Health inspection·December 26, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on interview and record review, the facility failed to provide pharmaceutical services that meet the needs of the residents when two of four sampled residents (Residents 1 and 2) did not receive their medications in a timely manner. These failures were not in alignment with the facility policy and procedures and had the potential to not meet the residents' therapeutic needs which could lead to the worsening of their health conditions. Findings: 1. During an interview on 12/26/24 at 3 p.m., Resident 1 stated her medication Carbidopa-Levodopa (used to treat the symptoms of Parkinson's disease [shaking palsy]) was scheduled three times a day but would often receive them late. Resident 1 stated even today's doses were more than an hour late . Resident 1 stated she would have preferred it if nurses would give her medications on time. During an interview on 12/26/24 at 3:15 p.m., Licensed Nurse A stated medications were supposed to be administered within an hour of its schedule. During a concurrent interview and record review on 12/26/24 at 5:40 p.m. with the Administrator, Resident 1's Levodopa-Carbidopa Administration History , dated 12/12/24-12/26/24 , was reviewed. The Administration History indicated the medication was scheduled for 0700 (7 a.m.), 1200 (12 p.m.) and 1700 (5 p.m.). The Administration History indicated the medications were administered at 08:46 (8:46 a.m.) and 13:59 (1:59 p.m.) on 12/26/24. Further review of the Administration History indicated the medication was administered an hour past its schedule 22 other times during the period of 12/12/24 to 12/26/24. The Administrator stated the medications were given late. During an interview on 12/26/24 at 6:05 p.m., the Administrator stated medications were supposed to be given as scheduled, per the physician's orders. The Administrator stated delays in medication administration could worsen the residents' symptoms. 2. During an interview on 12/24/24 at 1:50 p.m., Family Member (FM) stated it was upsetting when nurses were hours late in giving Resident 2 her scheduled 9 a.m. medications on 11/28/24. A review of Resident 2's MEDICATION ADMINISTRATION RECORD , dated 11/1/24-11/30/24 , indicated Resident 2 had three medications scheduled to be administered at 9 a.m. on 11/28/24: Metoclopramide (used to treat or prevent nausea and vomiting), Vitamin D3 (used to treat and prevent bone disorders) and Metoprolol Tartrate (used to lower the blood pressure). During a concurrent interview and review on 12/30/24 at 2 p.m. with the Administrator, Resident 2's (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: 056296 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 056296 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crescent City Care Center 1280 Marshall Street Crescent City, CA 95531 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)