complaint·August 14, 2023

Allegation: " Facility staff did not assist with resident's medication as prescribed:" It was alleged that Resident #1 (R1) was not assisted with their insulin and diabetes medication. LPA interviewed R1 and their family member, as well as other facility residents and facility staff. Interviews revealed that at the time of the complaint allegation, the facility employed Licensed Vocational Nurses (LVNs) to provide diabetic care to all applicable residents. At the time of the complaint and through 08/03/2022, there were at least 2 LVNs employed at the facility who administered all diabetic medications. After 08/03/2022, most residents' medications were changed to oral diabetes medications for self-administration. The residents requiring injections were able to be assisted with to hand-over-hand administration of injectable medications. As thus, medication technicians were able to assist residents with diabetes medication assistance and LVNs were not needed full time at the facility. LPA reviewed medication administration record (MAR) for R1, which indicated R1 refused blood sugar check on 5 dates in May 2022. R1 also refused their bedtime insulin pen injection on 05/21/2022 and 05/22/2022. Interviews revealed that R1's physician was informed of R1's medication refusal. Interview with R1 and other residents revealed that medications are offered regularly and on time. Staff interviews revealed that R1 wasn't always compliant with taking their medications as ordered, but they were offered daily and documented when refused. Based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that "facility staff did not assist with resident's medication as prescribed" is deemed UNSUBSTANTIATED at this time. Allegation: " Facility staff are not trained for the job assigned to them:" It was alleged that facility staff are not properly trained for medication administration, specifically related to diabetes medications. LPA reviewed records and interviewed facility management and staff regarding training procedures. All training records for medication technician staff reviewed were compliant with regulation. At the time of the complaint allegation, only LVNs were administering diabetes medications. As they are licensed medical professionals, additional medication training was not required per regulation. Following the change to medication technicians assisting residents with self-administration of injectable medications, an additional in-service training related to diabetes care was provided for all facility medication technicians. Interviews revealed that staff complete training on both a computer system and shadowing prior to administering any medications. Training practices reviewed during the course of the investigation were Report Continued on LIC 9099-C compliant with regulation at that time. Based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that "Facility staff are not trained for the job assigned to them" is deemed UNSUBSTANTIATED at this time. Allegation: Insufficient staffing:" The complaint alleges that the facility does not employ sufficient staffing, resulting in long wait times for residents when they push their call buttons. LPA reviewed the facility staff schedules and conducted interviews. Staff interviewed reported that as the facility census is lower than it has been, therefore less staff needed. Depending on how busy the care staff are determines the wait times. Additionally, there are a few residents that require a 2-person assist and when the staff are assisting those residents, other residents may have to wait a bit longer for a response, but this scenario doesn't occur often. During the daytime, care staff, management, and med techs are all available to assist residents when needed. At night, there are less residents requiring assistance as most residents are sleeping, therefore, less staff are employed during those hours. R1 indicated staff do come and check on their incontinence needs every 2 hours during the night shift. Interview with R1 revealed they could not reach their pull cord when they fell, resulting in R1 calling 9-1-1 for assistance. R1 indicated the problem was not with insufficient staffing, but rather with the location of the pull cord when R1 fell. R1 acknowledged that the facility staff had given R1 a longer pull cord to try to alleviate the problem, but that the location of R1's bed made it difficult to keep the pull cord in an easily accessible spot. When LPA asked R1 about moving their bed to make the pull cord more accessible, R1 refused. Based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support the allegation, therefore, the allegation " Insufficient staffing" is deemed UNSUBSTANTIATED at this time. No citations issued. Exit interview conducted. A copy of the report was provided.