The Lodge at Mallard's Landing.

Statement of Deficiencies License #: 2064 Compliance Determination # 52272 Plan of Correction The Lodge at Mallard's Landing Completion Date You are required to be in compliance at all times with all licensing laws and regulations to maintain your Assisted Living Facility license. The department completed data collection for an unannounced on-site follow-up on 12/27/2024 and 12/27/2024 of: The Lodge at Mallard's Landing 7083 Wagner Way NW Gig Harbor, WA 98335 This document references the following SOD dated: 12/30/2024 The following sample was selected for review during the unannounced on-site visit: 7 of 0 current residents and 0 former residents. The department staff that inspected the Assisted Living Facility: Kathy Heinz, Long Term Care Surveyor From: DSHS, Aging and Long-Term Support Administration Lakewood, WA 98496 As a result of the on-site visit(s) the department found that you are not in compliance with the licensing laws and regulations as stated in the cited deficiencies in the enclosed report. I understand that to maintain an Assisted Living Facility license, the facility must be in compliance with all the licensing laws and regulations at all times. . Statement of Deficiencies License #: 2064 Compliance Determination # 52272 Plan of Correction The Lodge at Mallard's Landing Completion Date Administrator (or Representative) Date WAC 388-78A-2320 Intermittent nursing services systems. (1) When an assisted living facility provides intermittent nursing services to any resident, either directly or indirectly, the assisted living facility must: (a) Develop and implement systems that support and promote the safe practice of nursing for each resident; and (b) Ensure the requirements of chapters 18.79 RCW and 246-840 WAC are met. This requirement was not met as evidenced by: Based on record review and interview, the facility failed to ensure 2 of 9 staff (Staff B and C) were delegated by a Registered Nurse (RN) delegator to administer two types of insulin to 1 of 4 sampled residents (Resident 1 [R1]). This failure resulted in residents receiving medications from staff untrained to administer them and placed residents at risk of harm and decline in their health status. Findings included... Review of the Nurse Delegation: Nursing Visit form dated 11/25/2024, showed R1 required delegated staff to administer insulin and check blood sugars. Review of the December 2024 Medication Administration record (MAR) for R1 showed an order for Basaglar (insulin) to be administered at 8:00 am. Staff B, Caregiver, administered the insulin eight times and Staff C, Caregiver, administered the insulin one time. Review of the December 2024 MAR for R1 showed an order for Novolog (insulin) to be administered three times a day before meals per the sliding scale. Staff B checked R1's blood sugar and administered the insulin 10 times and Staff C checked R1's blood sugar and administered the insulin three times. Staff A was interviewed on 12/27/24 at 11:00 AM. Staff A said she thought Staff B was delegated by the previous delegating RN. Staff A said Staff C was being trained to administer medications and was not delegated. This is an uncorrected deficiency previously cited on 10/15/2024. . Statement of Deficiencies License #: 2064 Compliance Determination # 52272 Plan of Correction The Lodge at Mallard's Landing Completion Date Plan/Attestation Statement I hereby certify that I have reviewed this report and have taken or will take active measures to correct this deficiency. By taking this action, The Lodge at Mallard's Landing is or will be in compliance with this law and / or regulation on (Date)________________ . In addition, I will implement a system to monitor and ensure continued compliance with this requirement. Administrator (or Representative) Date . Statement of Deficiencies License #: 2064 Compliance Determination # 47978 Plan of Correction The Lodge at Mallard's Landing Completion Date Administrator (or Representative) Date WAC 388-78A-2090 Full assessment topics. The assisted living facility must obtain sufficient information to be able to assess the capabilities, needs, and preferences for each resident, and must complete a full assessment addressing the following, within fourteen days of the resident's move-in date, unless extended by the department for good cause: (6) Significant known behaviors or symptoms