The Heights of Bulverde

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure all drugs and biologicals were stored in accordance with professional standards for 2 of 8 medication carts (100 Hall cart and 300 Hall cart) reviewed for storage of drugs. The facility failed to ensure the carts for 100 Hall and 300 Hall were locked and secured. This failure could place residents at risk of medication misuse, medication errors, drug diversion or harm due to accidental ingestion of unprescribed medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 5 residents (Resident #1) reviewed for infection control in that: Resident #1 had an open wound and did not have an EBP sign on Resident #1's room door and did not have a physician order for EBP.This failure could affect residents on enhanced barrier precautions and place them at risk for infection.

Inspectors wroteBased on observation, interview, and record review, in accordance with accepted professional standards and practices, the facility failed to maintain medical records on each resident that are complete, accurately documented, readily accessible, and systematically organized for two of six residents (Resident #1 and Resident #3) reviewed for clinical records. 1. The facility failed to ensure Resident #1's medical record included an initial physician visit note when reviewed greater than 90 days (09/22/2025) after admission [DATE]). 2. The facility failed to ensure Resident #3's medical record included an initial physician visit note when reviewed greater than 90 days (09/22/2025) after admission [DATE]). 3. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents were free from involuntary seclusion and any physical restraint not required to treat the resident's medical symptoms for 1 of 6 (Resident #1) residents reviewed for involuntary seclusion. The facility failed to obtain a physician order, documenting the clinical criteria met for placement in the secured/locked unit, prior to Resident #1's move to the secured unit on 06/24/2025. This failure could place residents who resided on the secure unit at risk for feelings of isolation and anxiety.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an Infection Prevention and Control Program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 1 laundry room reviewed for infection control. The facility failed to properly store clean resident clothing and mechanical lift slings in the facility clean laundry room. These failures could place the residents at risk of cross-contamination and development of infection.

Inspectors wroteBased on observation, interviews and record reviews, the facility failed to ensure, in accordance with accepted professional standards and practices, medical records were maintained on each resident that were complete and accurately documented for 1 of 8 residents (Resident #1) reviewed for clinical records. The facility failed to ensure Resident #1's electronic clinical record had Hospice A Physician I's handwritten order for the indwelling urinary catheter, that had been in place for 95 days and did not discontinue the order for Hospice A when the resident admitted to Hospice B. This failure could place residents at risk of not receiving the care and services needed due to inaccurate or incomplete clinical records.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the assessment accurately reflected the resident's status for 1 of 8 residents (Resident #1) whose assessments were reviewed. The facility failed to indicate Resident #1's had an indwelling urinary catheter on her Quarterly MDS dated [DATE]. This failure could place residents at risk for inadequate care due to inaccurate assessments.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure that a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible, for 1 of 3 residents (Resident #1) reviewed for urinary catheters. The facility failed to ensure Resident #1's Hospice A Physician I's handwritten order for the indwelling urinary catheter that had been in place for 95 days was on the electronic physician orders; and did not document when urinary catheter care was provided or if the urinary catheter had been replaced every 30 days as ordered by Hospice B. This failure could place residents at risk for a decline in their health status.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen observed for kitchen sanitation. 1. The facility failed to ensure trays of prepared and poured glasses of beverages were dated and labeled. 2. The facility failed to ensure soup warmer with soup was returned to kitchen after meal and not left out all night. These failures could place residents who received meals and/or snacks from the kitchen at risk for food borne illness.

Inspectors wroteBased on interview and record review, the facility failed to ensure the Resident has the right to be informed of, and participate in, his or her treatment, including: the accurate communication and implementation of code status for 1 of 4 residents (Resident #53) reviewed resident rights and advance directives. Resident #53 had a discrepancy in code status, as evidenced by contradictory records found in the medical chart. This failure to ensure consistency in the resident code status violates their autonomy and places them at risk of receiving treatment contrary to their expressed wishes.

Inspectors wroteBased on interview and record review, the facility failed to ensure the residents right to request to formulate an advance directive and accurate documentation of advance directives was maintained and implemented for 1 of 4 residents (Resident #53). Resident #53's OOH-DNR was signed and in misc. documents while face sheet and care plan were listed as full code. This deficient practice could place the resident at risk of receiving care inconsistent with their wishes.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental needs that are identified in the comprehensive assessment, and services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 of 8 residents (Resident #55) reviewed for care plans. The facility failed to ensure Resident #55 was provided a pad type call light which was care planned as an intervention for the resident. This deficient practice places residents at risk for not receiving proper care and services due to not implementing care plan interventions.

