complaint·March 23, 2023

It was further determined that R1 was receiving medication without a physician’s order on file at facility during the above noted time period. Additionally, based on medication count and review of medication logs, medication Trazodone had 19 pills present in a bottle which should have contained 22 pills, and medication Atrovastatin contained 21 pills in a bottle which should have contained 22 pills. Based on interviews and record reviews, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED. Allegation #2: Staff did not observe resident for change in condition. LPA interviewed Administrator and reviewed care notes for R1. Based on interview and record reviews, it was determined that R1 was sent to the hospital on 1-4-23 due to a behavioral episode, and learned that R1 had contracted scabies. It was further determined that facility staff was aware of redness on R1, but not aware of scabies due to not providing evidence of an appropriate regulatory required observation of R1 including notifying family and Physician of R1. As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED. Allegation #3: Licensee does not maintain a record for centrally stored medication. LPA interviewed Administrator and reviewed medication log sheets for R1. This allegation refers to alleged inaccurate medication logs sheets regarding central stored medication for R1. Based on interview and record review, it was determined that medication log sheets for December 2022 were inaccurate in that medication Hydroxizine was noted on the log sheet for R1 and initialed by facility staff as given to R1, however, medication did not contain a written order from Physician and should not have been included on the log sheet as a result. Additionally, based on medication count and review of medication logs, medication Trazodone had 19 pills present in a bottle which should have contained 22 pills, and medication Atrovastatin contained 21 pills in a bottle which should have contained 22 pills, resulting in inaccuracies of R1’s medication records. As a result, the preponderance of evidence standard is met and this allegation is SUBSTANTIATED. As a result of this allegation, citations are issued under Title 22, Division 6 and listed on LIC 9099D. An exit interview was conducted with Orchid Damrichob and a copy of this report was provided to Orchid. Appeal rights provided. Allegation #2: Staff do not assist resident with grooming. LPA conducted interviews as noted above and conduct additional facility observation. Based on observation of facility and residents, LPA observed residents to be appropriately clothed, with adequate grooming including combed hair, trimmed fingernails, and shaved hair as appropriate. No foul odors were observed by LPA. Additionally, LPA observed used grooming supplies available to staff for assisting residents as needed. Based on interviews, it was determined that residents in care have been receiving grooming assistance from staff. As a result, there is not a preponderance of evidence to conclude resident is not receiving regular bathing assistance, and this allegation is UNSUBSTANTIATED. Allegation #3: Staff are not safeguarding resident’s personal belongings. Allegation referred to R1’s personal belongings as indicated by an allegation of R1 wearing another resident’s clothing item. Based on interview and record review, it was determined that R1 had worn a clothing item purchased by facility staff after R1’s admission. LPA observed item and receipt of purchase to concur item was purchased after admission. Based on review of R1’s inventory sheet, it was determined that R1’s items have been accounted for. As a result, there is not a preponderance of evidence to conclude facility did not ensure safeguarding of R1’s personal property during R1’s residency, therefore, this allegation is UNSUBSTANTIATED. An exit interview was conducted with Orchid Damrichob and a copy of this report was provided to Orchid. Appeal rights provided.