D'arcy Manor Assisted Living Home, LLC

Based on record review, observation, and interview, the manager failed to ensure that medication administered to a resident was accurately documented in the resident's medical record for one of two residents sampled. The deficient practice posed a risk as medication could not be verified as administered against a medication order. Findings include: 1. A review of R1's medical record revealed a medication order, dated June 16, 2025, which included the following medications: Miralax 1 scoop in 4-6 ounces (oz) of liquid by mouth (po), every other day; and Carbidopa 25-100 milligrams (mg), 1 tablet po five times a day. 2. A review of R1's medication administration record (MAR) for July 2025 revealed R1 was administered the following medications: Miralax 1 scoop in 4-6 oz of liquid every day, and indicated it was administered July 1, 2025 - present; and Carbidopa 25-100 mg, 1 tablet po at 12:00 AM, 4:00 AM, 8:00 AM, 12:00 PM, 4:00 PM, and 8:00 PM, and indicated 1 tablet was administered six times a day, July 1, 2025 - present. 3. In an interview, E2 reported R1's medication was administered in compliance with the medication orders. However, E1 acknowledged medication administered to R1 was not accurately documented in R1’s medical record.

Based on observation and interview, the manager failed to ensure the premises and equipment used at the assisted living facility was cleaned which posed and health and safety risk. Findings include: 1. During a facility tour, E1 and the compliance officer observed in three of the four residents' bedrooms the ceiling fan blades had a build-up of dark product on the blades which gave the appearance they were not kept clean. 2. In an interview, E1 acknowledged the residents' bedrooms' ceiling fan blades were not kept clean.

Based on observation and interview, the manager failed to ensure oxygen containers were secured in an upright position. Findings include: 1. During a facility tour, E1 and the compliance officer observed setting in R2's bedroom three unsecured oxygen containers. 2. In an interview, E1 acknowledged the unsecured oxygen containers in R2's bedroom.