of the individual causing concern or requiring special care, including: (e) Other safety considerations that may pose a danger to the individual or others, such as use of medical devices or the individual's ability to smoke unsupervised, if smoking is permitted in the assisted living facility. This requirement was not met as evidenced by: Based on observations, record reviews, and interview, the Assisted Living Facility (ALF) failed to ensure assessments for the safe use of medical devices (bed canes and side rails) were completed for 6 of 9 sampled residents (Resident 1 [R1], Resident 2 [R2], Resident 5 [R5], Resident 6 [R6], Resident 7 [R7], and Resident 8 [R8]). This failure placed the residents at risk of physical injury and decreased quality of life. Findings included... R1 Observation on 10/03/2024 at 2:30 PM showed bilateral (both sides of the bed) side rails attached to R1’s bed. Review of R1's record failed to show an assessment for the use of the side rails. R2 Observation on 10/01/2024 at 11:00 AM showed a bed cane attached to R2’s bed. Review of R2's record failed to show an assessment for the use of the bed cane. R5 Observation on 09/30/2024 at 1:30 PM showed a bed cane attached to R5’s bed. Review of R5's record failed to show an assessment for the use of the bed cane. R6 Observation on 09/30/2024 at 2:00 PM showed bilateral side rails attached to R6’s bed. Review of R6's record failed to show an assessment for the use of the side rails. . Statement of Deficiencies License #: 2064 Compliance Determination # 47978 Plan of Correction The Lodge at Mallard's Landing Completion Date R7 Observation on 10/03/2024 at 3:00 PM showed bilateral side rails attached to R7’s bed. Review of R7's record failed to show an assessment for the use of the side rails. R8 Observation on 09/30/2024 at 2:15 PM, showed bilateral side rails attached to R8’s bed. Review of R8's record failed to show an assessment for the use of the side rails. Staff B, Director of Wellness said during an interview on 10/03/2024 at 11:00 AM, “there were no assessments for the use of the bed canes or side rails.” Plan/Attestation Statement I hereby certify that I have reviewed this report and have taken or will take active measures to correct this deficiency. By taking this action, The Lodge at Mallard's Landing is or will be in compliance with this law and / or regulation on (Date)________________ . In addition, I will implement a system to monitor and ensure continued compliance with this requirement. Administrator (or Representative) Date WAC 388-78A-2320 Intermittent nursing services systems. (1) When an assisted living facility provides intermittent nursing services to any resident, either directly or indirectly, the assisted living facility must: (a) Develop and implement systems that support and promote the safe practice of nursing for each resident; and (b) Ensure the requirements of chapters 18.79 RCW and 246-840 WAC are met. This requirement was not met as evidenced by: Based on interviews and record reviews, the facility failed to ensure 13 Staff (Staff D, E, F, G, H, I, J, K, L, M, N, O and P) were delegated by a Registered Nurse (RN) to administer medications to 6 of 6 sampled Residents (Resident 1[R1], Resident 5 [R5], Resident 6 [R6], Resident 7 [R7], Resident 8 [R8], and Resident 9 [R9]). These residents required staff to crush their medications, administer oral medications, administer behavior medications as needed, instill eye drops, and/or apply medication to their skin (topical) after the RN verified staff qualifications and provided staff training. This failure placed the residents at risk of decline in their health status from receiving medications incorrectly by unqualified and/or untrained staff. . Statement of Deficiencies License #: 2064 Compliance Determination # 47978 Plan of Correction The Lodge at Mallard's Landing Completion Date Findings included... R1 Review of R1’s Medication Administration Record (MAR) dated September 2024 showed orders for multiple oral medications, eye drops, nasal sprays and topicals. The MAR showed the following: Staff L, Caregiver, administered Acetaminophen, Buspirone, Gabapentin, Hydrocodone, Methocarbamol, Rosuvastatin on 09/05/2024. Staff O, Medication Technician, administered Acetaminophen, Buspirone, Gabapentin, Hydrocodone, Methocarbamol and Rosuvastatin on 09/11/2024, 09/12/2024 and 09/13/2024.

