Based on interview and record review, conducted during a site visit on 04/16/24, it was confirmed the facility failed to provide delegation and teaching that is documented by an RN for 3 of 3 sampled staff (#'s 6, 7, and 8). Findings include, but are not limited to:

A review of delegations for insulin administration for Residents 6,7, and 8 indicated the following:

·Re-evaluation was not completed within 60 days of the initial delegation and some of the documents were not completely filled out,

·For Resident 7, Staff 6 (MT) had an initial delegation for insulin administration on 06/23/23 (Rescinded on 07/27/23), an initial delegation on 08/26/23 and a review on 04/05/24,

·For Resident 7, Staff 8 (MT) had an initial delegation for insulin administration on 05/13/23 (Rescinded on 07/27/23), a review on 11/23/23 and 04/12/24,

·For Resident 8, Staff 8 had an initial delegation for insulin administration on 11/01/23 and on 04/11/24 by a different RN,

·For Resident 8, Staff 7 (MT) had an initial delegation for insulin administration on 11/01/23 and on 04/16/24 by a different RN

·For Resident 6, Staff 8 had an initial delegation for insulin on 07/20/23 and on 04/12/24 by a different RN

In an interview on 04/23/24, Staff 1 (ED) stated there had been several RNs that were rotating in during that time. S/He stated they always had an RN available.

The findings were reviewed with and acknowledged by Staff 1 via phone call on 04/23/24.

It was determined the facility failed to provide delegation and teaching that is documented by an RN.

Verbal plan of correction: The facility is working with an RN consultant and they are current with their delegations.

Based on interview and record review, conducted during a site visit on 04/16/24, it was confirmed the facility failed to carry out medication and treatment orders as prescribed for 1 of 1 sampled resident (#1). Findings include, but are not limited to:

A review of Resident 2's November 2023 MAR, progress notes, and physician orders indicated the following:

·Order dated 10/13/23 for Admelog Solostar U-100 Insulin Lispro 100 unit/ml (3ml) SQ pen. Inject 3-15 units by subcutaneous route TID per sliding scale. Sliding scale: <150= No Insulin; 150-199= 3 units; 200-249= 5 units; 250-299= 7 units; 300-349= 10 units; 350-400= 15 units

·Progress note dated 11/27/23 indicated resident was given 9 units of Lispro instead of 3 units in error, for a CBG of 179

In an interview on 04/23/24 with Staff 1 (ED), s/he stated the incident did occur and the MT was removed from administering insulin.

The findings were reviewed with and acknowledged by Staff 1 on 04/23/24.

It was confirmed the facility failed to carry out medication and treatment orders as prescribed.