Cadence at Clemmons

The facility failed to ensure that six sampled medication aides completed required training on the care of diabetic residents prior to administering insulin and performing finger stick blood sugars. This training is required for unlicensed staff to cover topics such as insulin action, storage, and management of hypoglycemia and hyperglycemia.

The facility failed to ensure that 6 of 6 sampled medication aides completed required training on the care of diabetic residents prior to administering insulin. The facility's computer-based training module lacked essential topics such as insulin storage, mixing, measuring, injection techniques, and sliding scale administration. Additionally, the training did not include hands-on return demonstrations for finger stick blood sugars or insulin administration.

The facility failed to provide required personal care assistance according to the resident's care plan. Specifically, one resident who required extensive hands-on assistance for transfers and toileting did not receive the documented level of care, which resulted in a fall.

The facility failed to provide adequate supervision for two residents who were disoriented and ambulatory, leading to repeated falls and injuries. Specifically, one resident suffered a cervical vertebrae fracture and elopement from the Special Care Unit due to a lack of documented interventions and failure to follow fall protocols.

The facility failed to provide adequate supervision for residents in accordance with their care plans, specifically for two residents who were disoriented and ambulatory. This lack of supervision resulted in repeated falls, including a cervical vertebrae fracture for one resident and an elopement from the Special Care Unit for another.

The facility failed to ensure medications and treatments were administered as prescribed to 2 of 6 residents. Specifically, during a medication pass on 03/23/17, Preservision Lutein vitamin was omitted from the administration for Resident #6 despite being ordered and documented as administered in the eMAR.

The facility failed to ensure medications and treatments were administered as prescribed for two residents. Specifically, a medication aide overlooked administering Preservision Lutein vitamins to one resident and incorrectly documented a medication as administered in the eMAR system without scanning the barcode.