Health inspection·September 22, 2022

F 0755 Level of Harm - Minimal harm or potential for actual harm Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interviews and record review, the facility failed to provide routine medications to meet the needs of 1 of 7 (#17) residents sampled for medication administration observation. Residents Affected - Few The findings include: On 9/21/22 at approximately 1:50 PM, during a medication administration observation of Nurse A, a Licensed Practical Nurse (LPN), Resident #17 asked Nurse A about his inhaler medication and when it would be available. The nurse responded that the pharmacy stated it would be that evening. On 9/21/22 at approximately 1:50 PM, an interview was conducted with Resident #17 who reported he has not received his inhaler for almost a month now. On 9/21/22 at approximately 1:55 PM, an interview was conducted with Nurse A. Nurse A stated that the medication Incruse Ellipta Aerosol Powder Breath Activated 62.5 MCG/INH (a steroid inhalation medication used to treat Chronic Obstructive Pulmonary Disease) has been out for several days. She further stated that she notified the pharmacy, and when it did not come in, notified the Assistant Director of Nursing (ADON). When asked if the physician had been notified that Resident #17 had been without his medication for several days, Nurse A stated No. On 9/21/22 at approximately 2:00 PM, an interview was conducted with the ADON, a Registered Nurse. The ADON stated that she had called the pharmacy the other day to re-order the medication, and the pharmacy stated it would be delivered that night. She continued that, when it did not arrive, she called the pharmacy again the next day. When asked if the physician had been notified that the medication was out, the ADON stated that the primary nurse would have notified the physician, and confirmed that she had not done so. When asked about the facility's policy on re-ordering medication and notifying the physician, she stated she was not sure and would have to get back to the surveyor later with an answer to the question. A record review was conducted of Resident #17's electronic medical record. Review of the electronic medication administration record (EMAR) revealed that on the following dates, the medication Ellipta Aerosol Powder Breath Activated 62.5 MCG/INH was documented as not given, 9/1/22, 9/3/22, 9/4/22, 9/8/22, 9/9/22, 9/12/22, 9/13/22, 9/14/22, 9/15/22, and 9/17/22. The EMAR revealed that the medication was documented as given on 9/2/22, 9/5/22, 9/6/22, 9/7/22, 9/10/22, 9/11/22, 9/16/22, 9/19/22, and 9/20/22. Review of the progress notes revealed no documentation that the physician was notified that the medication had not been given on 10 days. Further review of progress notes revealed that a progress note entered on 9/21/22 as a late entry for 9/19/22 revealed the pharmacy was notified of the medication not being delivered and the pharmacy reported it would be in that night. The note Page 1 of 2 105612 105612 09/22/2022 Silvercrest Health and Rehabilitation Center 910 Brookmeade Drive Crestview, FL 32539

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few further indicated that on 9/20/22 the medication did not arrive and the resident requested the pharmacy be called again. On 9/21/22 at approximately 2:15 PM, an interview was conducted with the Nurse Consultant and the Director of Nursing (DON). When asked about the expectation for re-ordering medications from the pharmacy, the Nurse Consultant responded that if the medication is out, they need to notify the physician and obtain a hold order, then notify the DON to contact the pharmacy, and if needed have the back up pharmacy fill the prescription to be picked up by the facility. The DON stated that she was not notified of the medication being out. On 9/21/22 at approximately 3:30 PM, a telephone interview was conducted with the Pharmacy Manger and Pharmacist who stated that the last time the inhaler medication was delivered to the facility was on 8/19/22, and the medication was a 7-day supply. They stated they did not have any record of it being re-ordered prior to today, but that the medication is on the run tonight. A review was conducted of the document titled Medication Delivery Expectations. Under the Protocol subtitle, section E. states, if pharmacy refuses to deliver or pharmacy does not respond to call, immediately notify the Director of Nursing or Administrator. Section F. states, Administrator, DON, or designee to immediately notify pharmacy of any medication availability issues. If pharmacist does not respond to needs notify pharmacy manager. Do not stop until medication is received, even if that involves further escalating the situation. Section H. states, Notify physician if medication will be given late or obtain order for different start times if appropriate or request medication to be held until available or ask for a change in equivocal medication to one that is available. 105612 Page 2 of 2