Laredo West Nursing And Rehabilitation Center

tablet by mouth every 12 hours as needed for agitation.

Resident was moved to a private room for

resident. At this time, resident was transitioned to another hall, surroundings were explained to

further questions at this time.

Another progress noted dated 07/08/25 at 3:30 pm by RN P stated, Resident was in hallway sitting on the wheelchair and started to become verbally aggressive with any resident that in the hallway.

The resident was escorted to his room and will have one to one assistance in the room until seen by Behavioral Health or Psychiatric services. PCP and RP are aware. A progress noted dated 07/09/25 at 6:58 pm by RN O reflected the following, NP rounds on resident and orders: 1.

Increase sertraline (antidepressant medication) to 50mg every morning. 2.

Oxcarbazepine (used to treat bipolar) 150mg twice daily. 3.

Stop hydroxyzine HCL. 4.

Vistaril (medication used to treat anxiety) 50mg every 4 hours PRN x 14 days. 5.

Discontinue one to one monitoring.

Record review of the facility's provider investigation report dated 07/16/25 reflected Resident #7 had a BIMS of 5.

The report further reflected Resident #6 stated Resident #7 had physically struck him on the left arm and left leg prior to staff intervention.

The facility staff immediately separated the residents, skin and pain assessments were performed on both residents with no injuries noted, and no pain voiced or observed for either resident. A police report was made. Resident #7 was moved to another hall, placed on one to one monitoring, and was referred to behavioral health and psychiatric services due to his sudden change in behavior.

The provider investigation report stated, Negative outcomes/ Injury of Patient: No negative outcomes were noted for either resident.

There were no injuries identified related to this incident.

Residents did not voice nor indicate emotional distress as a result of the incident.

Both residents continue their normal daily routines.

Conclusion:

During an interview with the facility administrator, Resident #6 was able to verbalize what occurred during the incident. Resident #6 explains that he was planning to attend an activity in Wing A which started at 2 p.m. Resident #6 stated that Resident #7 was attempting to tell him something in the hallway, but he could not understand what Resident #7 was saying and asked him to repeat himself. Resident #6 states that he did raise his voice when he was unable to understand what Resident #7 was saying. Resident #6 explains that when he raises his voice, it does not mean he is upset. It was then that Resident #6 alleges that Resident #7 started to attempt to hit him. Resident #6 states he told Resident #7 to be careful because he was going to fall and to stop or otherwise, he was going to react. In an interview with the facility administrator, Resident #7 denied the incident occurred. Resident #7 denied hitting anyone.

The resident seemed upset about being asked questions related to the incident.

When asked what he would do if a situation arose and he became upset with another resident, he said he would leave.

The police officer responding to the incident interviewed only Resident #6. Resident #6 did not want to press charges. Resident #6 further explained to the officer that he was concerned that Resident #7 would fall because he was standing up from his wheelchair without assistance. In a subsequent interview, Resident #6 does not state any concerns or emotional distress from the incident.

Prior to the incident, Resident #6 was already receiving routine psychological services from Behavioral Healt

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Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043

policy and procedure. It was signed by RN A and the ADON.

Record review of the facility's Medication

jeopardy to resident health or RN A (the off going nurse) and RN R (the oncoming nurse) on 04/27/25 at 10:24 pm.

The nurse was safety notified and gave a telephone order for Narcan to be administered immediately and neurologic checks and vital signs to be done every one hour for 24 hours on 04/27/25 at 10:55 pm.

The Employee's

medication- Lorazepam 0.5ml, but I accidentally gave 5ml.

Discovery of medication error was made during change of shift medication count.

The Management section was handwritten and signed by the DON on 04/28/25 and stated, RN A will have another nurse witness his medication administration (narcotics) for the next 30 days.

This form was also signed by the Admin on 04/28/25.

Record review of the facility's medication administration policy in-service dated 04/28/25 reflected that 25 of 26 RNs and LVNs attended the training.

Record review of the facility's Medication Administration Policy dated 10/24/22 reflected in part: Policy: Medications are administered by licensed nurses, or other staff who are legally authorized to do so in this state, as ordered by the physician and in accordance with professional standards of practice, in a manner to prevent contamination or infection.Policy Explanation and Compliance Guidelines:3.

Identify resident by photo in the MAR (medication administration record).10.

Review MAR to identify medication to be administered.11.

Compare medication source (bubble pack, vial, etc.) with MAR to verify resident name, medication name, form, dose, route, and time.14.

Administer medication as ordered in accordance with manufacturer specifications.17.

Sign MAR after administered.

For those medications requiring vital signs, record the vital signs onto the MAR.18. If medication is a controlled substance, sign narcotic book.19.

Report and document any adverse side effects or refusals.20.

Correct any discrepancies and report to nurse manager.