Meadows of Leipsic The

Based on observation, staff interviews, and resident interviews, the facility failed to ensure qualified personnel administered medication to residents. This affected three (#30, #26, and #27) residents observed for medication administration. The facility census was 24.

Findings include:

1. Review of the medical record for Resident #30 revealed an admission date of 11/11/22. Medical diagnoses included right knee pain and stroke.

Review of the functional assessment dated 11/11/22 revealed Resident #30 required supervision for activities of daily living. The 05/03/23 medication assessment evaluation revealed the resident was inappropriate for self-medication administration.

Interview on 05/31/23 at 2:37 P.M. with Regional Nurse #280 revealed Resident Care Assistants (RCAs) are able to provide medication reminders. RCAs do not prepare the medication; they are able to give the pharmacy prepared medication package to residents or family members have pre-prepared medications in weekly medication containers.

Observation on 06/01/23 at 8:11 A.M. revealed Resident Care Assistant (RCA) #202 was standing at the medication cart in the 200 hall when Resident #30 came up to her in his wheelchair. RCA #202 was observed to reach into the medication cart and pull a medication card, tear off a pre-prepared package, pop the pills into a medication cup and hand them to the resident.

Interview on 06/01/23 with RCA #202 at 8:13 A.M. verified she puts medications into a medicine cup prior to giving to residents because she was, afraid they would spill them.

2. Review of the medical record for Resident #31 revealed an admission date of 04/29/13. Medical diagnoses included paranoid personality disorder, Diabetes Mellitus type two, and hypothyroidism.

Review of the functional assessment dated 01/23/23 revealed Resident #31 was independent with activities of daily living and required assistance to administer and organize or store medication.

Observation on 06/01/23 at 11:28 A.M. of RCA #202 assisting Resident #31 with glucose testing, revealed RCA #202 handed Resident #31 a lancet. RCA #202 then placed a strip into the glucometer and obtained the blood sample for glucose testing. The glucometer reading was 171. RCA #202 referred to the sliding scale paper that was taped on the lid of the plastic container which contained Resident #31's diabetic supplies. RCA #202 announced a reading of 171 required 3 units and proceeded to place the needle on the insulin pen, turned the dial to three, did not prime the pen, and went to hand Resident #31 the pen. The surveyor intervened at this time. Assistant Living Director (ALD) #264 was observed walking down the hall and the surveyor requested her to come to the medication cart and informed her of the situation. ALD #264 took the insulin pen from RCA #202 and informed her she was not able to dose the insulin.

Interview on 06/01/23 at 11:30 A.M. with Resident #31 revealed staff doses the insulin pen prior to handing it to her for administration because she cannot see.

3. Review of the medical record for Resident #27 revealed an admission date of 07/27/21. Medical diagnoses included Wernicke's encephalopathy, schizoaffective disorder, bipolar type and anxiety. A Brief Interview for Mental Status (BIMS) dated 05/03/23 revealed a score of ten, indicating significant cognitive impairment.

Review of the functional assessment dated 05/03/23 revealed Resident #27 was independent with transfers, toileting, and required supervision for mobility. The medication administration assessment evaluation dated 05/03/23 revealed the resident was not appropriate to self-administer any medications.

Observation on 05/31/23 at 11:47 A.M. revealed Resident Care Assistant (RCA) #228 removed the noon medication from the pre-prepared medication card for Resident #27. The medication printed on the package was for Buspirone (anxiety) five milligrams. The package was handed to Resident #27, who opened the package and took the medication.

Interview on 05/31/23 at 2:15 P.M. with RCA #228 verified she did give Buspirone to Resident #27. RCA #228 explained she does not look at the name of the medications, only the time at which it was due.

Further review of the physician orders for Resident #27 revealed an order for Metoprolol (blood pressure medication) with parameters to hold for a systolic blood pressure of less than 110 or a heart rate less than 60 beats per minute.

Interview on 06/01/23 at 8:11 A.M. with RCA #202 revealed she takes the blood pressure for a resident using the automatic blood pressure machine if they have parameters listed. She shared if the blood pressure is outside of the parameters, she contacts the nurse on the skilled unit. The nurse will remove the pill from the pre-packed package for her to administer and added she was, not a nurse and does not know, what pill was what. RCA #202 revealed she had no formal training on how to use the automatic blood pressure machine, she was shown how to use it by a fellow RCA during her initial onboarding.