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . . From:263 868 4993 09/03/2024 14:69 #916 P.006/008 Statement of Deficiencies License#: 2064 Compliance Determination # 44662 f?la11,?rCorrection The Lodge at Mallard's Landing Completion Date P.a ge 2 of 3. Licensee: One Mallards Landing, LLC 08112/2024 :.: · Administrator (or Representative) Date WAC 388,78A·2690 Electronic monitoring equipment Resident requested use. (1) Au.dio ,or.video monitoring equipment may not be installed in the assisted living,facility.to·mo.nitor any, resident apartment or sleeping area unless the resident or the residents' representative has reque~ted and consents to the monitoring. (5) The release of audio or video monitoring recordings by the facility is prohibited, Each person or organization with access to the electronic monitoring must be identified in the resident's negotiated service agreement (6) If the res'ident requests the assisted living facility to conduct audio or video monitoring of his or her apartment or sleeping area, before any electronic monitoring occurs, the assisted living facility must ensure: (a) That the electronic monitoring does not violate chapter 9.73 RCW: (b) :r.:he resident's roommate has provided written consent to electronic monitoring, if the resii::iioott, has.·a ,toomrnate: and :;,,,: rhi (c) resident and the assisted living facility have agreed upon a specific duration for the electronic monitairing and the agreement is documented in writing. i:, (10) 'rbr thepurposes of consenting to any audio electronic monitoring, the term "resident'' in21Ldes: Tn'.1; (a) individual residing in the assisted living facility; or (b} The resident's court-appointed guardian or attorney-in-fact who has obtained a court order specifically authorizing the court-appointed guardian or attorney-in-fact to consent to electronic monitoring of the resident. (11} Jf:a:res[(:l~nt's decision maker consents to audio electronic monitoring as spetified in'(1df.f6ov'e, !he assisted' living facility must maintain a copy of the court order authorizing such consent in trie reside:f-1t's record. ",(;>' ".· (12) '1f'the atsisted living facility determines that a resident, resident's family, or other third party' is electronically.monitoring a resident's room or apartment without complying with the requirements of t11is section, the assisted living facility must disconnect or remove such equipment until the approgriate ,consent is obtained and notice given as required by this section. :; ' This requirement was not met as evidenced by: ' Ba~j'~d;on intt11rview, observation and record review the assisted living facility failed to remove.'aft) ,e cam~{a known to be recording both audio and video in a resident's (Resident 1) room prior tof "2 notifying an~ .receiving consent from all residents possibly affected by tl1is recording, and failedJo postsjgnage visible to facility residents that recording of audio and video was occurring in the facility. This'failure placed all 78 facility residents 'ty . Statement of Deficiencies License #: 2064 Compliance Determination # 44662 Plan of Correction The Lodge at Mallard's Landing Completion Date Page 2 of3 Licensee: One Mallards Landing, LLC 08/12/2024 Administrator (or Representative) Date WAC 388-78A-2690 Electronic monitoring equipment Resident requested use. (1) Audio or video monitoring equipment may not be installed in the assisted living facility to monitor any resident apartment or sleeping area unless the resident or the residents' representative has requested and consents to the monitoring. (5) The release of audio or video monitoring recordings by the facility is prohibited. Each person or organization with access to the electronic monitoring must be identified in the resident's negotiated service agreement. (6) If the resident requests the assisted living facility to conduct audio or video monitoring of his or her apartment or sleeping area, before any electronic monitoring occurs, the assisted living facility must ensure: (a) That the electronic monitoring does not violate chapter 9.73 RCW; (b) The resident's roommate has provided written consent to electronic monitoring, if the resident has a roommate; and (c) The resident and the assisted living facility have agreed upon a specific duration for the electronic monitoring and the agreement is documented in writing. (10) For the purposes of consenting to any audio electronic monitoring, the term "resident" includes: (a) The individual residing in the assisted living facility; or (b) The resident's court-appointed guardian or attorney-in-fact who has obtained a court order specifically authorizing the court-appointed guardian or attorney-in-fact to consent to electronic monitoring of the resident. (11) If a resident's decision maker consents to audio electronic monitoring as specified in (10) above, the assisted living facility must maintain a copy of the court order authorizing such consent in the resident's record. (12) If the assisted living facility determines that a resident, resident's family, or other third party is electronically monitoring a resident's room or apartment without complying with the requirements of this section, the assisted living facility must disconnect or remove such equipment until the appropriate consent is obtained and notice given as required by this section. This requirement was not met as evidenced by: Based on interview, observation and record review the assisted living facility failed to remove a camera known to be recording both audio and video in a resident's (Resident 1) room prior to notifying and receiving consent from all residents possibly affected by this recording, and failed to post signage visible to facility residents that recording of audio and video was occurring in the facility. This failure placed all 78 facility residents . From:263 868 4993 09/03/2024 14:69 #916 P.007/008 License #: 2064 Compliance Determination# 44662 The Lodge at Mallard's Landing Completion Da~t Licensee: One Mallards Landing, LLC . 