When the attending physician ordered vital signs to be checked every four hours for 72 hours, nursing staff documented measurements at only 9:34 a.m.
Nursing Home News — Page 588
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**Multiple nurses admitted to throwing used fentanyl patches directly into regular trash cans** without proper supervision or disposal procedures.
This violation directly contradicted physician orders designed to prevent choking and aspiration risks.
The violations encompassed critical documentation gaps across multiple areas of resident care.
Another resident in a persistent vegetative state also had catheter tubing on the floor.
The facility's wound nurse discovered two new pressure injuries during routine care.
Federal regulations require nursing homes to investigate all allegations of abuse and take immediate protective action.
Inspectors documented that an agency nurse used a blood glucose meter designated for one resident on another resident without proper disinfection procedures.
The resident remains hospitalized as of the inspection date.
This created a dangerous gap in the medical record that could lead to medication errors, including potential double-dosing or missed medications.
The facility, located at 501 W Austin Street, also faced citations for inadequate registered nurse coverage on weekends.
Medical orders were issued to treat the injuries with normal saline and antibiotic ointment.