Facility Evaluation Report

On 2/13/26, Licensing Program Analyst (LPA) J. Leffall conducted a case management. The purpose of the Case Management was from an interview that LPA conducted with R1's Responsible Party. LPA reviewed R1's medications and MAR in the Med-Tech room. Based on interview and record review, the following are medication errors:

Quetiapine Fumara 25 mg tablet. Take 1 tablet by mouth daily. Start date is 1/25/26. A total of 20 tablets should have punched out. A total of 26 tablets were punched out which is 6 over the required count.

Vitamin D3 2000U 50 MCG take 1 tablet by mouth daily. Start date is 1/8/26. A total of 183 tablets should have been taken. A total of 195 tablets were counted in medication count which equals 12 pills under the required count.

Metoprolol Suc ER 25 MG tabl ER 24H Take 1 tablet every day by mouth for 90 days. A total of 71 tablets should have been taken. The start date is January 26, 2026. A total of 72 were counted in medication count which equals to 1 pill under the required count.

A citation is issued on the attached 809-D wtih appeal rights regarding medications not ordered timely.

A copy of this report and Appeal Rights was distributed to Administrator whose signature confirms the receipt of this report.