0811.2120i4 at risk,of having their rights violated by potentially being recorded without their consent. Findings included .. Obsel'1,,lation on 07/24/2024 at 10:10am, showed there was a camera in Resident 1's room. The camera in question was functioning in Resident 1' s room, and the only signage posted noting the presence of the camera and that recording was in process was posted on the inside of the resident's door, where it would not be visible to residents or staff outside of the resident's room. During an interview on 07124/2024 at 9:30am, facility executive director (Staff A) stated tl1at,tne,, tacilfty; ha\:l kriown of the camera in Resident 1's room since receiving a transcript of an intervi~w with the resident's daughter conducted by a third-party quality assurance compat~y on 07/01/2024,' and that th'e camera was still in use in the resident's room at the time of this interview. Staff A stated that residents arid their fam iii es had not been informed of the camera being in use and had not provided consent to potentially being recorded (audio and/or video) by said camera. ' ,. ·i 1 J Redor~ review on 07/25/2024 at 9: 10 am of the quality assurance report provided to the facility regarding the interview with the resident's daughter on 07/01/2024, showed that the facility was aware of the camera in the resident's room from this time. During an interview on 08105/2024 at 10:50am, Staff A stated that there had still been no notification (lf r~;iit-Jents •. or families of the use of the camera in the facility, and that facility stafi were "WbrRf~..(~ .·. ,.cir)'.'. 1 notifyipg res'idents and families. As of 08/12/2024, there was no indication that any notificatio~'h,'8 ' ,.'1'. ·· , beeri provided to facility residents or their families. •. ·· t · 1' · . ':JV i_: r . Plan/Attestation Statement I hereby certify that I have reviewed this report and have taken or will take active . . 10 .':O qlf/11S,Ures. correct_this def!ciency. By taking this action, The Lodge at ~llard!s.BJ1di~9··:fri• ,~ 1qr w,11 b~ ,n compliance with this law and I or regulation on (Data) ~.,. '::::J_ . . X'.I , ;'' ; ~ In addif I will implement a system to monitor and ensure continued compliance with this re m . . ·"- Administrator (o ( Data ··<:<t ,· ··1 ' .·,, . Statement of Deficiencies License #: 2064 Compliance Determination # 44662 Plan of Correction The Lodge at Mallard's Landing Completion Date Page 3 of3 Licensee: One Mallards Landing, LLC 08/12/2024 at risk of having their rights violated by potentially being recorded without their consent. Findings included ... Observation on 07/24/2024 at 10:10am, showed there was a camera in Resident 1's room. The camera in question was functioning in Resident 1' s room, and the only signage posted noting the presence of the camera and that recording was in process was posted on the inside of the resident's door, where it would not be visible to residents or staff outside of the resident's room.

Findings included… During an interview on 01/25/2024 at 10:10am, Staff A, facility Director of Nursing, stated that R1 had run out of Lantus (long-acting) insulin on 01/21/2024, having only three units available out of an ordered daily dosage of 42 units, and that R1's physician was notified of the need to re-order this medication on the same day (01/21/2024). Staff A stated that R1's Lantus insulin was delivered to the facility on 01/23/2024, but that R1 had refused this medication on 01/23/2024 due to 'feeling unwell'. Staff A stated that R1 was evaluated by the facility staff after refusing this medication and noted to have a blood glucose reading over 500 (emergent; normal range 70-126) and was sent out to hospital for evaluation and treatment at this time. Record review on 01/25/2024 at 2:00pm of facility progress notes and facility Medication Administration Record (MAR) showed that R1 was given the remaining amount, three units of long- acting insulin on the evening of 01/21/2024 instead of the ordered dose of 42 units. Record review on 01/25/2024 at 2:00pm of facility fax communication sent by facility staff to R1's primary care physician on 01/21/2024 showed that the facility was out of Lantus (long-acting) insulin for R1 on 01/21/2024. Record review on 01/25/2024 at 2:00pm of the Packing List provided to the facility from Costless Pharmacy showed that R1's Lantus insulin was not delivered to the facility until 01/23/2024 at 9:18am. . Statement of Deficiencies License #: 2064 Compliance Determination # 35807 Plan of Correction The Lodge at Mallard's Landing Completion Date Record review on 01/25/2024 at 2:00pm of the facility MAR for R1 showed that Staff B, facility staff Med Tech, did document R1's Lantus insulin as being administered on the evening of 01/22/2024, even though (as supported by the above interview and records) this medication was not available in the facility at this time. Record review on 02/20/2024 at 3:40pm of R1's hospital medical records showed that R1's blood glucose on admission to hospital (01/23/2024 at 9:08pm) was 341 (normal range 70-126), and that R1 was noted to be experiencing “Hyperglycemia (elevated blood glucose) secondary to poorly controlled insulin dependent diabetes mellitus.” Plan/Attestation Statement I hereby certify that I have reviewed this report and have taken or will take active measures to correct this deficiency. By taking this action, The Lodge at Mallard's Landing is or will be in compliance with this law and / or regulation on (Date)________________ . In addition, I will implement a system to monitor and ensure continued compliance with this requirement. Administrator (or Representative) Date .

