Advantage Adult Healthcare LLC.

“Based on observation and interview, the manager failed to ensure that medications stored by the facility were stored in a locked area. The deficient practice posed a risk to residents who were not prescribed the accessible medication. Findings Included:  1. During an environmental tour with E1, the Compliance Officers observed an open bedroom door. Upon walking in, the closet was found open with a box on the floor and items on top of the box. A medication bottle of 100 mg “Nitrofurantoin” was on top of the box.  2. In an interview, E1 reported that the room was an empty resident room that caregivers use while they are working.   3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.”

“Based on record review and interview, the manager failed to ensure a caregiver or an assistant caregiver documented the services provided to a resident in the resident's medical record, for three of three residents sampled. The deficient practice posed a health and safety risk as services could not be verified as provided against a service plan. Findings include: 1. A review of R1's, R2's and R3's medical records revealed service plans that stated "Fluids encourage 6-8 glasses per day." However, a review of R1's, R2's and R3's activities of daily living (ADL) sheets revealed "Fluids encourage:" was not documented as provided daily to R1, R2, and R3 from September 1, 2024 to September 8, 2024. 2. In an interview, E2 acknowledged "Fluids encourage 6-8 glasses per day" was not documented as provided for R1, R2, and R3.”

“Based on interview and record review, the manager failed to ensure a medication administered to a resident was documented in the resident's medical record, for one of three residents sampled who received medication administration services. The deficient practice posed a risk if a resident experienced a change in condition due to improper administration of medication. Findings include: 1. In an interview, E2 reported all residents received medication administration. 2. A review of R1's medical record revealed a signed medication order for Atorvastatin 40 milligrams (mg) tablet taken once at bedtime daily, prescribed on August 31, 2024. However, a review of R1's medication administration record (MAR) sheet for September revealed Atorvastatin was not listed as a medication administered from September 1, 2024 to September 8, 2024. 3. In an interview, E2 reported R1 had been receiving the medication, and had forgotten to list the medication on the MAR for R1. 4. In an interview, E2 acknowledged Atorvastatin was not documented as administered in R1's medical record.”

“Based on record review and interview, the manager failed to ensure a resident medical record contained a medication order from a medical practitioner for each medication that was administered, for one of three residents reviewed. The deficient practice posed a health and safety risk. Findings include: 1. Review of R3's medical record revealed a current written service plan dated January 10, 2024. This service plan indicated R3 received medication administration. 2. Review of R3's medical record revealed a document titled "Report Of Unusual Occurrence" dated December 29, 2023. This document stated "...Patient was being repositioned in the wheelchair and (R3) sustained bruises under the armpit on the left side...Ensured patient had no pain. Pain medication (Tylenol) was given." 3. Review of R3's medical record revealed no documentation of a signed medication order or verbal medication order for Tylenol. 4. Review of R3's medical record revealed a December 2023 medication administration record (MAR). This MAR did not include documentation Tylenol was administered on December 29, 2023. 5. In an interview, E1 acknowledged a signed medication order or a verbal order was not available for Tylenol and acknowledged R1's medical record did not contain a medication order from a medical practitioner for each medication that was administered.”

“Based on record review, observation, and interview, the manager failed to ensure a written order verifying the verbal order was obtained from the medical practitioner within 14 calendar days after receipt of the verbal order, for one of three residents reviewed. The deficient practice posed a health risk to the resident. Findings include: 1. Review of R1's medical record revealed a current written service plan dated January 10, 2024. This service plan indicated R1 received medication administration. 2. Review of R1's medical record revealed a verbal medication order dated July 15, 2023. This order stated "Omeprazole Oral Tablet delayed Release 20mg Give 1 tablet by mouth one time a day" and "Keppra Oral Tablet 500mg Give 2 tablet by mouth two times a day". However, documentation was not available that showed a written order was obtained from the medical practitioner within 14 days. 3. Review of R1's medical record revealed a January 2024 medication administration record (MAR). This MAR stated the following: "Omeprazole 20mg Take 1 tablet by mouth daily" and indicated one tab was administered at 8am January 1st - 31st. "Keppra 500mg Take 2 tablet by mouth BID" and indicated two tabs were administered at 8am and 8pm January 1st - 31st. 4. During an observation of R1's medications, Omeprazole 20mg and Keppra 500mg were observed. 5. In an interview, E1 reported the medications were administered per the verbal medication orders and acknowledged R1's medical record did not include written orders from the medical practitioner within 14 days.”

“Based on record review and interview, the manager failed to ensure a medication was administered in compliance with a medication order, for one of three residents reviewed. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. Review of R3's medical record revealed a current written service plan dated January 10, 2024. This service plan indicated R3 received medication administration. 2. Review of R3's medical record revealed a document titled "Report Of Unusual Occurrence" dated December 29, 2023. This document stated "...Patient was being repositioned in the wheelchair and (R3) sustained bruises under the armpit on the left side...Ensured patient had no pain. Pain medication (Tylenol) was given." 3. Review of R3's medical record revealed no documentation of a signed medication order or verbal medication order for Tylenol. 4. Review of R3's medical record revealed a December 2023 medication administration record (MAR). This MAR did not include documentation Tylenol was administered on December 29, 2023. 5. In an interview, E1 acknowledged a signed medication order or a verbal order was not available for Tylenol and acknowledged the medication was not administered in compliance with an available medication order. 6. This is a repeat deficiency from the compliance inspection conducted May 30, 2023.”