Health inspection·March 11, 2025

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a routine medication was available for one of three sampled residents (Resident 1). This failure resulted in Resident 1 not receiving scheduled medication and caused the resident distress. Findings: During an interview on 3/7/25 at 3:40 p.m. with the director of nursing (DON), the DON stated Resident 1 was admitted on [DATE] at 5:30 p.m. The list of medications was sent electronically to the pharmacy and the facility eventually received delivery of the medications from the pharmacy. Missing from the medications was Alprazolam (medication for anxiety) 2 mg (milligrams). Resident 1 takes Alprazolam 2 mg. at bedtime routinely. During a telephone interview on 3/7/25 at 4:20 p.m. with the pharmacist, the pharmacist stated all controlled medications need to be faxed to the pharmacy. The facility can send medication requests, even controlled medications electronically but a fax still needs to be sent for any controlled medication. The only exception for not sending a fax for a controlled medication is when the doctor/prescriber sends the order electronically directly to the pharmacy. During an interview on 3/7/25 at 4:50 p.m. with admitting nurse (LN 1), LN 1 stated admitted Resident 1 on 3/4/25 at 5:30 p.m., reconciled the medications, sent the medication list electronically to the pharmacy and called the pharmacy to confirm they received the requested medication list sent. LN 1 admitted was not aware a fax had to be sent for the controlled medication, Alprazolam 2 mg. During a review of Resident 1's Nursing Progress Notes (Notes), dated 3/4/25 at 10:42 p.m., the Notes indicated, LN 2 documented, Medication did not arrive with pharmacist sender. Will call and get information on it . There were no further updates/documentation regarding the missing Alprazolam or attempt to call the physician to request an alternative medication. During a review of Resident 1's Notes, dated 3/5/25 at 10:56 p.m., LN 4 documented, Patient was upset Alprazolam wasn't here. This writer explained to pt (patient) that I will call pharmacy for ETA (Estimated Time of Arrival) of med.(medication) MD notified requesting alternative med d/t (due/to) Alprazolam not available. Resident 1's Representative was very upset and signed Resident 1 out of the facility AMA (Against Medical Advise) on 3/5/25 at 10 p.m. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 055563 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Santa Maria Post Acute 820 West Cook Street Santa Maria, CA 93458 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)