Interview on 06/01/23 at 10:59 A.M. with Assistant Living Director #264 revealed she was the only nurse scheduled for assisted living. She was trained to the unit by an RCA. The facility told her upon taking the position, they were going to hire more nurses for the unit. It has not happened.

Based on medical record review and staff interviews, the facility failed to maintain a resident's medication administration record. This affected one (Resident #27) of one resident reviewed for medication administration records. The facility's census was 24.

Finding include:

Review of the medical record for Resident #27 revealed an admission date of 07/27/21. Medical diagnoses included Wernicke's encephalopathy, schizoaffective disorder, bipolar type and anxiety. A Brief Interview for Mental Status (BIMS) dated 05/03/23 revealed the resident was cognitively impaired.

Review of the functional assessment dated 05/03/23 revealed Resident #27 was independent with transfers, toileting, and required supervision for mobility. The medication administration assessment evaluation dated 05/03/23 revealed the resident was not appropriate to self-administer any medications.

Observation on 05/31/23 at 11:47 A.M. revealed Resident Care Assistant (RCA) #228 removed the noon medication from the pre-prepared medication card for Resident #27. Medication printed on the package was for Buspirone (anxiety) five milligrams. The package was handed to Resident #27, who opened the package and took the medication.

Review of the physician orders for Resident #27 revealed no order for Buspirone. Interview on 05/31/23 at 2:15 P.M. with RCA #228 verified she did give Buspirone to Resident #27. RCA #228 explained she does not look at the name of the medications, only the time at which it was due.

Interview on 05/31/23 at 2:25 P.M. with Director of Nursing (DON) #251 verified there was no order for Buspirone in the electronic charting, or on the May Medication Administration Record (MAR) for Resident #27.

Interview on 05/31/23 at 3:37 P.M. with Regional Nurse #280 revealed the physician for Resident #27 called a prescription directly to the pharmacy and did not inform the facility.

Further review of the medical record revealed the prescription for Resident #27's Buspirone five milligrams, three times a day was dated 08/16/22.

Review of the progress note dated 05/31/23 at 3:57 P.M. revealed during medication review, Resident #27 was receiving Buspirone five milligrams, three times a day. No order could be found for this medication. The pharmacy was contacted and stated the physician had called in for the medication.

Interview on 06/01/23 at 10:59 A.M. with Assistant Living (AL) Director #264 revealed the MAR was generated through the electronic charting system, and not supplied by the pharmacy. AL Director #264 added if the orders were not put in properly, they would not be accurate on the MAR.

Further review of the physician orders for Resident #27 revealed an order for Metoprolol (blood pressure medication) with parameters to hold for a systolic blood pressure of less than 110 or a heart rate less than 60 beats per minute.

Review of the May MAR for Resident #27 revealed an X was pre-printed daily for the Metoprolol.

Review of the electronic charting for Resident #27 revealed blood pressure was out of parameters on 05/01/23 (109 systolic), 05/02/23 (104 systolic), 05/04/23 (108 systolic), 05/06/23 (99 systolic), 05/17/23 (105 systolic), 05/23/23 (109 systolic), 05/25/23 (104 systolic), 05/28/23 (86 systolic), 05/31/23 (105 systolic) and heart rate was out of parameters on 05/03/23 (59 heart rate).

Interview on 06/01/23 at 10:59 A.M. with Assistant Living Director #264 acknowledged there was no documentation of whether the Metoprolol was given or held when parameters were not met and added it was assumed it was not given.

Based on observation, staff interview, and policy review, the facility failed to ensure dietary staff were provided beard protectors while working in the kitchen. This affected all 39 residents who resided in the facility and received food from the kitchen. The facility census was 39.

Findings include:

Observation on 05/30/23 at 8:27 A.M. revealed Cook #205 had a full beard and mustache approximately one inch long and was working in the kitchen. The Cook was not wearing a beard protector.

Interview with Cook #205 on 05/30/23 at 8:32 A.M. verified he did not wear a beard protector while working, as they were not provided for staff.

Interview with the Director of Food Services on 05/30/23 at 8:35 A.M. revealed the facility did not have beard protectors in stock and she would look into purchasing.

Review of the facility policy titled, Hair Restraint