complaint·July 8, 2025

All staff members denied that the medication was not administered according to the physician’s order. The prescription specifies that 17 mg of the medication must be mixed with 4 to 8 ounces of water prior to administration. The Licensing Program Analyst (LPA) discussed and observed the process of how the medication is to be administered. During the observation, staff demonstrated that the medication is measured up to the 17 mg line on the cap and then mixed with water as instructed. A review of R1’s Medication Administration Record (MAR) confirmed that the laxative was administered as prescribed. Additionally, bowel movement logs showed that R1 experienced regular daily bowel movements. In a follow-up interview, facility management acknowledged that medication technicians were not using a full capful but confirmed that the dosage provided still met the prescribed 17 mg. Based on the information gathered, there is not sufficient evidence to prove that staff did not provide medication as directed. Allegation: Staff do not ensure outside patio is clean and free of debris. It was alleged that staff do not ensure outside patio is clean and free of debris. During the course of this investigation, LPA conducted observations of the outdoor patios on 04/22/2025 and 05/22/2025. During the visit conducted on 04/22/2025, LPA Pascua observed the patio adjacent to the main dining room in the main building was found to be littered with tree debris, including pine needle-like droppings and small, circular fruits approximately half an inch in diameter. However, on 05/22/2025 and 06/13/2025, subsequent visit was conducted by the LPA who observed that the patio areas were free of debris. Based on the information gathered, there is not sufficient evidence to prove that the staff did not ensure the outside patio was clean and free of debris. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time. An exit interview was conducted and a copy of this report and appeals rights were provided to the facility at the end of this visit.