Complaint Investigation Report

9099C(1).. Allegation: Licensee is not following doctors orders.

Allegation states that on/around September/October 2021, the Administrator refused to allow resident (R1) to have her prescribed Ativan medication for pain because the Administrator would have to dispense the medication to her. Allegation further states that resident was believed to be in pain due due to picking the open wounds on her chest and arms, and the wounds are not healing because resident picks at them.

Physician's orders dated 7/31/2021 note that R1 was to be discharged from hospice services and to discontinue multiple medications, including Ativan. A subsequent order was issued on 8/27/2021 to discontinue all hospice medications given at bed-time and to start Trazadone 100 mg at bedtime for insomnia.

E-mail dated 8/2/2021 from R1's health care provider to the Administrator states that R1 is "being discharged from hospice services as her prognosis has extended" and discusses how home health will be able to assess and manage the "non-healing lesions" while R1 resides at the facility.

Home Health Nurse charting notes, dated 9/23/2021 to 12/6/2021, document that wound care was being provided, R1 tolerated it well and there were no signs of infection. Notes dated 11/17/2021, indicate that the wound was "improving-doing well" and skin assessment was performed with no breakdown shown. Notes entered on 11/22/2021 document that R1 stated ""ouch" during wound care but shows no signs of being in pain".

Staff (S1) stated in an interview that Ativan is a medication for agitation and not for pain. Staff (S2) stated that her understanding is that Ativan is a comfort medication that hospice care provides even if it is not needed and that if R1 shows discomfort from the wound, staff would give PRN medications. R1 was not able to be interviewed due to a diagnosis of Alzheimer's Dementia and being non-verbal, as noted on the Resident Appraisal, dated 12/6/2020.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.