Boston Manor 1

Based on record review and interview, the manager failed to ensure a resident's medical record contained a medication order from a medical practitioner for each medication administered to the resident, for one of two residents sampled who received medication administration. The deficient practice posed a risk if a resident experienced a change in condition due to improper medication administration Findings include: 1. A review of R1's medical record revealed a current service plan for directed care services. The service plan revealed R1 received medication administration. 2. The Compliance Officer observed the following medication in a locked medication box belonging to R1: - Famotidine 40 mg, take one tablet by mouth every day; - Lisinopril 20 mg, take one tablet by mouth every morning; - Atorvastatin 40 mg, take one tablet by mouth at bedtime; - Divalproex 125 mg, take one tablet by mouth at bedtime; - Donepezil HCL 10 mg, take one tab by mouth at bedtime; - Trazadone HCL 50 mg, take two tablets by mouth at bedtime; - Lidocaine 5% patch, apply one patch topically every day; and - Diclofenac NA 1%, apply topically twice a day. 3. A review of R1's medication administration record (MAR) dated July 2023 revealed the following medications were documented as administered on the following dates and the following times: - Famotidine 40 mg, July 1 - 12, 2023, at 5:00 PM; - Lisinopril 20 mg, July 1 - 12, 2023, at 8:00 AM; - Atorvastatin 40 mg, July 1 - 12, 2023, at 8:00 PM; - Divalproex 125 mg, July 1 - 12, 2023, at 8:00 PM; - Donepezil HCL 10 mg, July 1 - 12, 2023, at 8:00 PM; - Trazadone HCL 50 mg, July 1 - 12, 2023, at 8:00 PM; - Lidocaine 5% patch, July 1 - 12, 2023, at 5:00 PM; - Diclofenac NA 1%, July 1 - 12, 2023, at 8:00 AM and 5:00 PM. 4. A review of R1's medical record revealed a medication list (dated June 2023) which included the aforementioned medications. However, the list was not a medication order. 5. In an interview, E2 reported R1's medical practitioner provided the list to the facility. However, E2 acknowledged R1's medical record did not contain medication orders from a medical practitioner for each medication administered to the resident.

Based on record review and interview, the manager retained a resident who was confined to a bed or chair because of an inability to ambulate even with assistance without meeting the requirements in R9-814(B)(2)(b)(iii), for one of two residents sampled who received directed care services. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: R9-10-814(B)(2) A manager of an assisted living facility authorized to provide personal care services may accept or retain a resident who is confined to a bed or chair because of an inability to ambulate even with assistance if: b. The resident's primary care provider or other medical practitioner: iii. Signs and dates a determination stating that the resident's needs can be met by the assisted living facility within the assisted living facility's scope of services and, for retention of a resident, are being met by the assisted living facility; 1. A review of R1's medical record revealed a service plan (dated in June 2023) for directed care services. The service plan stated "Moves in and out of bed with assistance with one/two person assist, hoyer lift... Moves in and out of wheelchair with assistance with one/two person assist...hoyer lift..." 2. A review of R1's medical record revealed a document (dated in June 2022) titled "Determination for Residency or Continues Residency." The document stated "The individual is unable to ambulate and is confined to a bed or chair due to poor prognosis and continued decline." The document was signed and dated by a medical practitioner in June 2022. 3. In an interview, E2 reported R1 was bedbound. E2 acknowledged R1 did not have documentation from R1's medical practitioner stating R1 was examined, R1's needs were met by the facility and if R1's care was within the facility's scope of services, at least once every six months, was not available for review.

Based on record review, observation, and interview, the manager failed to ensure medication administered to a resident was administered in compliance with a medication order, for one of two residents sampled. The deficient practice posed a risk if a resident experienced a change in condition due to improper medication administration. Findings include: 1. A review of R1's medical record revealed a current service plan for directed care services. The service plan revealed R1 received medication administration. 2. The Compliance Officer observed the following medication in a locked medication box belonging to R1: - Famotidine 40 mg, take one tablet by mouth every day; - Lisinopril 20 mg, take one tablet by mouth every morning; - Atorvastatin 40 mg, take one tablet by mouth at bedtime; - Divalproex 125 mg, take one tablet by mouth at bedtime; - Donepezil HCL 10 mg, take one tab by mouth at bedtime; - Trazadone HCL 50 mg, take two tablets by mouth at bedtime; - Lidocaine 5% patch, apply one patch topically every day; and - Diclofenac NA 1%, apply topically twice a day. 3. A review of R1's medication administration record (MAR) dated July 2023 revealed the following medications were documented as administered on the following dates and the following times: - Famotidine 40 mg, July 1 - 12, 2023, at 5:00 PM; - Lisinopril 20 mg, July 1 - 12, 2023, at 8:00 AM; - Atorvastatin 40 mg, July 1 - 12, 2023, at 8:00 PM; - Divalproex 125 mg, July 1 - 12, 2023, at 8:00 PM; - Donepezil HCL 10 mg, July 1 - 12, 2023, at 8:00 PM; - Trazadone HCL 50 mg, July 1 - 12, 2023, at 8:00 PM; - Lidocaine 5% patch, July 1 - 12, 2023, at 5:00 PM; - Diclofenac NA 1%, July 1 - 12, 2023, at 8:00 AM and 5:00 PM. 4. A review of R1's medical record revealed a medication list (dated June 2023) which included the aforementioned medications. However, the list was not a medication order. 5. In an interview, E2 reported R1's medical practitioner provided the list to the facility. However, E2 acknowledged R1 had not received medication administration in compliance with a medication order.

Based on documentation review and interview, the manager failed to ensure a disaster drill for employees was conducted on each shift at least once every three months. The deficient practice posed a risk if employees were unable to implement a disaster plan. Findings include: 1. A review of the facility's staffing schedule, dated July 2023, revealed the facility maintained the following shifts: - 7:00 AM - 7:00 PM; and - 7:00 PM - 7:00 AM. 2. A review of the facility's documented disaster drills revealed the following: - June 3, 2022, at 9:00 AM; - September 4, 2022, at 9:15 PM; - December 4, 2023, at 9:10 PM; - March 3, 2023, at 9:00 PM; and - June 4, 2023, at 10:00 AM. 3. In an interview, E2 acknowledged the facility had not conducted a disaster drill on each shift at least once every three months. Technical assistance was provided on this Rule during the compliance inspection conducted on May 18, 2022.