Failure to Administer Medications According to Professional Standards
Penalty
Summary
The facility failed to ensure that medication administration services met professional standards of quality. Observations revealed that a Certified Medication Aide (CMA) prepared medications for residents without verifying orders using the electronic Medication Administration Record (MAR). Multiple residents' names were highlighted in pink on the computer screen, indicating overdue medications. When questioned, the CMA did not provide an explanation and walked away. A Licensed Nurse (LN) confirmed that 14 residents had overdue medications scheduled for 07:30 AM, and acknowledged that the facility did not have a liberalized medication pass policy. The LN stated that it was difficult to administer medications on time to independent residents and that staff did not have time to locate them for timely administration. Further observations showed that another CMA administered 07:30 AM scheduled medications to a resident at 09:52 AM, resulting in 18 oral and one inhaled medication being given late, with the resident declining a nasal spray. Interviews with administrative nursing staff confirmed that medications were expected to be administered on time and that the facility did not have a policy allowing for flexible medication pass times. The facility's policy required adherence to the right drug, dose, time, route, indication, and documentation, but staff training and practice did not align with these standards, as evidenced by the late administration and lack of MAR verification.