Orchard Pointe Senior Alzheimer Community.

This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website. This document was prepared by Residential Care Services for the Locator website.

Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES AGING AND LONG-TERM SUPPORT ADMINISTRATION Statement of Deficiencies License #: 2724 Compliance Determination # 54030 Plan of Correction Orchard Pointe Senior Alzheimer Community 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 complaint investigation on 01/30/2025 of: Orchard Pointe Senior Alzheimer Community 300 S Kitsap Blvd Port Orchard, WA 98366 This document references the following complaint number(s): 162022, 164940 The following sample was selected for review during the unannounced on-site visit: 4 of 0 current residents and 0 former residents. The department staff that investigated the Assisted Living Facility: Michael Goulet, Complaint Investigator From: DSHS, Aging and Long-Term Support Administration Lakewood, WA 98496 . Statement of Deficiencies License #: 2724 Compliance Determination # 54030 Plan of Correction Orchard Pointe Senior Alzheimer Community Completion Date 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. 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 interview, observation and record review, the Assisted Living Facility (ALF) failed to ensure that 1 of 1 resident's (Resident 1 [R1]) medication was not administered following the medication order being discontinued by the resident's physician. This failure resulted in harm (seizure, abnormal electrical activity in the brain) for the resident. Findings included... Record review on 02/03/2025 at 8:15am of the facility's “Medication Order History” for R1 showed that R1's order for long-acting (Glargine) insulin was discontinued per their physician's orders on 01/09/2025, and that this discontinuation had been noted in the facility’s medication administration system by Staff C, the facility Resident Care Coordinator on 01/09/2025. Record review on 02/03/2025 at 8:15am of a written statement made by Staff A, the facility Med Tech noted that Staff A had continued to administer long-acting (Glargine) insulin to R1 from 01/09/2025 to 01/28/2025. Staff A wrote in this statement, "I did not realize that insulin pen had been discontinued on 01/09/2025." Record review on 02/03/2025 at 8:15am of the January 2025 Medication Administration . Statement of Deficiencies License #: 2724 Compliance Determination # 54030 Plan of Correction Orchard Pointe Senior Alzheimer Community Completion Date Record (MAR) for R1 showed that the resident's long-acting (Glargine) insulin was noted as "D/C" (discontinued) in the MAR from 01/10/2025. Record review on 02/10/2025 at 1:40pm of facility’s policy (MP21) regarding Permanent Discontinuance of Medications showed that the facility policy stated that 'discontinued medications will not be retained' in the facility. Record review on 02/10/2025 at 1:40pm of an email communication from Staff B, the facility Director of Nursing Services (DNS) noted that although R1's long-acting (Glargine) insulin pen was removed from the facility medication cart upon being discontinued (01/09/2025), that additional long-acting (Glargine) insulin pens for R1 did remain in the facility refrigerator, allowing the medication to be available for administration after it was discontinued. During an interview on 02/04/2025 at 9:55am, Staff A stated that although they believed that R1's long-acting (Glargine) insulin order was not immediately removed from the facility computer system when the medication was discontinued (01/09/2025), that they (Staff A) had administered this medication to R1 for at least some period of time without any current order being reviewed. Staff A stated, "She (R1) had two insulin pens, I was just giving it (long-acting insulin) to her by memory." 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, Orchard Pointe Senior Alzheimer Community 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 .