Lack of Monitoring for Psychotropic Medications: The facility failed to document monitoring for effectiveness and adverse effects for multiple residents receiving psychotropic meds. Residents with diagnoses including dementia, psychotic disturbance, anxiety, depression, COPD, and other conditions received medications such as mirtazapine, olanzapine, buspirone, sertraline, cariprazine, ziprasidone, and lurasidone, but the MAR/TAR and progress notes showed no documented monitoring, despite care plans calling for staff to monitor and report adverse effects.
A resident with dementia, depression, psychosis, and severely impaired cognition received multiple PRN doses of lorazepam for anxiety/restlessness, but the record showed no documented non-pharmacological interventions before those administrations. The care plan directed staff to use PRN psychoactive meds only after non-drug measures were ineffective, and the DON confirmed no such interventions were provided before the doses reviewed.
Inadequate Monitoring for Psychotropic Medication Adverse Effects: A resident with morbid obesity, type II DM, and a left femur fracture received buspirone for anxiety and duloxetine for depression, with orders for behavior and adverse effect monitoring. The MAR showed the meds were administered as ordered, but the adverse effect monitoring order was discontinued and there was no current monitoring order despite the resident being cognitively intact and having no documented behaviors or adverse reactions.
Unjustified Psychotropic Medication Use: A resident with Parkinson's disease, dementia, anxiety, depression, and other diagnoses was prescribed Quetiapine and Depakote for delusions, paranoia, psychotic disorder, and dementia-related mood disturbance without documentation supporting a psychotic disorder diagnosis. Psychiatry notes did not document psychotic disorder, behavioral logs showed little documented behavior, and the DON confirmed there was no diagnosis supporting the antipsychotic use.
Unnecessary antipsychotic use without CMS-supported indication. A resident with moderate cognitive impairment and multiple chronic diagnoses was receiving Lurasidone 20 mg daily despite a psychiatric note stating the medication lacked a CMS-supported indication and was without an appropriate diagnosis per CMS guidelines. An RN confirmed the resident was still on the medication and acknowledged it was not recognized as appropriate per CMS guidelines, while citing a mood disorder documented by another provider as the basis for use.
A resident with anxiety disorder and other psychiatric and pain-related diagnoses received PRN Ativan beyond the 14-day limit for psychotropic meds. The order did not include a stop date, and MAR review showed the medication was given for 23 total days before it was discontinued; the DON confirmed the missing 14-day stop date.
Inadequate indication for antipsychotic use: A resident who was cognitively intact and had no mood, psychosis, or behavioral symptoms was given Abilify 20 mg daily for mood/anxiety/depression without an approved diagnosis. The MAR showed daily administration with no documented behaviors, and an RN confirmed the resident lacked an approved indication for the antipsychotic.
Antipsychotic Used Without Timely Supporting Diagnosis: A resident with severe cognitive impairment and dementia received Risperdal 0.5 mg BID for agitation without an appropriate diagnosis documented to support its use. The MRR identified the missing diagnosis, but the physician did not address the irregularity in a timely manner, and the DON confirmed the delay.
Lack of Monitoring for Psychotropic Medications: The facility failed to document routine monitoring for effectiveness, side effects, and adverse effects for several residents receiving psychotropic medications, including antidepressants and antianxiety agents. Residents with diagnoses such as depression, dementia with mood disturbance, stroke, and cardiac conditions received medications including Zoloft, Buspirone, Lexapro, Lorazepam, Bupropion HCL, and Duloxetine, but the record contained no evidence of ongoing monitoring in the nurses’ notes, MARs, or TARs, and the DON confirmed the lack of documentation.
A facility failed to document monitoring for the effectiveness, side effects, and adverse effects of psychotropic medications for four residents receiving antidepressant, antianxiety, antipsychotic, and mood-stabilizing drugs. Records showed no monitoring documentation for residents with conditions including depression, anxiety, dementia, bipolar disorder, and psychotic disturbance, and the DON confirmed the lack of monitoring. Facility policy required documentation of resident response and adverse effects, but the reviewed charts did not reflect this.
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