Inspectors wroteBased on observation and interview the facility failed to ensure medication error rates are not 5 percent or greater for 1 of 4 residents (Resident #19), reviewed for pharmacy services in that the automatic calculation of the medication error rate in the Long-Term Care Survey Process (LTCSP) after 25 opportunities with 2 errors was 8%. LVN A poured two different over the counter bulk facility medications into her bare hand to administer to Resident #19 and put the ones she did not need back into the bottle during a medication administration observation. This failure could place residents at risk of cross contamination, health complications, and illness.

Inspectors wroteBased on observations and interviews, the facility failed to store medication with the expiration date on packaging in compliance with state laws and regulations for 1 of 2 medication rooms (300/400 hall) observed for medication storage. The medication room on the 300/400 hall had a box with an [NAME] boot stored without an expiration date. This failure could affect residents prescribed medications and result in less potent medications provided and could result in decreased health response or misuse of medication.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medical records were kept in accordance with professional standards and practices and were complete and accurately documented for 1 of 4 residents (Resident #53) reviewed for accuracy of records. The facility failed to ensure Resident #53 expressed Full Code status and the code status documented in the electronic medical record, placing the resident at risk of receiving improper treatment. These failures could place residents at risk for improper care due to inaccurate records.

Inspectors wroteBased on observation, interview, and record review the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 4 residents (Resident #19) reviewed for infection control. LVN A poured two different over the counter bulk facility medications into her bare hand to administer to Resident #19 and put the pills she did not need back into the bottle during a medication administration observation. This failure could place residents at risk of cross contamination, health complications, and illness.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure resident medical records were kept in accordance with accepted professional standards and practices, the facility must maintain medical records on each resident that are complete and accurately documented for 2 of 3 residents (Resident #1 and Resident #2) reviewed for clinical records. 1. The facility failed to ensure Resident #1's [EMR] Skin & Wound- Total Body Skin Assessments were documented in her medical record for 5 (the weeks of: 01/03/2025, 01/17/2025, 01/31/2025, 02/14/2025, and 04/04/2025) of 16 weeks. 2. The facility failed to ensure Resident #2's [EMR] Skin & Wound- Total Body Skin Assessments were documented in her medical record for 3 (the weeks of 01/14/2025, 01/28/2025, and 02/11/2025) of 15 weeks. [...]

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure the assessment accurately reflected the resident's status for 2 (Resident #1 and Resident #2) of 3 residents reviewed for accuracy of assessments. 1. The facility failed to ensure Resident #1 was coded on her Annual MDS assessment, signed as completed on 04/21/2025, for a fall without injury that occurred on 02/03/2025. 2. The facility failed to ensure Resident #2 was coded on her Quarterly MDS assessment, signed as completed on 03/09/2025, for two falls without injury, 02/09/2025 and 02/14/2025, and one fall with an injury (not major), 02/25/2025. These failures could place residents at risk of improper or incorrect care and services necessary for their physical, mental, and psychosocial well-being.

Inspectors wroteBased on observation, interview, and record review, the facility failed to in accordance with accepted professional standards and practices, the facility must maintain records that are complete, accurately documented temperature for 1 of 1 kitchen reviewed. 1. The facility failed to ensure temperatures were taken and accurately logged for the 04/13/25 Breakfast and Lunch meals 2. The facility failed to ensure temperatures were taken and accurately logged for meals on 04/15/25 3. The facility failed to ensure temperatures were taken and accurately logged for for breakfast milk or juices from 04/13/2025 through -04/19/2025 These deficient practices could place residents at risk of serious illness related consuming meals that are prepared in an unsanitary manner.

Inspectors wroteBased on interview, and record review, the facility failed to ensure that the resident's environment remained as free of accident hazards as possible for 1 of 23 residents (Resident #1) reviewed for accidents and supervision. The facility failed to provide that Resident # 1's environment remained as free of accident hazards as is possible when Resident #1 swallowed wet wipes, choked and expired. An IJ was identified on 03/14/25. The IJ template was provided to the facility on [DATE] at 4:11 p.m. While the IJ was removed on 03/21/25, the facility remained out of compliance at a scope of isolated and a severity level of potential for more than minimal harm because the facility needed to monitor the implementation of the plan of removal. The failure placed all residents at risk for serious injury, harm, and/or death.

