Health inspection·April 9, 2025

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 interview and record review, the facility failed to administer medications as ordered by the physician in 2 of 4 residents (R2, R3) reviewed for pharmacy services in the sample of 4. Residents Affected - Few Findings include: 1. On 4/8/25 at 11:55 AM, V5, R2's Daughter, stated R2 had not been receiving her daily medications. R2's Face sheet, undated, documents R2 has the following diagnoses: Three Part Fracture of the Left Humerus, COPD (Chronic Obstructive Pulmonary Disease), Neuropathy, MDD (Major Depressive Disorder), CHF (Congestive Heart Failure), Cardiac Pacemaker and Defibrillator, History of Falling, Arthropathy, Gout, HTN (Hypertension), Low Back Pain, and Chronic A. Fib (Atrial Fibrillation). R2's MAR (Medication Administration Record), dated 4/1/25 through 4/30/25, documents the following physician orders, dated 4/1/25: Spironolactone Oral Tablet 25 MG (Milligrams) give 0.5 tablets by mouth one time a day for High Blood Pressure; Sertraline HCl (Hydrochloride) Oral Tablet 25 MG give 1 tablet by mouth one time a day for Depression; Furosemide Oral Tablet 40 MG give 1 tablet by mouth one time a day for Cardiac Failure; Empagliflozin Oral Tablet 10 MG give 1 tablet by mouth one time a day for Heart Failure; Neurontin Oral Capsule 100 MG give 1 capsule by mouth one time a day for Neuropathy; Protonix Tablet Delayed Release 40 MG give 1 tablet by mouth one time a day for GERD; Clopidogrel Bisulfate Tablet 75 MG give 1 tablet by mouth one time a day for blood clot prevention; - Atorvastatin Calcium Oral Tablet 40 MG give 1 tablet by mouth one time a day; and Amiodarone HCl Oral Tablet 200 MG give 1 tablet by mouth one time a day for Atrial Fibrillation. The MAR goes on to document those medications were not administered on 4/2/25 or 4/3/25. R2's Progress Notes, dated 4/2/25 and 4/3/25, document these medications were not administered due to not on hand. 2. On 4/8/25 at 8:00 AM, R3 stated she is supposed to get 4 calcium carbonates after meals, and they were out for a while, so she wasn't getting them. R3's Face sheet, undated, documents R3 has a diagnosis of GERD (Gastro-Esophageal Reflux Disease). R3's MAR, documents an order, dated 3/22/25, for Calcium Carbonate Oral Tablet Chewable 500 MG (Antacid) give 4 tablets by mouth three times a day for supplement. R3's MAR goes on to document that R3 did not receive her medication as ordered on 3/22/25, 3/23/25, 3/24/25, 3/25/25, 3/26/25, and 3/27/25; therefore, missing a total of 8 doses. Page 1 of 2 145656 145656 04/09/2025 Bria of Godfrey 1623 29 West Delmar Godfrey, IL 62035

F 0755 Level of Harm - Minimal harm or potential for actual harm R3's MDS (Minimum Data Set), dated 3/29/25, documents R3 has a BIMS (Brief Interview of Mental Status) score of 14, indicating R3 is cognitively intact. R3's Care plan, dated 3/24/25, documents R3 has a diagnosis of GERD and is at risk for complications related to hyperacidity with an intervention to administer medications as ordered. Residents Affected - Few On 4/8/25 at 4:44 PM, V2, Director of Nurses, stated medications are to be given as ordered by the physician. The Medication Administration Policy, dated 6/2015, documents all medications are to be administered safely and appropriately to aid the residents to overcome illness, relieve and prevent symptoms and help in diagnosis. 145656 Page 2 of 2