Terrabella Asheboro

The facility failed to ensure medications were administered according to physician orders for a resident in the Special Care Unit. Specifically, staff administered midodrine when blood pressure parameters required the medication to be held, and held the medication when it should have been administered. This failure to follow parameters for 'greater than' or 'less than' blood pressure readings constitutes a failure to abate a previous Type B violation.

The facility failed to ensure medications were administered according to physician orders. Specifically, for one resident in the Special Care Unit, midodrine was administered on multiple dates despite blood pressure readings being above the ordered threshold of systolic BP less than 103.

The facility failed to administer medications as ordered, specifically failing to ensure a resident rinsed their mouth after using an inhaler as prescribed. Additionally, record reviews identified failures to administer an opioid and a vitamin supplement as ordered for other residents.

The facility failed to administer medications as ordered for several residents. Specifically, a medication aide failed to prompt a resident to rinse their mouth after using an inhaler as required by physician orders, and a dietary supplement was administered despite a physician order to discontinue it.

The facility failed to ensure that 2 of 6 sampled staff members (Staff A and Staff D) had completed the required 5, 10, or 15-hour medication aide training course or provided verification of previous employment as a medication aide. Specifically, Staff A's personnel record lacked documentation of required training despite evidence of administering medications to residents.

The facility failed to ensure that medication administration competency evaluations, including both written examinations and clinical skills evaluations, were properly conducted and documented according to state requirements.

The facility failed to maintain accurate records and proper controls for lorazepam. Discrepancies were found between the electronic Medication Administration Record (eMAR) and the Controlled Substance Count Sheet (CSCS), and staff were documented as inappropriately borrowing medication from another resident's supply to cover shortages.

The facility failed to ensure medications were borrowed only in an emergency and replaced promptly. Specifically, for 2 of 5 sampled residents with orders for anti-anxiety medication, medication was not managed according to regulatory requirements regarding borrowing and replacement.