Fair Haven Of Forest City, Llc

which included bipolar disorder.No PASRR level II evaluation had been completed per review of Resident #14's medical record. Resident #14's admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #14 had an active diagnosis of bipolar disorder and was not currently considered by the state Level II PASRR process to have a serious mental illness or intellectual disability. Resident #14's quarterly MDS assessment dated [DATE] revealed he was severely cognitively impaired. He had no behaviors and no signs of depression. Resident #14 was coded for an active diagnosis of bipolar disorder and received anticonvulsant and antidepressant medications daily. Resident #14's physician orders revealed the following active medication orders: mirtazapine (antidepressant medication) 15 milligrams by mouth daily at bedtime for depression and appetite; Lamictal (anticonvulsant medication used as a mood stabilizer) 25 milligrams by mouth daily for bipolar disorder. Resident #14's active care plan dated 06/17/25 revealed a focus area for antidepressant medications with indication of depression and bipolar disorder.

The stated goal was that Resident #14 would remain free from side effects of the medication.

Interventions included administering medications as ordered, and monitoring for adverse effects of medication. An interview with the Social Worker on 04/02/26 at 9:16 AM revealed that Resident #14 had a level I PASRR when he was admitted to the facility.

The Social Worker stated that since he already had a PASRR level I evaluation completed, she did not submit a referral for a Level II PASRR evaluation and was not aware she had to.

The Social Worker stated that she was aware Resident #14 had a bipolar disorder diagnosis and acknowledged she did not submit a request for a level II PASRR evaluation for Resident #14. An interview with the Administrator on 04/02/26 at 4:02 PM revealed that it was important that level II PASRR evaluations were completed for residents who met criteria so they could receive the services they needed.

345314 04/02/2026

Fair Haven of Forest City, LLC 830 Bethany Church Road Forest City, NC 28043

should have a respiratory care plan in place due to her ongoing impaired respiratory status.

The DON indicated the MDS Nurse who was responsible for updating care plans and had recently quit and this may have contributed to the overlooking Resident #1's respiratory care plan.

An interview with the Administrator was conducted on 08/28/25 at 4:02 PM.

The Administrator stated the care plans should reflect the clinical condition of the residents, including respiratory symptoms or diagnoses.

• Resident #32 was admitted to the facility on [DATE] with diagnoses which included myocardial

infarction (heart attack) and chronic atrial fibrillation.

The quarterly Minimum Data Set (MDS) assessment for Resident #32 dated 01/16/2026 indicated Resident #32 was receiving an anticoagulant.

The active medication orders for Resident #32 revealed an order for Apixaban (an anticoagulant medication) 2.5 milligrams (mg) by mouth twice a day for history of myocardial infarction and deep vein thrombosis (blood clot) prevention.

The medication had a start date of 10/11/2025. Resident #32's active comprehensive care plan initiated on 10/17/2025 and last revised on 01/21/2026 did not reveal any care plan focus area or interventions related to Resident #32 receiving an anticoagulant medication.

Review of Resident #32's Medication Administration Record (MAR) from 01/01/2026 through 03/31/2026, revealed Resident #32 received Apixaban 2.5 mgs by mouth twice a day as ordered by the physician.

An interview was conducted on 04/01/2026 at 10:30 AM with the Informatics Nurse who stated the facility did not currently have an MDS Coordinator and he had been temporarily filling in for the past couple of weeks.

The Informatics Nurse stated that Resident #32's quarterly MDS assessment dated [DATE] was accurately coded for anticoagulant use, but her care plan did not address the use of anticoagulant medications. He indicated anticoagulant medications were considered high-risk medications and should be care planned.

An interview was conducted on 04/02/2026 at 1:45 PM with the Director of Nursing (DON).

The DON stated she did not know why Resident #32's anticoagulant medication was not care planned, but she expected that all high-risk medications be care planned including anticoagulant medications.

An interview was conducted with the Administrator on 04/02/2026 at 2:45 PM who stated she did not know why Resident #32's anticoagulant medication was not care planned, but she expected all resident care plans to be reflective of the resident's clinical condition including the use of anticoagulant medications.

The Administrator stated that an anticoagulant care plan should have been implemented for Resident #32.