Inspectors wroteBased on interview and record review the facility failed to ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury to the State Survey Agency for 2 of 8 Residents (Residents #1 and #2) who were reviewed for abuse, in that: 1. The facility failed to report an allegation of abuse or neglect per facility policy to the State Survey Agency (HHSC) when Resident #1 died after ingesting and choking on wet wipes. 2. [...]

Inspectors wroteBased on interviews and record review, the facility failed, in response to allegations of neglect, have evidence that all alleged violations were thoroughly investigated and report the results of all investigations to the administrator and to other officials in accordance with State law, including the State Survey Agency, within 5 working days of the incident for 1 of 4 (Resident #2) residents reviewed for abuse, neglect, and exploitation investigations. The facility failed to investigate an injury of unknown origin sustained by Resident #2 that was suspicious of abuse or neglect. This failure could cause diminished quality of life and place residents at risk for mistreatment.

Inspectors wroteBased on interviews, and record review, the facility failed to develop and implement a comprehensive care plan for 1 of 6 residents (Resident #2) reviewed for care plan revision/timing. The facility failed to ensure Resident #2's care plan addressed newly developed pressure wound for 40 days after initial assessment. The noncompliance was identified as PNC. The noncompliance began on 11/14/2024 and ended on 12/24/2024. The facility had corrected the noncompliance before the survey began. This failure put the resident at risk for declining health due to specific needs being unaddressed or unmet by lack of care planning.

Inspectors wroteBased on observations, interviews, record review, the facility failed to maintain an infection prevention program to help prevent the development and transmission or communicable diseases and infections for 1 of 2 residents (Resident #3). The facility also failed to handle and transport linens so as to prevent the spread of infections for infection control practices. 1. The facility failed to ensure CNA FF utilized appropriate PPE when providing direct care to Resident #3, who had been identified as requiring enhanced barrier precautions. 2. The facility failed to ensure CNA M removed soiled gloves prior to exiting a room, as well as securing soiled linen in a bagged or contained method at the point of collection prior to transporting. These failures could lead to the spread of infection.

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental needs that are identified in the comprehensive assessment, and services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 2 of 12 residents (Resident #1 and Resident #3) reviewed for comprehensive care plans, in that: 1. The facility failed to ensure Residents #1's care plan reflected using a sit-to-stand lift for Resident #1 only when holding the resident to standing position from sitting position for ADL care, including shower. 2. The facility failed to ensure Residents #3's care plan reflected the need for substantial asssitance with eating. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 2 of 12 residents (Residents #2 and Resident #3) reviewed for the provision of routine and emergency drugs and biologicals, in that: 1. Resident #2 did not receive her morning dose of antianxiety medication (busPIRone HCL for anxiety) because of lack of communication between a nurse and a CMA regarding the resident's out on pass for appointments. 2. Resident #3 did not receive her fentanyl patch for pain relief as ordered on 1/3/2023, 2/05/2023, 3/30/2023, 4/02/2024, and 5/17/2024. These failures could place residents at risk for harm by adverse reactions and not receiving the intended therapeutic effects of their medications.

Inspectors wroteFACILITY Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 facility kitchen reviewed, in that: 1. The walk-in freezer container approximately twenty-five boxes of frozen foods which were stored on the floor and haphazardly stacked on top of each other. 2. The reach-in refrigerator near the kitchen door contained a bottle of soda which belonged to a staff member. 3. The floor under the three-part sink in the dish room was soiled with a dark brown substance that appeared to be dirt or mud. 4. The walls throughout the kitchen were soiled with substances of various color. 5. The commercial toaster was soiled with an abundance of crumbs. 6. The microwave was soiled inside on all sides, the bottom, and the roof. 7. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to dispose of garbage and refuse properly for 1 of 1 dumpster site reviewed, in that: The area near the facility's two dumpsters was soiled with spilled kitchen oil and other refuse. This deficient practice could lead to an unsanitary environment and encourage the presence of pests.

Inspectors wroteBased on interview and record review, the facility failed to provide a Notice of Medicare Non-Coverage (NOMNC) for 3 of 3 residents reviewed (Resident #235, Resident #236, and Resident #237 ) who received Medicare skilled services and were discharged with benefits remaining, in that: 1. Resident #235 was not given a NOMNC upon discharge from skilled services. 2. Resident #236 was not given a NOMNC upon discharge from skilled services. 3. Resident #237 was not given a NOMNC upon discharge from skilled services. This deficient practice could affect residents who were discharged from skilled services with benefits remaining by denying them the right of appeal.

