WILMINGTON, DE - Federal inspectors cited Regency Healthcare & Rehab Center for failing to properly manage essential psychiatric medication for a dementia resident and inadequately addressing continence care issues that contributed to multiple falls.
Critical Medication Gaps Left Dementia Resident Without Treatment
The most serious violation involved a resident with dementia and bipolar disorder who went without his prescribed antipsychotic medication for multiple days due to pharmacy delivery issues and inadequate facility oversight. The resident, identified as R43 in the inspection report, had been prescribed quetiapine fumarate (Seroquel) 50 mg twice daily to manage aggressive behaviors associated with his conditions.
According to the inspection findings, the medication became unavailable on December 3, 2024, but the facility failed to immediately notify the prescribing physician. The resident missed a total of five doses over two days - three doses on December 3rd and two additional doses on December 4th. Nursing staff documented that despite reordering the medication from the pharmacy, delivery was repeatedly delayed.
A nurse practitioner's note revealed the severity of the situation: "patient quetiapine 50 mg tablets not delivered by pharmacy and missed PM dose yesterday as well as AM and PM doses today." The practitioner was forced to adjust the treatment plan, adding an additional 50 mg dose at bedtime to compensate for the missed medications.
Medical Risks of Antipsychotic Discontinuation
Abrupt discontinuation of antipsychotic medications like quetiapine can pose significant health risks for patients with dementia and behavioral disorders. When these medications are suddenly stopped, patients may experience a rapid return of aggressive behaviors, increased agitation, and potential psychotic symptoms.
The medication serves as a behavioral stabilizer for residents with dementia who exhibit physical aggression. Without proper medication management, these individuals face increased risk of injury to themselves and others, as well as potential worsening of their underlying psychiatric conditions. Standard medical protocols require immediate physician notification when prescribed psychiatric medications become unavailable, allowing for alternative treatments or emergency medication procurement.
Proper pharmaceutical management in nursing homes requires backup protocols and direct communication channels with prescribing physicians to prevent treatment interruptions. Facilities should maintain emergency medication supplies or have expedited delivery arrangements to ensure continuity of care for residents dependent on psychiatric medications.
Continence Care Failures Linked to Resident Falls
The inspection also identified serious deficiencies in bowel and bladder care management for the same resident. Federal investigators found that the facility failed to properly evaluate the resident's declining urinary continence and did not implement appropriate interventions to maintain or restore continence function.
The violation specifically noted that the resident experienced multiple falls related to his need for toileting assistance, indicating that staff were not providing adequate support for his continence needs. This represents a failure in basic nursing home care standards, which require facilities to help residents maintain their highest level of independence in daily activities, including toileting.
Standards for Continence Management in Long-Term Care
Professional nursing home standards require comprehensive assessment and individualized care plans for residents experiencing continence issues. Proper continence care involves regular toileting schedules, appropriate assistance with mobility to bathroom facilities, and environmental modifications to ensure resident safety during toileting activities.
When residents experience declining continence, facilities must conduct thorough evaluations to determine underlying causes and implement targeted interventions. This may include scheduled toileting programs, mobility assistance, adaptive equipment, or medical evaluation for treatable conditions affecting bladder function.
The connection between inadequate continence support and fall risk is well-established in geriatric care. Residents who need toileting assistance but don't receive timely help may attempt to reach bathroom facilities independently, significantly increasing their fall risk. Effective fall prevention programs must integrate continence care protocols to address this common cause of nursing home injuries.
Additional Issues Identified
The inspection revealed other compliance concerns beyond the major medication and continence violations. While specific details of additional findings were not provided in the available documentation, the facility received citations affecting multiple residents across different areas of care.
The inspection was conducted on February 4, 2025, and findings were discussed with facility leadership including the nursing home administrator, director of nursing, and corporate representatives during an exit conference. All violations were classified as causing "minimal harm or potential for actual harm" to residents, though the medication management failure posed significant risks for behavioral escalation.
Regulatory Response and Oversight
Federal nursing home regulations require facilities to provide pharmaceutical services that meet professional standards and ensure each resident receives proper treatment. The medication management violation represents a failure to meet basic pharmaceutical care standards that protect vulnerable residents from treatment interruptions.
Similarly, continence care requirements mandate that facilities help residents achieve and maintain their highest possible level of bladder and bowel function. The identified failures in this area directly impacted resident safety through increased fall risk and compromised dignity.
Both violations highlight systemic issues in care coordination and staff training that nursing homes must address to maintain federal compliance and ensure resident safety. The facility's response to these findings and implementation of corrective measures will be subject to ongoing regulatory oversight.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Regency Healthcare & Rehab Center from 2025-02-04 including all violations, facility responses, and corrective action plans.
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