Wilson House

The facility failed to ensure medications were administered as ordered for one resident. Specifically, the resident was prescribed Jardiance 25mg daily for diabetes, but the medication was unavailable in their multidose pack despite being documented as administered in the eMAR.

The facility failed to ensure medications were administered as ordered for a resident with Type II diabetes. Specifically, the facility failed to follow the prescribed administration of Jardiance 25mg as documented in the resident's medical orders and hospital discharge summary.

The facility failed to maintain the special care unit in an uncluttered, clean, and orderly manner free of hazards. Specific hazards identified included unsecured hazardous chemicals like bleach and aerosol disinfectants, sharp objects such as a paper cutter and scissors, and broken equipment. Additionally, an exit door was found partially open while remaining locked, creating a potential safety risk.

The facility failed to maintain the special care unit in an uncluttered, clean, and hazard-free manner. Observations revealed unsecured hazardous materials including bleach, aerosol disinfectant, and acetone, as well as broken equipment and sharp-edged metal bedframes in unlocked rooms. Additionally, an exit door was found partially open and not properly secured.

The facility failed to administer medications as ordered for 4 of 5 residents sampled in the Assisted Living Unit. Specifically, on 11/07/22, a medication aide refused to administer night-time medications to all 25 residents in the unit, resulting in missed doses of critical medications for diabetes, bipolar disorder, and anxiety.

The facility failed to administer medications as ordered for 4 out of 5 sampled residents in the Assisted Living Unit on 11/07/22. Specifically, a medication aide refused to administer nighttime medications, resulting in missed doses for critical treatments including diabetes, high cholesterol, and mood stabilization.

The facility failed to maintain a safe environment by leaving personal care hygiene products and chemicals unlocked and accessible to residents in the Special Care Unit. Specifically, items such as lotion, body wash, shampoo, conditioner, and shave cream were found unattended in common shower areas and multiple resident rooms. This lack of oversight created potential hazards from substances that require careful handling or must be kept out of reach.

The facility failed to ensure the environment was free of hazards by leaving personal care products, including hair conditioner, body wash, and shaving cream, unattended and accessible to residents in the Special Care Unit (SCU). Several room doors were also found unlocked and accessible, and hazardous substances were stored in unlocked cabinets or on countertops.