Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted a Case Management visit. LPA met Adriane Runge (Executive Director) and discussed the purpose of this visit.

During the course of a complaint investigation,(allegation: staff falsified medication records for another resident pertaining to Oxycodone), LPA discovered through staff interviews that S-1 falsified medication administration records for R-1 pertaining to the administration of R-1’s Metamucil medication. Per staff interviews, R-1 was not provided with Metamucil on 05/03/25 and S-1 documented the medication as being administered to R-1. Per documentation review, this was reported to this Department via Special Incident Report. Per staff interviews, S-1 was terminated for failure to adhere to the facility’s Medication Administration Policy. Additionally, per documentation, S-1 also received a written “disciplinary action notice” on 02/12/25 pertaining to medication/documentation error.

Exit interview and a copy of this report and appeals rights were provided to Adriane Runge (Executive Director).