Complaint Investigation Report

Allegation #1: Staff is not administering resident's medication as prescribed.

The complaint alleges that staff are not following the resident’s doctor’s orders in administering the resident's medications. On September 24, 2025, between 10:30 AM and 1:30 PM, the Licensing Program Analyst (LPA) conducted interviews with the Executive Director (ED), who denied the allegation. The ED explained that the facility utilizes a medication administration system called Quick Mar, which the Medication Technicians (Med Techs) follow to ensure proper medication delivery to residents.

During the same time frame, the LPA also interviewed four additional staff members #1-4, all of whom similarly denied the allegations. Additionally, a Med Tech (MT) was interviewed, and they also denied the allegations, emphasizing that they are very thorough when it comes to administering residents' medications. If the facility receives medication from the pharmacy without a doctor's orders, the medication technician (MT) will call the pharmacy to request the doctor's orders. It is crucial to have these orders, so the MT knows when the medications were prescribed and how the doctor intends for them to be administered. The MT also mentioned that they do not administer any internal medications; that responsibility falls to hospice staff or nurses.

On September 24, 2025, between 10:30 AM and 1:30 PM, the LPA interviewed seven residents (R2-R8). All seven residents reported never experiencing any issues with their medications. They also stated that the MTs are very helpful regarding their medication needs.