Inspectors wroteBased on observation, interview and record review the facility failed to provide necessary services to maintain good grooming, personal hygiene for residents who were unable to carry out activities of daily living for 3 of 8 Residents (Resident #182, Resident #183, and Resident #184) whose records were reviewed for grooming and personal hygiene. The facility failed to ensure: 1. Resident #182 received scheduled showers on 4/29/24 and on 5/1/24. 2. Resident #183's dirty t-shirt was changed out on 5/1/24. 3. Resident #184's face had not been shaved, his eyebrows and nose hair had not been trimmed since 4/30/24. These deficient practice could affect any resident and contribute to feelings of poor self-esteem and hopelessness.

Inspectors wroteBased on observations, interview, and record review the facility failed to ensure residents' environment remained as free of accidents and hazards as possible and each resident received adequate supervision and assistive devices to prevent accidents for 6 of 20 residents (#1, #3, #27, #39, #46 and #185 ) reviewed for assistance with safe mechanical lifts and falls. 1. On 05/05/2024 at 03:54 PM CNA R transferred Resident #39 from her bed to her wheelchair with the assistance of 1 person and caused Resident #39 discomfort and pain. 2. On 04/16/2024 The facility assessed 4 residents (#1, #3, #27, and #46) with the need for a mechanical lift and planned for residents to receive assistance with mechanical lifts with the aid of 1 person. 3. Resident #185 fell multiple times and on 4/21/24 sustained a laceration which required multiple sutures to the left side of her head. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure its medication error rates were not 5% or greater. The facility had a medication error rate of 10%, based on 3 errors out of 30 opportunities which involved 2 of 8 residents (Resident #46 and #285) reviewed for medication administration and medication errors. 1. On 05/04/2024 at 07:31 AM LVN U failed to perform a safety check on the insulin injection pen prior to administering Resident #285's insulin injection. 2. On 05/04/2024 at 09:40 AM Medication Aide V administered Resident #46's antibiotic and nerve pain medication 40 minutes late. These deficient practices could place residents at risk for not receiving therapeutic effects of their medications and possible adverse reactions.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to ensure residents were free from significant medication errors for 4 of 12 residents (Residents #13, #32, #33 and #285) reviewed for significant medication errors. 1. On 05/04/2024 at 07:31 AM LVN U failed to perform a safety check on the insulin injection pen prior to administering Resident #285's insulin injection. 2. On 05/04/2024 at 10:04 AM Medication Aide V administered oxcarbazepine (an anti-seizure medication), and Baclofen (an anti-muscle spasm medication) to Resident #13 late by 1 hr. and 5 minutes. 3. On 05/04/2024 at 10:09 AM Medication Aide V administered ferrous sulfide (an iron medication) and midodrine (a drug used to raise blood pressure) to Resident #32 late by 1 hr. and 9 minutes. 4. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an effective pest control program for 1 of 1 facility kitchen reviewed, in that: Flies too numerous to count were observed in and around the food preparation area. This deficient practice could affect residents, staff, and visitors who consume foods prepared in the facility kitchen.

Inspectors wroteBased on observation, interview and record review the facility failed to provide maintenance services necessary to maintain a comfortable interior for 1 of 8 Residents (Resident #182) who was observed for homelike environment. The facility failed to ensure Resident #182's bathroom was free of bad odors since admission. This deficient practice could affect any resident and contribute to feelings of hopelessness.

Inspectors wroteBased on observation, interview and record review the facility failed to have physician for the resident's immediate care for 1 of 8 Residents ( Resident #185) whose records were reviewed for new orders. 1. Nursing staff failed to obtain an order for the use of side rails for Resident #185 upon admission, 4/19/24. These deficient practices could affect any resident who was a new admission and could result in residents not receiving the treatment as needed or result in not obtaining physician orders for the use of equipment.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure residents received care, consistent with professional standards of practice, to prevent pressure ulcers based on the comprehensive assessment for 1 of 3 Residents (Resident #183) whose record were reviewed for pressure ulcers. Nursing staff failed to apply a prevalon boot (designed with an open, floated-heel design which means the heel is completely floated. This provides continuous pressure relief) or offload Resident #183's left foot, on 4/30/24 and on 5/2/24, to prevent him from developing a pressure ulcer. This deficient practice could affect residents at risk for developing pressure ulcers and could contribute to developing avoidable pressure ulcers.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to ensure residents who were incontinent of bladder received appropriate treatment and services to prevent urinary tract infections for 1 of 8 residents (Resident #183) reviewed for catheter care. CNA T lifted Resident #183's urine collection bag above the bladder during indwelling catheter care for Resident #183. This failure could place residents at risk for catheter associated urinary tract infections (CAUTI).

