Graceville Estate LLC.

“Based on record review, observation, and interview, the manager failed to ensure a medication administered to a resident was documented in the resident's medical record, for one of two residents reviewed. The deficient practice posed a risk as medication could not be verified as administered against a medication order. Findings include: 1) Review of R's medical record revealed a current written service plan dated March 9, 2025. This service plan indicated R1 received medication administration. 2) Review of R1's medical record revealed a signed medication order dated March 9, 2025. The medication order stated "Alendronate 70 mg(milligrams);1 tab; Q (every) Friday". 3) Review of R1's medical record revealed a May 2025 medication administration record (MAR). This MAR stated "Alendronate; 70mg; Take 1 tab by mouth every Friday". However, the MAR indicated R1 was administered "Alendronate" every day at 7 am. 4) During an observation of R1's medications, Alendronate was observed. 5) In an interview, E1 reported Alendronate was administered per the medication order. E1 acknowledged R1's medication record did not accurately reflect the medication was given per the medication order.”