complaint·December 14, 2024

These training procedures were outlined in the packet that was designated for facility staff training and medication assistance procedures submitted by the facility designated Administrator into CCL for review. These procedures and staff related tasks outlined and stated the following: Insulin Pen Dialing for Self Injection on page 72 Hand resident the insulin pen, and ensure they have a secure grip secure before letting go to avoid dropping. Be aware of exposed needle at all times Allow resident to self administer injection and have them hold pen in place for 10 seconds Blood Glucose Checks on page 74 Hand resident the blood glucose meter, and ensure they have a secure grip secure before letting go to avoid dropping. Be aware of exposed needle/lancet at all times Watch resident pierce their finger and place blood onto test strip according to manufacturer instructions It was learned that facility staff designated as Med Techs had to be passed and checked off by an evaluator prior to being able to handle, dispense, and document the resident medications on their own. This was done so by the Competency Verifications for the same policies and procedures conducted on Pages 78, 80, and 81 of the Medication Assistance Procedures. It was learned that facility staff designated as Med Techs were allowed to assist residents with Blood Glucose Check by using hand over hand techniques to assist with piercing their finger and placing the blood onto the test strips. It was learned that facility staff designated as Med Techs were allowed to assist residents with Insulin Pen Dialing for Self Injection by using hand over hand techniques to assist with injections and holding the pen in place for 10 seconds. Based on a review of the forms and documents, as well as interviews conducted, facility staff designated as Med Techs were allowed to conduct these types of assistance with hand over hand with facility residents Manager, Brisa Romero, who also held a current Administrator Certificate at this time. Based on a tour of the facility that was conducted, it was learned that all resident medications were centrally stored in the Memory Care Unit at all times. It was observed that resident medications that were to be dispensed on a daily basis were stored in a mobile cart. It was observed that this mobile cart was locked and made inaccessible to the residents at this time. It was learned that overflow medications were stored in bins in a closet type until also found in the facility medication room. It was learned that this medication room was locked at all times except in the case when facility staff, designated as Med Techs, were present to pour the medications and ready them for dispensing to the residents. A review of the facility medication administration record (MAR) and dispensing log was conducted. It was observed that the medications were being dispensed and documented as prescribed by the responsible licensed medical professionals at this time. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegations finding of Unsubstantiated meant that although the allegations may have happened or were valid, there was not a preponderance of the evidence to prove that the alleged violations occurred. There were no deficiencies observed or cited at this time. Exit Interview requiring assistance with Blood Glucose Checks and Insulin Pen Dialing for Self-Injection without proper documented training. It was learned that these techniques were not found to be present in the Medication Assistance Procedures at this time even though they were being conducted and performed by the Med Techs at this time. As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegations were valid because the preponderance of the evidence standard had been met. The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes. Appeal rights were printed and a copy was left with the facility designated representative at this time. Exit Interview