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . Investigation Summary Report Provider/Facility: The Lodge at Mallard's Provider Type: Assisted Living Facility Landing License/Cert.#: 2064 Intake ID: 92699 Compliance Determination #: 28447 Region/Unit #: RCS Region 3 / Unit D Investigator: Michael Goulet Investigation Date(s): 08/22/2023 through 09/18/2023 Complainant Contact Date(s): Allegation(s): 1) Resident not administered vaginal insert medication (Estradiol) by staff, leading to urinary tract infection Investigation Methods: Sample: Total residents: Resident sample size: 5 Closed records sample size: Observations: General environment Resident Condition Residents in their rooms Interviews: Residents Staff Record Reviews: Medication administration records (MAR) Investigation Summary: 1) Per facility staff interview and record review of the named resident's medication administration records (MAR), the resident was not administered Estradiol vaginal insert on four occasions (7/3/23, 7/28/23, 7/31/23 and 8/11/23). One instance was stated (on the resident's MAR) as being related to the medication only being administered by nursing staff, which per remaining records was not factual. Two instances were related to the resident being otherwise predisposed at the scheduled time of administration, but no follow up attempt by staff was noted to have been made. The final instance was related to the medication not being available due to not having been refilled by facility staff. Per facility staff interview, the medication was intended to prevent urinary tract infection (UTI), and staff stated they felt the resident's diagnosis with a was directly related to the missed administration of this medication. Cited per WAC 388-78A-2210 (2) Medication Services Conclusion / Action: . Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . Investigation Summary Report Provider/Facility: The Lodge at Mallard's Provider Type: Assisted Living Facility Landing License/Cert.#: 2064 Intake ID: 93168 Compliance Determination #: 28447 Region/Unit #: RCS Region 3 / Unit D Investigator: Michael Goulet Investigation Date(s): 08/22/2023 through 09/18/2023 Complainant Contact Date(s): Allegation(s): 1) Resident pain medication (Oxycodone liquid) found to have been diverted as evidenced by adulteration of medication (medication removed from bottle and replaced with water). Investigation Methods: Sample: Total residents: Resident sample size: 5 Closed records sample size: Observations: General environment Resident Condition Residents in their rooms Interviews: Residents Staff Record Reviews: Medication administration record (MAR) Investigation Summary: 1) Per facility staff interview, the resident's bottle of liquid Oxycodone (pain reliever) was noted to have been adulterated, as evidenced by a change in the color of the medication and staining to the label indicative of the medication being replaced with water. Per staff and resident interviews, the named resident had not used this medication and no harm was noted. Per staff, the facility has taken steps to secure narcotic medications, and to only receive narcotic medications in the future in tamper resistant and tamper evident packaging. Consultation only per WAC 388-78A-2260 (1) Storing, Securing and Accounting for Medications (evidence available did not rise to level of citation) Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written . N/A . Investigation Summary Report Provider/Facility: The Lodge at Mallard's Provider Type: Assisted Living Facility Landing License/Cert.#: 2064 Intake ID: 93466 Compliance Determination #: 28447 Region/Unit #: RCS Region 3 / Unit D Investigator: Michael Goulet Investigation Date(s): 08/22/2023 through 09/18/2023 Complainant Contact Date(s): Allegation(s): 1) "Hydralazine (blood pressure medication) held numerous times by staff due to wrong education" Investigation Methods: Sample: Total residents: Resident sample size: 5 Closed records sample size: Observations: General environment Resident Condition Residents in their rooms Interviews: Residents Staff Record Reviews: Medication Administration Records (MAR) Investigation Summary: 1) Per record review of the named resident's medication administration records (MAR), there were numerous times when the medication in question (Hydralazine, blood pressure medication) was held by staff in accordance with the physician's orders (hold medication if systolic blood pressure less than 