Complaint Investigation Report

Staff do not ensure medications are dispensed as prescribed - UNSUBSTANTIATED

It was reported that Resident 1 (R1) went to the ER and was prescribed an antifungal cream and antibiotics but R1 did not receive their antibiotics until 9/17/24.

LPA reviewed documentation of R1 being seen in the ER on 08/26/2024 to be treated for an abscess. During this visit R1 was prescribed an oral antibiotic to take twice a day for ten days, no antifungal cream was prescribed. Discharge instructions also included a recommendation for follow up appointments for wound care. LPA reviewed documents that show R1 attended wound care appointments on 09/09/2024,09/16/2024, and 09/23/2024. LPA reviewed R1’s Medication Administration Record (MAR) for the months of August and September 2024 which shows that R1 was dispensed their first dose of the oral antibiotic on 08/27/2024 and twice per day for ten days. R1’s MAR does not include an antifungal cream and there is no record of R1 ever being prescribed an antifungal cream.

Administrator stated on 08/26/2024 in the ER they did not prescribe an antifungal cream for R1. They gave R1 an IV antibiotic in the ER, prescribed R1 an oral antibiotic and sent an oral antibiotic home with R1 for the next day. Stated R1 does not use an anti-fungal cream. Stated staff picked up the oral antibiotic on 08/27/2024 and it was dispensed to R1 the same day.

It was determined that R1 was prescribed an oral antibiotic on 08/26/2024, the facility picked up the medication from the pharmacy on 08/27/2024 and dispensed to R1 the same day. R1 has never been prescribed or dispensed an antifungal cream. This allegation is unsubstantiated.