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to store all drugs and biologicals in locked compartments under proper temperature controls and permit only authorized personnel to have access to the keys, for 1 of 4 medication carts reviewed for drug security and 1 of 8 residents (Resident #62) reviewed for medications at the bedside. 1. On 05/03/2024 LVN W was assigned the 100-hall nurse medication cart when at 08:16 AM he left the medication cart unattended and unlocked. 2. On 04/30/2024 at 11:42 AM Resident #62 had her medicated eye drops and medicated nasal spray unsecured at her bedside. This failure could place residents at risk for misappropriation of property and could place residents at risk for accidents and hazards.

Inspectors wroteBased on interview and record review revealed the facility failed to promptly notify the ordering physician, physician assistant, nurse practitioner or clinical nurse specialist that fall outside of clinical reference ranges in accordance with facility policies and procedures for notification of a practitioner or per the ordering physician's orders for 2 of 8 Residents (Resident #9 and #30) whose records were reviewed for lab services. 1. The facility failed to report to Resident #9's physician and document abnormal laboratory results on 02/16/2024 and again on 03/01/2024, to include low abnormal sodium blood serum levels to the physician. 2. The facility failed to report to Resident #30's physician and document abnormal laboratory results on 03/02/2024. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that each resident receives, and the facility provides food that accommodates resident allergies, intolerances, and preferences for 1 (Resident #70) of 25 residents reviewed, in that: Resident #70 had an intense dislike of cheese and was served a cheese omelet for breakfast. This deficient practice could lead to diminished quality of life and weight loss.

Inspectors wroteBased on observation, interview, and record review, the facility failed to enact a policy regarding use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption, for 1 (Resident #62) of 25 residents reviewed, in that: A bottle of prune juice which has been opened and was unrefrigerated, unlabeled, and undated was found on Resident #62's bedside table. This deficient practice could lead to illness due to foodborne pathogens.

Inspectors wroteBased on interview and record review, the facility failed to ensure that all allegations involving abuse, neglect, and misappropriation were reported immediately, but no later than 2 hours after the allegation is made if the events result in serious bodily injury, to the State Survey Agency for 2 of 7 residents (Resident #1 and Resident #2) reviewed for reporting. 1. The facility failed to report to the State Survey Agency (HHSC) allegations of neglect resulting in serious bodily injury during an incident involving Resident #1 on 2/4/24 within the specified timeframe. 2. The facility failed to report to the State Survey Agency (HHSC) allegations of neglect resulting in serious bodily injury during in incident involving Resident #2 on 3/4/24 within the specified timeframe. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen, in that: 1. There were two 5-lb. containers of commercially prepared salads in the walk-in cooler that were past their use-by dates. 2. There was an open bag of dry cereal in the dry storage room that was not stored in a closed or tightly covered container. 3. The tabletop can opener blade, bar, and base were covered in sticky black and brown grime. 4. [NAME] C wore a wristwatch on her arm while preparing food in the kitchen. These failures could place residents who received meals and/or snacks from the kitchen at risk for food borne illness.

Inspectors wroteBased on observation, interviews and record review, the facility failed to accurately reflect the resident's status on the MDS assessment for one resident (#16) of 8 residents reviewed for MDS assessments in that: Resident #16 was admitted with a cardiac pacemaker and it was not reflected on his MDS assessment. This deficient practice could affect residents with active healthcare devices and could result in equipment malfunction and heart failure.

Inspectors wroteBased on observation, interviews and record reviews, the facility failed to assure that residents receive a therapeutic diet as prescribed by the physician for one resident (#36) of 8 residents reviewed for diets in that: Resident #36 was prescribed a renal diet (A renal diet is one that is low in sodium, phosphorous, and protein. A renal diet also emphasizes the importance of consuming high-quality protein and usually limiting fluids. Some patients may also need to limit potassium and calcium) and was provided a regular diet which did not meet his special dietary needs and was provided a regular diet. This deficient practice could affect residents who are prescribed renal diets and could result in potassium building up in the blood stream and could result in a heart attack.

Inspectors wroteBased on observation, interviews and record reviews, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for one resident (#63) out of 6 residents observed for medication pass in that: LVN A put her bare finger in the medication cup and carried the cup back and forth up and down the hall twice with her hands over the rim of the cup prior to giving Resident #63 her medications. This deficient practice could affect residents who receive medications and could result in cross contamination and the spread of infection.