Incident investigation·January 18, 2024

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection following receipt of an incident report on 1/4/24. LPA met with Toni Jones, Administrator, and explained the reason for the inspection. LPA discussed the incident report with the Administrator where resident (R1) was sent to the emergency room on 1/4/24 due to needing medication refills. The report states resident returned to the community the same day and medication refill orders were sent electronically to a local pharmacy to be filled. After discussing the incident further with the Administrator, it was learned that (R1's) responsible person had recently changed (R1's) insurance plan, and the refills were unable to be filled by the assigned doctor in another city as (R1) had no way to travel out of town to see that physician. LPA discussed the incident report that was faxed in and had missing information on the first page, explaining the reason why (R1) was sent to the emergency room. The Administrator provided LPA with a paper copy of the incident report where additional information was included that was not included on the faxed copy. The additional information explains that (R1) was sent out was due to the insurance company incorrectly assigning (R1) to a doctor out of the area. The Administrator confirmed (R1) had (3) remaining days of medication when he was sent out. The new insurance is effective 2/1/24. There are no deficiencies issued in this report. Copy of report provided to Administrator.