Complaint·July 24, 2025

In regards to the allegation that resident is not receiving medications as prescribed: Licensing Program Analyst (LPA) Renese Howell-Small interviewed (5) staff and ten (10) residents. Staff stated that medical technicians are trained through Relias, monthly in-services, pharmacist and hospice agencies. Staff denied not administering medications as prescribed by a physician. LPA audited the Medication Administration Record(s) (MAR) for Resident 1 (R1), Resident 2 (R2) and Resident 3 (R3). LPA did not observe any errors when the MAR was reviewed. The MAR and the facility's resident notes in the August program, indicate that R1 had a record of refusing medications and although R1 was unable to administer their own medications, kept medications in their room. All ten (10) of the residents stated that they received their medications. Staff also stated that residents may become upset when the physician adjusts their medication and the new medication has changed in appearance. Based on interview and record review, this allegation is UNSUBSTANTIATED. In regards to the allegation that call button not in working order for months: LPA interviewed ten (10) residents. All ten (10) of the residents stated that they have a call button and it is in working condition. LPA observed ten (10) residents interviewed to have a call button and tested random call buttons during the visit in which staff arrived to assist. LPA interviewed five (5) staff and staff stated that each resident is given a call button when hey become residents of the facility. Residents will communicate with staff if their call button is not working. Staff will test the call button and replace the battery when needed. Staff denied that call buttons have not been in working order for months. R1 received a call button but refused it, stating to staff that it was broken. Facility notes confirm that when R1 left the facility on 03/21/2025, R1 turned in their keys/pendant. Based on interviews and record review, this allegation is UNSUBSTANTIATED. UNSUBSTANTIATED is defined as the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted where this report LIC9099 and LIC9099C was discussed and a copy was provided to staff.