110 or diastolic blood pressure less than 60), but there were also multiple times (8) noted where this medication was held with no blood pressure reading noted. In four cases the medication was noted by staff to be "too close to previous administration" but in these instances administration would have been within appropriate parameters (within 30 minutes of time ordered) for administration. In one case the medication was stated by staff as being "too close to previous administration", but this was noted by staff more than one hour (11:52am) prior to the ordered time of administration (1:00pm), and no re- attempt to administer the medication within the order parameters was noted. In two cases no exception or administration was noted, and in one case the medication was appropriately held due to low diastolic blood pressure, but the blood pressure was not noted on the MAR. Cited per WAC 388-78A-2210 (2) Medication Services . Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . Statement of Deficiencies License #: 2064 Compliance Determination # 28447 Plan of Correction The Lodge at Mallard's Landing Completion Date Administrator (or Representative) Date WAC 388-78A-2210 Medication services. (2) The assisted living facility must ensure the following residents receive their medications as prescribed, except as provided for in WAC 388-78A-2230 and 388-78A-2250 : This requirement was not met as evidenced by: Based on interviews and record reviews, the Assisted Living Facility (ALF) failed to ensure that 3 of 5 residents (Residents 1, 2 and 4) received their medication as ordered. This failure placed these residents at risk of potential harm. Findings Included... During an interview on 08/23/2023 at 11:40am, Facility Administrator (Staff A) stated that Resident 1 (R1) did not receive polyethylene glycol (Miralax, laxative medication) as ordered, and that this led to a bowel blockage requiring hospitalization for the resident on /2023. During an interview on 08/23/2023 at 11:40am, Staff A stated that Resident 2 (R2) did acquire a urinary tract infection (UTI, bladder infection), and that facility staff believed this was a direct result of UTI preventative medication (Estradiol vaginal insert) not being administered by facility staff. During an interview on 08/23/2023 at 11:40am, Staff A stated that Resident 4's (R4) blood pressure medication was held by facility staff when the medication should have been administered to the resident. Record review on 08/24/2023 at 7:00am of R1's Medication Administration Records (MAR) for July and August 2023 showed that R1 did not receive polyethylene glycol/ Miralax on 07/05/2023, 07/06/2023, 07/10/2023 and 07/18/2023 through 08/01/2023 due to this medication being unavailable per staff notation. There was no notation in the MAR of any action taken by staff in order to secure this medication for the resident or that administrative staff had been informed of this non- availability. Record review on 08/24/2023 at 7:00am of R2's Medication Administration Records (MAR) for July and August 2023 showed that R2 missed a total of four doses of their Estradiol vaginal insert medication over this time. One dose on 07/03/2023 was not given due to staff noting incorrectly that only nursing staff could administer this medication, but there was no indication that any nursing staff were contacted regarding this missed dose or that . Statement of Deficiencies License #: 2064 Compliance Determination # 28447 Plan of Correction The Lodge at Mallard's Landing Completion Date any other staff member subsequently administered this dose. One dose on 07/28/2023 and one dose on 07/31/2023 were missed due to the resident being unavailable at the scheduled time of administration (once due to a visitor and once due to a dentist visit), but there was no indication that staff attempted to administer the medication when the resident was available. One dose on 08/11/2023 was missed due to the non-availability of the medication. Record review on 08/24/2023 at 7:00am of R4's Medication Administration Records (MAR) for July and August 2023 showed that R4 missed a total of seven doses of Hydralazine (blood pressure medication) during August 2023. On 08/01/2023 and on 08/20/2023, no medication was administered as scheduled at 1:00pm, with no exception (reason for non-administration) noted, and no resident blood pressure noted (as required per order parameters) to have been taken by facility staff.