complaint·February 7, 2023

Regarding the allegation of staff are not keeping accurate medication logs, it was determined that facility staff did not accurately log R1’s MARs when medication is dispensed. Based on review of R1’s MARs for the month of September 2022, there were multiple dates with missing staff signature. According to staff S4 and S5 who corroborated that the medication was provided to R1, but staff did not complete the MARs as required. As a result of this investigation, the Department finds the allegations above to be Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on the LIC 9099-D, per Title 22 Regulations. Exit interview was conducted, a copy of the report, LIC 9099-D and appeal rights were provided. Regarding the allegation of facility staff is not performing resident's glucose testing as ordered, it was determined that there was insufficient evidence to substantiate this allegation. According to staff who were interviewed, R1’s glucose testing is being followed as ordered by R1’s physician. Staff S5 stated that R1 receives insulin within 30 minutes of glucose testing before meal. S5 stated that normally medication can be dispensed within 1 hour window before or after meal. S5 stated that staff will not administer Insulin without glucose testing. As a result of this investigation, the Department finds the allegations above to be UNSUBSTANTIATED- A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted and a copy of the report was provided.