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F0656
D

Failure to Care Plan Antipsychotic Medication Use

Weaverville, North Carolina Survey Completed on 07-31-2025

Penalty

No penalty information released
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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.

Summary

The facility failed to develop and implement a care plan for a resident who had a physician's order for an antipsychotic medication. The resident was admitted with a diagnosis that included adjustment disorder and was assessed as cognitively intact. The admission Minimum Data Set (MDS) indicated the resident had received an antipsychotic during the look-back period, and a physician's order for quetiapine fumarate was documented. Despite this, a review of the resident's care plan showed no care plan addressing the use of antipsychotic medication. Interviews with staff confirmed that the antipsychotic order was not incorporated into the care plan, as it was missed during the interdisciplinary team (IDT) meeting where new orders are reviewed.

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