Print Inspection: 213Z

Based on interview and record review, conducted during a site visit on 05/09/24, 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 1's February 2024 MAR and progress notes, investigation form dated 02/26/24, and picture of the bubble pack, indicated the following:

·MAR shows Levetiracetam oral tablet 500 MG; Take 1 tablet by mouth twice daily, in the morning and at bedtime,

·MAR was signed off as given on 02/21/24 at 10:00 am and 10:00 pm,

·Picture of the bubble pack shows the medication was not popped,

·Investigation form indicated  "med tech clicked off the medication and did not administer the medication, it was still sitting in the bubble pack".

In an interview, Staff 1 (Administrator) and Staff 2 (RN) stated the incident did occur.

The findings were reviewed with and acknowledged by Staff 1 and Staff 2 on 05/09/24.

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

Verbal plan of correction: Self-reported med error. Additional training on med cart provided to staff. MT meetings every 2 weeks with the ED and RN.