Resident 17, an 83-year-old woman with Alzheimer's disease and severe cognitive impairment, had been receiving respite care at the facility since July.
Nursing Home News — Page 466
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The problems weren't isolated incidents.
Resident #92 scored 65 on the facility's fall risk assessment — well into the "high risk" category that begins at 45 points.
The hospital also ordered weekly vancomycin trough levels — blood tests that measure how much of the powerful antibiotic remains in the bloodstream.
The December 23 observation at Park View Care Center occurred during an active COVID-19 outbreak that had infected 10 of the facility's 62 residents.
The patient had been ordered to receive Rivaroxaban 10 milligrams each morning to prevent deep vein thrombosis following joint replacement surgery.
The most serious case involved a resident with dementia, diabetes, heart failure and an antibiotic-resistant organism infection.
Federal inspectors found no evidence in the medical record that staff checked on the resident's condition during the overnight shift from 11 p.m.
Federal inspectors observed the violation on December 23 during a complaint investigation at Desert Springs Post Acute.
The facility's Assistant Director of Nursing told inspectors she knew police had visited to investigate an abuse allegation.
The medication error at Chaparral House involved a resident who had been admitted with a right femur fracture.
The outbreak began December 22 when staff documented that Resident 2 had contracted head lice.