complaint·January 30, 2024

9099C-1... Allegation: Medication mismanagement. The complaint alleges that resident (R1) ran out of medications on (2) occasions. Resident’s (R1) family member stated the first time (R1) missed her medications was after the initial (30) day supply of Olanzapine 2.5 mg, taken at bedtime, was started on 7/26/23. The MAR and LIC622 document this prescription was filled and started on 7/26/23 , with no automatic refills. The Med-Tech/Nurse communication log also documents that medications were received on 7/26/23, and Olanzapine was logged and stored as well as other medications. MAR documentation for July and August 2023 does not reflect the medication was administered consistently and shows (3) days/dosages were missed in July and multiple days/dosages were missed in August. If the medication was started on 7/26/23, it should have run through 8/24/23. The next prescription, noted as a (3-day) emergency supply, was not filled until 8/27/23. Resident’s responsible person stated that on Tuesday, 8/29/23- there was a medical follow up for this anti-psychotic medication that was prescribed for "auditory hallucinations". The LIC622 documents that a (5) day prescription was filled on 8/29/23, but not started on 9/6/23. Staff interviews indicated that they would reach out to the resident’s responsible person and leave voice messages regarding a medication needing to be refilled and the responsible person did not return the call. The RCC stated that when (R1) first moved in, she had no medical insurance and "everything was still out of state". RCC stated that there was only "one time" when (R1) missed medications, stating she believes the medication was "Olanzapine". The Administrator stated the Med-Tech would call for refills and then call the family member to pick them up, and she was aware of what was needed" for the refills and agreed to pick up the meds when (R1) moved in. Resident’s family member mentioned that a medication ran out for resident again, on Friday, 10/13/23, and she was just notified by staff, and the last dosage to be administered had been poured for the evening of 10/13/23. LIC622 documents that a 90- day supply of scheduled Levothyroxine .88mg, was filled on 10/13/23 and started on 10/14/23. MAR shows resident did not miss any dosages of this medication taken in the morning in October. Exit interview. Co py of report and appeal rights provided. cont on 9099C-2...