Glendale Uptown Home (May 2nd)

Based on observation, review of clinical records, facility policy and procedure it was determined that the nursing home failed to ensure physician orders were carried out. Findings included the following: In observation during the medication pass, on April 30, 2013 at 10:45 a.m. revealed that Employee E3, a licensed nurse, crushed the resident’s medications altogether in one container. These medications included Aspirin 81 milligrams, Carveditol 6.25 mg. Tamsulosin .4 mg, Zinc Sulfate and Vitamin C. Further observation revealed that Employee E3 also crushed a one-a-day vitamin. Employee E3 then was observed administering these medication altogether to Resident R84, via the peg tube. In review of the facility’s medication policy and procedure, revised December 21, 2010 and reviewed annually, stated if administering more than one medication, flush the peg tube with 5 to 10 ml. warm water between medications. Interview with Employee E3 on May 1, 2013 at 11:30 a.m. confirmed that the facility failed to administer the liquid multivitamin as ordered and failed to ensure that the water flush between each of the medication was completed as ordered. The resident was ordered an undisclosed medical treatment on Tuesday-Thursday and Saturday, with pickup at the facility at 11:00 a.m. Interview with the resident on May 1, 2013 at 2:00 p.m. confirmed that the resident was usually out of the facility from 11:00 a.m. to 5:00 p.m.

A review of physician’s orders revealed that the resident was to receive 60 milligrams of an undisclosed medication twice a day. Observation of medication pass on April 30, 2013 with Employee E3, at 9:30 a.m. revealed that the employee poured one undisclosed medication 20 mg tablet for administration. A review of the medication punch card with the employee, prior to administration, verified that the employee should have poured three 20 mg tablets of the undisclosed medication for administration. In an interview with the director of nursing on May 2, 2013 at 10:30 a.m. confirmed that the facility failed to ensure physician’s orders.

Based on staff interviews and review of clinical documentation, it was determined that the nursing home failed to ensure that physician’s visits were completed every 60 days as required for two of 30 residents reviewed. The findings included the following: Review of Resident R1’s clinical record revealed that the resident had been admitted to the facility at an undisclosed date. There was no documentation to indicate that the physician had examined the resident every 60 days as required by the regulation. An interview with Employee E2 on May 2, 2013 at 9:30 a.m. confirmed that the physician had only examined the resident twice in the previous eight months Review of Resident R84’s admission fact sheet revealed that the resident was admitted to the facility on an undisclosed date. They neglected to document that the resident was examined at least every 60 days as required by the regulation.