Assisted Living and Residential Care Facilities must operate and provide services in compliance with all applicable State and local laws, regulations and codes.  This report reflects the findings of the complaint investigation conducted 11/10/2022.  The facility was evaluated for compliance with Oregon Administrative Rule 411, Division 54 and if applicable, Oregon Administrative Rule 411, Division 57.  The following deficiencies were identified:

Abbreviations possibly used in this document:

ADL:activities of daily living

bid:twice a day

CBG:capillary blood glucose or

blood sugar

cc:cubic centimeter

CG:caregiver

cm:centimeter

F:Fahrenheit

HH:Home Health

HS or hs:hour of sleep

LPN:Licensed Practical Nurse

MA:Medication Aide

MAR:Medication Administration

Record

MCCMemory Care Community

mg:milligram

ml:milliliter

O2 sats:oxygen saturation in the

blood

OT:Occupational Therapist

PT: Physical Therapist

PRN:as needed

qd:every day or daily

qid:four times a day

RN:Registered Nurse

SP:service plan

TAR:Treatment Administration

Record

tid:three times a day

Based on record review and interview, it was confirmed that the facility failed to administer medications as prescribed. Findings include:

Compliance Specialist (CS) reviewed Resident #1s medication administration records (MARs) and progress notes for September 2022, medication policy and procedures, and facility incident self-report form from 9/28/22. Self-reported incident form reports that Resident #1 received another resident ' s medication on 09/28/22.

The above information was shared with Staff #1 who acknowledged the findings.

In a phone interview on 11/10/22, Staff #1 stated that the incident did occur. The staff member involved in the incident did not grab the right resident ' s medication or check it before giving it to the resident. The supervisor noticed it right away. The resident was sent out and did not have any adverse reactions. They self-reported to APS.

Facility plan of correction:

There was follow up with the staff member involved and their training was extended.