Nursing notes documented the encounter but revealed no follow-up safety measures.
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Licensed vocational nurse 1 told inspectors during a September 16 interview that Resident 1 lacked a care plan for apixaban use.
The patient had suffered a suspected overdose on March 28.
The incident at Carrara involved a resident who required regular dialysis treatments.
The September 2nd incident escalated when the victim immediately retaliated with a punch to his attacker's upper chest.
The April 12 incident exposed multiple safety failures at the facility.
After Christmas, everything changed.
Federal inspectors discovered the security failures at Oasis at The Conch Republic Nursing and Rehab during a September complaint investigation.
The incident occurred on September 17 when LPN J went to complete a critical admission assessment for Resident 108 around 7:00 PM.
Federal inspectors found the facility failed to follow mandatory notification procedures for residents discharged between late August and early September.
A nurse documented the requirement that same evening at 8:58 PM, noting the resident needed the specialist appointment within the prescribed timeframe.
The facility's Director of Nursing admitted that care plans for three residents should have been revised after each fall, but weren't.