Complaint Investigation Report

On 11/23/2023, R1 ft the facility a second time for a home visit. When it was time to administer night medication, it was observed that two medications had only one medication left in each box and did not have the refills. The family contacted the facility to inform them that there was only one medication left and asked if another refill was available. The house manager confirmed that they did not provide the family with the refills and would come meet the family half way to provide the medication. On 04/09/2023, R1 left the facility for a 3rd home visit. When administering night medications, it was observed that an AM medication that was packaged separately was not provided. During the home visit, the family did have extra medication to ensure that the resident had their PM medication as prescribed by the physician. It is unclear that the facility did not ensure that medication was not administering medication as prescribed.

Based on information provided through interviews and records reviewed, this allegation is deemed UNSUBSTANTIATED, meaning that there was not a preponderance of evidence to prove or disprove that the allegation occurred as reported.

Allegation: Facility is not keeping an adequate medication record for residents

It was alleged that the facility is not keeping an adequate medication record. Based on interviews, records review, and observation it was determined that the resident's medication reflected what was given based on the medication dispensing logs. LPA observed medications stored at the facility to match physicians orders and medication records. LPA Pascua interviewed 4 staff members, 4 out of 4 staff members stated that medication is given per doctors orders. 4 out of 4 staff members also state that medication logs are audited by the Administrator on daily basis to ensure that medication will match with the count of medication available. 4 out of 4 staff membered both reported that they watch residents to ensure that their medication was taken. Record review revealed that medications are documented appropriately to indicate when medication is taken or refused. it is unclear if the facility is not keeping an adequate medication record for residents.

Based on information provided through interviews and records reviewed, this allegation is deemed UNSUBSTANTIATED, meaning that there was not a preponderance of evidence to prove or disprove that the allegation occurred as reported.

Allegation: Facility does not provide activities to residents

It was alleged that the facility does not provide activities to residents. Throughout this the investigation LPA conducted 4 staff interviews and 4 resident interviews and reviewed facility records. 4 out of 4 staff members state that most of the residents go out to day program during the day.