Facility Evaluation Report

On 12-1-21 at 9:55am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management for an incident regarding missed medication. LPA met with assistant Administrator Heather Mobley and explained the purpose of the visit. Administrator Scott Campbell was not present and gave permission for assistant administrator to accompany LPA and sign in his absence. LPA was screened for COVID precautions upon entry. LPA requested and reviewed copies of Resident1 (R1) medication log, medication transfer sheet/release of responsibility form, physician’s report, facility sign in and sign out sheet, and facility’s plan of operation. LPA also interviewed Administrator. Incident report reviewed involved missed doses of medication for R1 during an outing with family member.

It was determined on 11-11-21, R1 was picked up by family member and drove to Ohio for a scheduled outing. Administrator stated during interview that resident stayed with family member until 11-13-21 before departing for Ohio. Based on interview and record reviews it was revealed that family member signed “medication transfer sheet/release of liability” form and signed R1 out on 11-11-21. LPA reviewed “medication transfer sheet/release of liability” form and determined medication released matched those on the medication log sheet. Interview with Administrator also revealed that medication orders and instructions were reviewed with family member prior to departure. It was also revealed that a meeting took place on 11-2-21 to discuss R1’s plan for the 10-day outing. Present at this meeting were R1, family member, Administrator, licensee, regional case worker, and day program manager. {Cont. on 809C}