Complaint·December 20, 2023

LPA observed two (2) medications for R2 that were off count and were under the amount documented and one (1) medication that was over the amount documented. LPA observed that R3 had one (1) medication that was off count and over the documented amount. There were several of R1, R2, and R3's medications that were not observed during the first medication count conducted. During a visit conducted on 12/14/23, LPA conducted a medication count for R1, R2, and R3 comparing the residents' medication lists on file with medication centrally stored for the residents. LPA observed one (1) medication for R1 that was off count in relation to what was documented and was over the amount documented. LPA observed one (1) medication for R2 that was off count and was over the documented amount. No medication refusals were provided for either medication counts conducted on 10/25/23 and 12/14/23. According to R1's medication list, R1 is prescribed to receive Insulin before meals. Interviews conducted with staff (S3, S4, & S5) indicated that they were on duty during the brunch event the facility held on 8/27/23. S3, S4, and S5 recall that there were no nurses on duty during the morning shift on 8/27/23. The nurse scheduled (S2) came in after the brunch event. According to the schedule provided to LPA, S2 was the only nurse scheduled on 8/27/23. S2 was scheduled for the PM shift starting at 2pm. S3 indicated that R1's responsible party was concerned that R1 had not received their insulin injection prior to mealtime as prescribed. Interview with S3 indicated that they spoke with S4 regarding R1's responsible party's concern regarding the insulin medication. Interview with S4 and S5 indicated that they assisted each other with providing insulin injections using the hand-over-hand method for any residents requiring insulin injections. S4 and S5 both recall that R1's insulin medication may have been given late during the brunch event on 8/27/23. Based on interviews conducted, a medication count, and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Exit interview conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents. facility has a total of 5 nurses that work at the facility. ED indicated that there are only two Med Techs that have been used for insulin injections in an emergency situation. Interviews with staff (S1 & S2) indicated that the nurses at the facility can assist residents with insulin injections. Interviews also indicated that the Med Techs who are trained to assist residents with injections use the hand-over-hand method. S1 stated that the residents understand how to do their own injections with hand-over-hand assistance from a Med Tech. S2 stated that some residents require more assistance with injections than the hand-over-hand method and a nurse would provide the assistance. The facility provided LPA with training documentation indicating that the two staff (S4 & S5) utilized to assist with hand-over-hand injections have completed medication training. The facility also provided documentation indicating that the 5 vocational nurses have current licenses through the Board of Vocational Nursing and Psychiatric Technicians. Based on interviews conducted and documentation reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. No deficiencies are being cited during this visit. Exit interview conducted. A copy of this report provided. Signature on these forms acknowledges receipt of these documents.