The facility failed to have an appropriate diagnosis for one resident's antipsychotic order and failed to limit another resident's PRN antipsychotic order to 14 days. One resident received quetiapine for depression despite diagnoses including Parkinson's disease with dyskinesia, and another resident had haloperidol PRN for hallucinations with no stop date. The DON, Administrator, and MD stated psychotropic meds should have an appropriate diagnosis and PRN antipsychotics should have a 14-day stop date.

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

A resident with dementia and a history of stroke was admitted without psychotropic medications and initially assessed as alert and pleasant, yet staff quickly obtained and administered IM haloperidol for attempts to ambulate without assistance, followed by multiple PRN and scheduled orders for risperidone, lorazepam, Zoloft, and Seroquel for behaviors such as anxiety, yelling, roaming, and standing up from a wheelchair. The facility did not complete a comprehensive assessment or develop a care plan addressing antipsychotic use, and nursing documentation frequently lacked detailed descriptions of behaviors, nonpharmacological interventions, or behavior monitoring at the time medications were given. Interviews with an RN, DON, NP, physician, and the Administrator confirmed that the indications and dosing for antipsychotics, including high-dose risperidone and IM haloperidol, were not appropriate for the behaviors described and that nonpharmacological approaches should have been attempted first, contrary to facility policy requiring residents to be free from chemical restraints and mandating thorough, interdisciplinary care planning.

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Staff failed to document the clinical rationale for administering PRN antipsychotic and antianxiety medications to a resident with multiple psychiatric diagnoses. Despite facility policy requiring assessment and documentation of behaviors or symptoms justifying PRN use, staff administered these medications without recording the necessary behavioral evidence in the progress notes, as confirmed by MAR reviews and staff interviews.

Fine: $47,740

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

An LPN administered Lorazepam to a severely cognitively impaired resident without a physician's order, using medication from another resident's supply to calm behavioral symptoms. The medication was given for staff convenience, not as a standard treatment, and was not documented in the medical record, in violation of facility policy and residents' rights to be free from chemical restraints.

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.