Violation Details: CALMS - 00083411

Date
10/21/2024
Report number
CALMS - 00083411
Type
Licensing Violation
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to administer medication as ordered
Result
Substantiated
Findings
Based on observation, interview, and record review, conducted during a site visit on 10/21/24 the facility’s failure to carry out medication and treatment orders as prescribed was substantiated for 1 of 1 sampled resident (# 1). Resident 1’s physician orders, dated 07/23/24, indicated s/he was to receive a pureed diet and use a “Safestraw” with liquids. On 10/21/24, Resident 1 was observed to be served a mechanical soft diet. Staff were not observed assisting Resident 1 with his/her Safestraw. Staff 5 (LPN) stated staff had “confused” Resident 1’s plate with another resident’s. The facility’s failure to carry out medication and treatment orders as prescribed was substantiated.