Complaint·May 25, 2023

LPA Moleski observed doctor’s orders dated February 22, 2023, ordering R1’s prescription be discontinued. The latest of these doctor’s orders indicate the dosage of this medication was one half tablet to be taken every other day. LPA Moleski reviewed R1’s MARs for the months of September 2022 through February 2023. R1 received a daily dose of this medication during the month of September 2022 through the first several days of October 2022. Starting on October 6, 2022 and lasting through October 25, 2022, R1 received doses of this medication every other day. Beginning on October 27, 2022, and lasting through February 15, 2023, R1 regularly received a daily dose of this medication. Whinery was unable to provide LPA Moleski any doctor’s orders justifying the increase in dosage in late October. The department has determined the following as it relates to the allegation that facility staff are mishandling a resident’s medication: Based on review of R1’s MARs and doctor’s orders, and based on interviews with Whinery, R1’s medication was increased without having a physician’s authorization on file. Therefore, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met. This facility is being cited per 22 CCR Section 87465(a)(5)(A). An exit interview was held with Whinery. Appeal rights and a copy of this report were left with Whinery.