Penalty

Fine: $10,905

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 prevent the administration of unnecessary psychotropic medication to a resident who was admitted with diagnoses including dementia, anxiety disorder, and post-traumatic stress disorder. Upon admission, the resident was prescribed Risperdal 1 mg at bedtime for dementia with behavioral disturbance. Subsequently, a new order was written to decrease the Risperdal dose to 0.5 mg at bedtime for 14 days, with an end date specified. However, the original 1 mg order was not discontinued, resulting in the resident receiving both the 1 mg and 0.5 mg doses over a weekend. The resident expressed a lack of understanding regarding the reason for taking Risperdal and indicated a desire not to receive the medication. The DON confirmed that the resident had come from a geriatric psychiatric hospital and that the facility intended to discontinue Risperdal due to an inaccurate diagnosis. The DON acknowledged that the continued administration of Risperdal 1 mg was unnecessary and resulted from a failure to discontinue the previous order when the dose was reduced.