Markley Rehab: Medication Errors Affect Two Residents - PA
The licensed nurse, identified in inspection records only as Employee E3, told the resident the small pill was their Spiriva and that it was simply going to be given orally this time, rather than through an inhaler. The resident swallowed it. Spiriva is not an oral medication. It is a capsule designed to be punctured and inserted into a handheld inhaler device, where the powder inside is drawn into the lungs. Swallowing it delivers the drug to the wrong place entirely.
The resident, referred to in the inspection report as Resident R1, reported the incident the following day, on November 8, 2025. The nurse confirmed what had happened. The Director of Nursing, Employee E2, told inspectors during an interview on November 20 that Spiriva 10 mcg is a small pill that gets inserted into the cartridge of the inhaler and inhaled through the device. That description made clear the medication has no oral use.
What the inspection report does not say is whether anyone checked on Resident R1 for respiratory effects after the error. It does not say whether the nurse received retraining, or whether the facility reviewed how the medication had been stored and dispensed in the first place. The record shows the error happened, the resident reported it, and the nurse confirmed it. That is where the documentation ends.
The second medication failure at Markley involved a resident with epilepsy.
Resident R3 was admitted to the facility and had a diagnosis of epilepsy, a condition in which disrupted nerve cell activity in the brain causes seizures. A physician ordered two anticonvulsant medications, Keppra and Lacosamide, to be given twice daily beginning November 9, 2025. When a registered nurse, Employee E4, entered those orders into the facility's electronic medical record system on November 8, the software defaulted the start date to November 9. The result was that the system showed no doses were due on November 8 itself. Resident R3 missed both medications that day.
The family filed a grievance on November 12, 2025. The facility opened an investigation the same day and determined what had happened. The Nursing Home Administrator, Employee E1, confirmed in an interview with inspectors on November 20 that Resident R3 missed one dose of Keppra and one dose of Lacosamide on November 8.
One missed day of anticonvulsant medication matters. Both Keppra and Lacosamide are used to control seizure activity, and gaps in dosing can reduce the drugs' protective effect. The inspection report does not describe what, if anything, happened to Resident R3 on November 8 or in the days that followed. It does not say whether the resident had a seizure. It does not say whether a physician was notified that the doses were missed.
The inspection, triggered by a complaint, was conducted on November 20, 2025. Inspectors cited the facility under Pennsylvania pharmacy and nursing services regulations. The harm level for both violations was recorded as minimal harm or potential for actual harm.
The phrase "potential for actual harm" does real work in a case like this. A resident with epilepsy, newly admitted, starting two seizure medications for the first time under the facility's care, missed both of them on the first day they were supposed to be given. Whether that gap caused harm is something the inspection report leaves unanswered, because the inspection report was not designed to follow the resident forward in time. It captured what the records showed and what staff confirmed. It stopped there.
Resident R1 swallowed a pill meant to be breathed. Resident R3 went without seizure medication on the day their treatment was supposed to begin. Both errors were confirmed by the staff members involved. Neither required a disputed finding or a complicated investigation. They happened, they were documented, and they were reported to inspectors who cited the facility and moved on.
What the residents experienced after that is not in the record.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Markley Rehabilitation and Healthcare Center from 2025-11-20 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 21, 2026 · Our methodology
MARKLEY REHABILITATION AND HEALTHCARE CENTER in NORRISTOWN, PA was cited for violations during a health inspection on November 20, 2025.
Spiriva is not an oral medication.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.