Clemmons Village I

The facility failed to administer medications as ordered by a licensed practitioner for one resident. Specifically, the facility continued to administer levothyroxine 50mcg despite a physician's order from June 2025 to decrease the dosage to 35mcg.

The facility failed to administer medications as ordered by a licensed practitioner for one resident. Specifically, the facility continued to administer 50mcg of levothyroxine despite a physician's order dated 06/23/25 to decrease the dosage to 35mcg. The error persisted through August 2025 because the new order was not properly communicated to the pharmacy or implemented in the medication administration records.

The facility failed to ensure physician orders were implemented for one resident regarding a thyroid stimulating hormone (TSH) laboratory test. Although an order was signed in March 2023, the required laboratory test was not completed during the specified timeframe, and the facility lacked a system to verify that lab orders were fulfilled by the contract laboratory.

The facility failed to ensure that all staff performing unsupervised medication aide duties had completed the required clinical skills evaluation. Specifically, 2 of 3 sampled staff members lacked documentation of a Medication Clinical Skills Competency Validation prior to administering medications to residents.

The facility failed to ensure that two out of three sampled staff members (Staff A and Staff B) had documentation of a completed Medication Clinical Skills Competency Validation prior to administering medications. Specifically, while Staff B had passed a written exam, there was no record of a clinical skills competency validation performed at the current facility.

The facility failed to maintain a matching therapeutic diet menu for all physician-ordered therapeutic diets. Specifically, there was no menu available for a resident prescribed a low concentrated sweets (LCS) diet, making it impossible to verify if the resident's dietary needs were being met.

The facility failed to maintain a matching therapeutic diet menu for residents with physician-ordered therapeutic diets. Specifically, there was no menu available for a resident on a low concentrated sweets (LCS) diet, making it impossible to determine if the resident was being served the correct diet as ordered.

The facility failed to provide documentation of supervision in accordance with resident needs, care plans, and current symptoms. Specifically, for a resident with a history of falls and dementia, there was no updated fall risk assessment (FRAF) after February 2015, and the resident experienced six unwitnessed falls between March and June 2015.