complaint·March 6, 2024

LPA conducted a medication count for residents (R1, R2 & R3), comparing the residents' medication lists on file with medication centrally stored for the residents. LPA observed one (1) medication for R1 that was over the amount documented and there were four (4) medications for R1 that were under the amount documented. LPA observed five (5) medications for R2 that were over the amount documented. LPA observed that two (2) medications for R3 were over the amount documented. LPA also observed during the medication count that there were several other residents that didn't have start dates for their medications. According to the facility's Order Summary Report and interviews conducted with the Executive Director and Health and Wellness Director, R1 had a new prescription for Losartan Potassium 25mg tablets that was ordered by the prescribing physician on 2/27/24. Facility Progress Notes for R1 dated 2/29/24 indicated that staff (S1) contacted R1's physician's office requesting that the medication order be faxed to the pharmacy. Progress Notes dated 3/3/24 indicated that S1 contacted R1's responsible party informing them that the facility was having issues getting the new prescription filled. Progress Notes also indicated that R1's responsible party would provide R1 with the their discontinued medication until the facility was able to get the new prescription filled. R1 did not begin receiving their new prescription until 3/5/24, which was 7 days after the original physician's order date of 2/27/24. Based on 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.