Parker's Adult Care, LLC

Based on record review and interview, the manager failed to ensure a resident had a written service plan completed no later than 14 calendar days after the resident's date of acceptance for two of two resident records reviewed. Findings include: 1. A review of R1's medical record revealed an initial service plan initiated on March 13, 2024, with the following information; - Facility nurse signed and dated the document on April 23, 2024, per the electronic authentication; - Facility manager signed and dated April 22, 2024, per the electronic authentication, though the typed in date was March 13, 2024; and - Resident/Legal Representative, signed and dated document on April 23, 2023, per the electronic authentication, though the typed in date was March 13, 2024. Based on R1's date of acceptance, the service plan was not completed within 14 calendar days of R1's date of acceptance. 2. A review of R2's medical record revealed an initial service plan initiated on July 28, 2024, with the following information; - Facility nurse signed and dated the service plan on August 14, 2024, per the electronic authentication; - Facility manager signed and dated the service plan on August 13, 2024, per the electronic authentication; and - Resident/Legal Representative signed and dated document on August 14, 2024, per the electronic authentication, though the typed in date was August 13, 2024. Based on R2's date of acceptance, the service plan was not completed within 14 calendar days of R2's date of acceptance. 3. In an interview, E1 acknowledged the service plans were not completed within 14 calendar days of the residents' date of acceptance.

Based on record review, observation, and interview, the manager failed to ensure medication administered to a resident is accurately documented in the resident's medical record, for one of two resident records reviewed. The deficient practice posed a risk as medication could not be verified as administered against a medication order. Findings include: 1. A review of R2's medical record revealed R2 was receiving medication administration. 2. A review of R2's medical record revealed a signed list of medication orders dated June 28, 2024. 3. A review of R2's medical record revealed a medication administration record (MAR) for October 2024. 4. The MAR revealed: - Magnesium Citrate Solution was scheduled to be administered, "take 150ML by mouth one time a day every Tuesday". Magnesium Citrate Solution was not documented as being administered on October 8, 15, 22, and 29, 2024. - Methocarbamol 500mg was scheduled to be administered, "1 tab PO TID", scheduled at 8am, noon, and 8pm. On October 29, 2024, methocarbamol was initialed as being administered a fourth time. A review of the narcotic count sheet revealed the medication was administered three times on October 29, 2024. - Pregabalin 100mg was scheduled to be administered, "Take one capsule by mouth three times daily", scheduled at 8am, noon, and 5pm. On October 23 and 29, 2024, Pregabalin was initialed as being administered a fourth time. A review of the narcotic count sheet revealed the medication was administered three times on October 23 and 29, 2024. - Nystatin 100,000 U/GM Powder was scheduled to be administered, "Apply topically to affected area(s) three times daily". Nystatin powder was initialed as being administered a fourth time on October 3, 7, 8, 23, and 29, 2024. 5. In an interview, E2 reported giving the Magnesium Citrate Solution to R2. 6. In an interview E1 acknowledged the medications administered to R2 were correctly administered, though not documented or incorrectly documented in the MAR. This is a repeat citation from the on-site compliance inspection conducted on September 5, 2023.

Based on observation and interview, the manager failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit. Findings include: 1. During a tour of the facility, the Compliance Officer found unlocked plastic drawers in a resident room. The Compliance Officer observed a box of 30 tablets of "Senna-S... Laxative and Stool Softener", a bottle of Nystatin Topical Powder and a box of Narcan Nasal Spray, in the unsecured drawers. 2. In an interview, E1 acknowledged the medications were stored in an unlocked drawer in a resident room and not stored in a separate locked room, closet, cabinet, or self-contained unit.

Based on record review, observation, and interview, the manager failed to ensure medication administered to a resident is documented in the resident's medical record, for one of three 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 R1 was receiving medication administration. 2. A review of R1's medical record revealed a document titled "Outpatient Medications". This document is a list of R1's medications dated September 5, 2023. 3. A review of R1's medical record revealed a medication administration record (MAR). The Compliance Officer observed no documentation of the following medication for September 1, 2, 3, 4, and 5, 2023: - Terbinafine (LamISIL) 250 mg tablet, take one tablet by mouth daily for nail fungus. 4. In an interview, R4 reported giving the medications to R1. 5. The Compliance Officer observed in R1's medication box a bottle of "Terbinafine (LamISIL) 250 mg tablet". The Compliance observed the bottle had a quantity of 30 pills. The medication bottle had a dispensed date of August 29, 2023. The Compliance officer observed 26 pills left in the bottle. 6. A review of the facility's policy's and procedures revealed the following "... 3. Medication administrated to a resident is: ... c. Documented in the residents MAR". 7. In an interview, E1, and E4 acknowledged R1 was prescribed Terbinafine (LamISIL) 250 mg tablet, and the medication had been given to R1, however, the medication was not documented in R1's medical record.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials were maintained in labeled containers in a locked area, and were inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed an unlocked laundry room with the following toxic materials: - 3 Dun-Edwards gallon paint cans; and - a large bucket of Tucson Dura-A-Coat Roof Coating. 2. The Compliance Officer observed on the back patio and accessible to residents sitting outside smoking the following toxic materials: - 3 Dun-Edwards gallon paint cans; and - a large gray bucket of what looked to be paint, without a label on the outside. 3. In an interview, E1 acknowledged poisonous or toxic materials were not maintained in a locked area inaccessible to residents.