Resident #31. [...]

Inspectors wroteBased on observation, interview, and review of facility provided documentation, it was determined that the facility failed to store foods and maintain kitchen sanitation in a manner intended to prevent the spread of food borne illness as evidenced by the following: On 01/22/23 at 12:31 PM, the surveyor toured the kitchen with the Food Service Manager (FSM), in the presence of the Region Food Service Director (RFSD) and the Account Manager (AM) and observed the following: 1. In the freezer the surveyor found; one opened box of hamburgers without an open and use by date. The interior bag holding 12 hamburgers was opened and unlabeled. The FSM stated that the exterior of the box should be labeled with the open and used by date. He also stated, the interior bag once opened should be label and dated. 2. In the freezer the surveyor found; one opened box of tilapia fish fillets. [...]

Inspectors wroteBased on observation, interview, and review of the facility provided documentation, it was determined that the facility failed to properly dispose and maintain waste in garbage dumpster areas. This deficient practice was identified for three of three garbage dumpsters in garbage disposal area. This deficient practice was evidenced by the following: On 01/22/2023 at 9:15 AM, the surveyor observed trash and food waste behind and surrounding three dumpsters in the parking lot. The dumpster lids and surrounding gate were not closed. On 01/23/2023 at 11:15 AM, the surveyor observed trash and food waste behind and surrounding three dumpsters in the parking lot. The dumpster lids and the surrounding gates were not closed. On 01/23/23 at 11:40 AM the Regional Maintenance Director (RMD), explained that it is every departments responsibility to maintain the dumpster area. [...]

Inspectors wroteBased on interview and review of facility documents, it was determined that the facility failed to a.) employ staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, b). employ a full-time dietitian, or c.) employ a qualified director of food and nutrition services. This deficient practice was evidence by the following: On 4/29/21 at 9:38 AM, the surveyor interviewed the Dining Services Director (DSD) in the presence of another surveyor. The DSD stated that he was Serve Safe Certified. On 5/04/21 at 10:29 AM, the surveyor interviewed the Registered Dietitian (RD) in the presence of another surveyor. She stated that she worked two -eight-hour days a week, usually Tuesdays and Thursdays. On 5/04/21 at 11:00 AM, the surveyor reviewed the DSD's Serve Safe Certification which revealed an expiration date of 11/11/20. [...]

Inspectors wroteBased on observation, interview, record review, and review of facility policies, it was determined that the facility failed to maintain proper kitchen sanitation practices and properly store potentially hazardous and dry foods in a safe and sanitary environment to prevent the development of food borne illness. This deficient practice was observed during two kitchen tours and was evidenced by the following: On 4/29/21 at 9:38 AM, the surveyor conducted an initial tour with the Dining Services Director (DSD) in the presence of another surveyor and observed the following: There was a small black plastic garbage bin without a lid, uncovered and overflowing with trash at the handwashing sink. The handwashing sink was observed flush alongside and at the height of the stainless-steel table attached to the sanitizer sink. The paper towel dispenser was mounted directly over the same table. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to have Consultant Pharmacist Services for the Month of April 2021. This deficient practice was identified for 12 of 12 residents (Residents #2, #3, #4, #6, #10, #16, #17, #30, # 35, # 38, # 41, and # 192) reviewed for drug regimen. This deficient practice was evidenced by the following: 1. On 5/4/21 at 11:25 AM, the surveyor reviewed the admission Record for Resident #2 which indicated that the resident was admitted to the facility on [DATE] with diagnoses which included, but were not limited to: Heart Failure, Cerebrovascular Disease and Hypertension. Review of the Consultant Pharmacist Evaluation Report revealed that the last monthly drug regimen review was dated 3/26/21. 2. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to provide: a.) a meal in accordance with their weekly cycle menu for 13 residents observed during the lunch meal on 5/3/21; b.) the correct portion of milk for 21 residents observed during the breakfast meal on 5/4/21 and 5/5/21 in accordance with their weekly cycle menu; and c.) individual resident preferences as indicated on a meal ticket identified for 1 of 13 residents reviewed. This deficient practice was evidenced by the following: On 5/03/21 at 10:26 AM, the surveyor conducted a resident council meeting with three residents in the presence of another surveyor. One resident was the resident council president. Two of the three residents expressed concerns regarding food and the menus. They stated that what they receive does not always match the menu and/or the meal tickets. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to: a.) ensure that the personal protective equipment (PPE) was readily available and accessible to the staff on the persons under investigation (PUI) unit; b.) ensure proper use of PPE for 1 of 4 staff; c.) perform handwashing appropriately for 2 of 13 staff in accordance with the Centers for Disease Control and Prevention (CDC) guidelines for infection control to mitigate the spread of COVID-19; and d.) follow appropriate infection control practices for the administration of eye drops, identified for 1 of 2 nurses during the medication observation pass. This deficient practice was evidenced by the following: According to the U.S. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to monitor and track the use of antibiotics for 2 of 2 units from January through March 2021 according to the Antibiotic Stewardship Program. This deficient practice was evidenced by the following: According to the U.S. CDC Core Elements of Antibiotic Stewardship for Nursing Home, page last reviewed June 11, 2020, included, Tracking and Reporting Antibiotic Use and Outcomes Nursing homes monitor both antibiotic use practices and outcomes related to antibiotics in order to guide practice changes and track the impact of new interventions. Data on adherence to antibiotic prescribing policies and antibiotic use are shared with clinicians and nurses to maintain awareness about the progress being made in antibiotic stewardship. Process measures: [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to: a.) clarify a physician's order for 1 of 12 residents (Resident #3) and b.) follow a physician's order with regards to a Glucerna supplement for 1 of 12 residents, (Resident #44) according to the standards of clinical practice. This deficient practice was evidenced by the following: Reference: New Jersey Statutes Annotated, Title 45. Chapter 11. Nursing Board. The Nurse Practice Act for the State of New Jersey states: [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to properly label, store and dispose of medications in 2 of 4 medication carts and 1 of 2 medication refrigerators inspected. This deficient practice was evidenced by the following: On [DATE] at 11:00 AM, the surveyor inspected the 2nd floor low-side medication cart in the presence of a Registered Nurse (RN#1). The surveyor observed an opened bottle of Pro-Heal solution with an opened date of [DATE]. An opened bottle of Pro-heal solution has a 60-day expiration date. The surveyor interviewed RN #1 who stated that the opened bottle of Pro-Heal solution was expired and should have been removed from the medication cart. On [DATE] at 11:15 AM, the surveyor inspected the 2nd floor medication refrigerator cart in the presence of RN #1. [...]