complaint·September 26, 2024

Allegation: “Facility staff did not administer medications to resident as prescribed:” The complaint alleges that Resident #1 (R1) requested PRN medication on 03/26/2023 in the evening, but was never administered the PRN (as needed) medication requested. LPA reviewed medication logs for R1, which indicate PRN pain medication was administered in the morning of 03/26/2023, but not the evening/night. The log indicated that R1 was administered their PRN pain medication 15 (fifteen) times during the month of March 2023. LPA was unable to interview R1, as R1 was agitated and refused interview during the LPA’s visit at the facility and LPA did not receive a response by telephone. So LPA could not confirm whether there were additional times the medication was requested and not administered. Staff interviewed indicated that residents can request PRN medication at any time of the day or night and there is always a medication technician on shift to administer the medication to the resident. The medication technician then records the medication on the electronic MAR as administered. The only exception is if it’s too close to the time the resident had taken a previous dose of the PRN medication. Staff interviewed indicate that R1 does call often for PRN medication and that the doses are administered. 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 “facility staff did not administer medications to resident as prescribed” is deemed UNSUBSTANTIATED at this time. Allegation: “The licensee did not provide assistance needed to meet the resident’s home health needs:” It was alleged that R1 had orders for physical therapy, which included daily walks with facility staff, but that facility staff were not walking with R1. LPA interviewed staff, who indicated that they walk with R1 once daily, typically to the dining room. Staff indicated there is a log in R1’s room where they can mark daily walks with R1. During the initial complaint visit, LPA asked R1 where the log was and R1 indicated they had thrown it away. Staff interview revealed that R1 frequently refused to participate in walking exercises, likely due to pain R1 reported experiencing. As LPA was unable to interview R1, LPA was unable to confirm whether walking exercises were offered to R1 and they were refused or if exercises were not offered. 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 “the licensee did not provide assistance needed to meet the resident’s home health needs” is deemed UNSUBSTANTIATED at this time. Report Continued on LIC 9099-C (p.3) Allegation: “Licensee did not allow resident's chosen third-party provider to provide services to the resident:” It was alleged that R1’s home health provider was changed and R1’s preferred provider was not allowed to continue providing services. Record review revealed that R1 was with one home health provider prior to R1’s hospitalization and when R1 was re-admitted to home health services that R1 was placed with Aasta’s preferred home health provider rather than the previous provider. Reporting party indicated that it was the facility who changed R1’s provider. Interview with facility management revealed that upon discharge from the hospital that the previous provider did not receive home health orders for R1 to resume services and that the provider changed due to the hospital discharge orders. Upon request, R1’s provider changed back to the previous provider shortly after. Documents reviewed indicated R1 was discharged from their preferred provider on 03/22/2023 and readmitted back to their preferred provider on 03/27/2023. LPA was unable to discuss the allegation with R1. 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 “Licensee did not allow resident’s chosen third-party provider to provide services to the resident” is deemed UNSUBSTANTIATED at this time. Allegation: “Facility is understaffed:” The reporting party stated that they believe the facility is understaffed, but no additional information was provided. LPA interviewed staff and reviewed staff schedules. Staff interviewed indicated that during the day there are sufficient amounts of care staff and activity staff present at the facility, as well as medication technicians, cleaning staff, dining staff and other various administration staff. Staff stated that there are call outs, but typically a staff will stay and work later or management staff will cover the shift. Residents interviewed felt their needs were met timely and that there is a sufficient number of staff. Based on interview and observation, 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 “facility is understaffed” is deemed UNSUBSTANTIATED at this time. No citations issued. Exit interview conducted. A copy of today’s report was provided.