Cherry Creek Retirement Village

A revisit survey was completed on 8/10/23 for all previous deficiencies cited on 1/29/23. The agency is in compliance with all regulations surveyed. Citation coded "0000" or "9999" are initial and final comments of an inspection for informational purposes, this field may also have been left blank intentionally

A relicensure survey was completed on 1/19/23. Deficiencies were cited. Based on interviews and record review, the residence failed to document accurate information in the electronic medication administration record (eMAR), affecting three of six sample residents (#2, #4, and #6). (Cross-reference Q1468)Findings include:1. Resident #2 was admitted to the residence on 12/28/22, with diagnoses including systemic inflammatory response syndrome, hypotension, gastro-esophageal reflux disease, hypovolemia, and vitamin deficiency.a. Carboxymethylcellulose Written practitioner' s orders, dated 12/15/22, directed the residence to instill one drop of 0.5% carboxymethylcellulose in each eye two times daily. However, the January 2023 eMAR contained check marks that an out-of-stock medication was given on 1/2-1/4/23 in the morning, 1/6/23 in the morning, and 1/3/23 in the evening.b. MetoprololWritten practitioner' s orders, dated 12/3/22, directed the residence to administer 12.5 mg of metoprolol twice daily. However, the January 2023 eMAR contained check marks that an out-of-stock me.. Based on record review and interview, the residence failed to for comply with authorized practitioner orders associated with medication administration, affecting four of six sample residents (#2, #4-#6). Findings include: 1. Residence PolicyA resident agreement dated December 2016, read in part: "staff may administer medications in an assisted living community to ensure prescribed. Medications are delivered to the appropriate resident at the appropriate time as prescribed by the physician."2. Resident #2 was admitted to the residence on 12/28/22, with diagnoses including systemic inflammatory response syndrome, hypotension, gastro-esophageal reflux disease, hypovolemia, and vitamin deficiency.a. SennaA written practitioner order, dated 12/15/22, directed the residence to administer an 8.6 mg tablet of senna, twice daily. However, the January 2023 read senna was not administered on 1/1-1/3/23, 1/4/23 in the evening, 1/5/23, and 1/6/23 in the evening, due to the medication being unavailable, for .. THIS PORTION OF THE REPORT IS FOR INFORMATIONAL PURPOSES ONLY.No response is necessary.The residence was advised it must review and maintain the following processes in accordance with existing program regulations found at 6 CCR 1011-1, Chapter2 and Chapter 7.7.13 If the employee or volunteer is a qualified medication administration person, the following shall also be retained in the employee' s or volunteer' s personnel file: (A) Documentation that the individual' s name appears on the Department' s list of individuals who have successfully completed the medication administration competency evaluation; and (B) A signed disclosure that the individual has not had a professional medical, nursing, or pharmacy license revoked in this or any other state for reasons directly related to the administration of medications.11.2.3 Facilities and agencies shall ensure that ninety percent (90%) of employees and direct contractors have received the influenza vaccine during a given influenza season. In order to demonstrate that ..