cms_UT: 49

In collaboration with The Seattle Times, Big Local News is providing full-text nursing home deficiencies from Centers for Medicare & Medicaid Services (CMS). These files contain the full narrative details of each nursing home deficiency cited regulators. The files include deficiencies from Standard Surveys (routine inspections) and from Complaint Surveys. Complete data begins January 2011 (although some earlier inspections do show up). Individual states are provides as CSV files. A very large (4.5GB) national file is also provided as a zipped archive. New data will be updated on a monthly basis. For additional documentation, please see the README.

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rowid	facility_name	facility_id	address	city	state	zip	inspection_date	deficiency_tag	scope_severity	complaint	standard	eventid	inspection_text	filedate
49	MT OLYMPUS REHABILITATION CENTER	465006	2200 EAST 3300 SOUTH	SALT LAKE CITY	UT	84109	2018-04-30	757	E	1	1	C87F11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY > Based on interview and record review, it was determined that for 5 of 43 sample residents, the facility did not ensure that each resident's drug regimen was free from unnecessary drugs. An unnecessary drug is any drug when used in excessive dose; or for excessive duration; or without adequate monitoring; or without adequate indications for its use; or in the presence of adverse consequences which indicate the dose should be reduced or discontinued; or any combinations of the reasons above. Specifically, multiple residents had multiple medications administered late as well as medications that were not available for administration. Resident identifiers: 4, 25, 37, 45 and 59. Findings include: 1. Resident 37 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 4/26/18 resident 37's medical record was reviewed. physician's orders [REDACTED]. a. 10/18/17, [MEDICATION NAME]/[MEDICATION NAME] 2.5/0.05 Nebulizer every 8 hours. b. 12/1/16, [MEDICATION NAME] 20 mg (milligrams)/ml (milliliter) subcutaneous at Bedtime. c. 12/27/18 through 2/8/18, [MEDICATION NAME] 1 mg to 3.5 mg daily (QD). d. 7/17/18, [MEDICATION NAME] 70 mg weekly. e. 9/26/18, [MEDICATION NAME] 40 mg QD. f. 1/6/18, [MEDICATION NAME] 100 mg three times daily (TID). g. 1/2/18, [MEDICATION NAME] 2.5 mg QD. h. 10/9/17, [MEDICATION NAME] 20 mg QD. i. 1/11/18, Potassium Chloride 20 mEq twice daily (BID). j. 5/11/18, [MEDICATION NAME] 40 mg QD. k. 5/1/17, Sprionolactone 25 mg QD. l. 5/11/17, [MEDICATION NAME] 50 mcg QD. m. 12/12/18, [MEDICATION NAME] 200 mg at bedtime. The Medication Administration Record [REDACTED] a. On 1/8/18 and 1/14/18 [MEDICATION NAME] 20 mg injection was not administered due to Drug/Item unavailable. According to the MAR for (MONTH) (YEAR), (MONTH) (YEAR), (MONTH) (YEAR) and (MONTH) (YEAR) resident 37 had multiple medications administered late including the following dates: a. [MEDICATION NAME]/[MEDICATION NAME] TID, 2.5/0.05 every 8 hours 1/1/18, 1/2/18, 1/4/18, 1/5/18 x 2, 1/6/18 x 2, 1/7/18, 1/9/18 x 3, 1/10/18, 1/11/18 x 2, 1/12/18 x 2, 1/13/18 x 3, 1/14/18, 1/15/18, 1/16/18, 1/17/18 x 2, 1/20/18, 1/21/18, 1/22/18, 1/23/18, 1/24/18 x 2, 1/25/18, 1/27/18, 1/28/18, 1/29/18, 1/30/18, 1/31/18, 2/2/18, 2/5/18, 2/6/18, 2/7/18, 2/8/18, 2/9/18 and 2/10/18. b. [MEDICATION NAME] 20 mg at bedtime, 1/8/18, 1/11/18, 1/12/18, 1/13/18, 1/14/18, 1/18/18, 1/26/18, 2/1/18, 2/6/18, 2/7/18, 2/8/18, 2/9/18, 2/10/18, 3/8/18, 3/9/18, 3/14/18, 3/23/18, 3/28/18, 3/31/18, 4/13/18, 4/16/18 and 4/20/18. c. [MEDICATION NAME] 3 mg QD, 1/13/18, 1/17/18, 1/20/18, 1/21/18, 1/22/18, 1/23/18, 1/24/18, 1/25/18, 1/27/18, 1/29/18, 1/31/18, 2/5/18, 2/6/18, 2/19/18, 3/9/18, 3/30/18, 4/4/18 and 4/17/18. d. [MEDICATION NAME] 70 mg weekly, 1/30/18, 2/6/18, 3/6/18, 3/20/18 and 4/3/18. e. [MEDICATION NAME] 40 mg QD, 1/4/18, 1/5/18, 1/6/18, 1/7/18, 1/9/18, 1/11/18, 1/12/18, 1/13/18, 1/17/18, 1/20/18, 1/21/18, 1/22/18, 1/23/18, 1/24/18, 1/25/18, 1/27/18, 1/28/18, 1/29/18, 2/7/18, 2/8/18, 2/10/18, 2/11/18, 2/12/18, 2/13/18, 2/16/18, 2/17/18, 2/18/18, 2/21/18, 2/22/18, 2/23/18, 2/24/18, 2/25/18, 2/26/18, 2/27/18, 2/28/18, 3/1/18, 3/2/18, 3/3/18, 3/4/18, 3/8/18, 3/9/18, 3/10/18, 3/12/18, 3/15/18, 3/22/18, 3/23/18, 3/24/18, 3/27/18, 3/29/18 and 3/31/18. f. [MEDICATION NAME] 100 mg TID, 1/7/18, 1/8/18, 1/9/18 x 2, 1/10/18, 1/11/18 x 3, 1/12/18 x 2, 1/13/18 x 3, 1/14/18, 1/16/18, 1/17/18, 1/18/18, 1/20/18, 1/21/18, 1/22/18 x2, 1/23/18 x 2, 1/24/18 x 2, 1/25/18, 1/26/18, 1/27/18 x 2, 1/28/18, 1/29/18 x 2, 1/30/18, 1/31/18 x 2, 2/1/18, 2/2/18, 2/6/18, 2/7/18, 2/8/18, 2/9/18, 2/10/18, 2/11/18, 2/12/18, 2/13/18, 2/16/18, 2/17/18, 2/18/18, 2/21/18, 2/22/18, 2/23/18, 2/24/18, 2/25/18, 2/26/18, 2/27/18, 2/28/18, 3/2/18, 3/3/18, 3/4/18, 3/8/18, 3/9/18, 3/10/18, 3/12/18, 3/14/18, 3/15/18, 3/20/18, 3/22/18, 3/23/18, 3/24/18, 3/26/18, 3/27/18, 3/28/18, 3/29/18, 3/31/18, 4/1/18, 4/3/18, 4/4/18, 4/5/18, 4/7/18, 4/9/18, 4/12/18, 4/13/18, 4/16/18, 4/19/18, 4/20/18, 4/21/18, 4/23/18 and 4/24/18. g. [MEDICATION NAME] 2.5 mg QD, 1/4/18, 1/5/18, 1/6/18, 1/9/18, 1/11/18, 1/12/18, 1/17/18, 1/20/18, 1/21/18, 1/22/18, 1/23/18, 1/24/18, 1/25/18, 1/26/18, 1/27/18, 1/29/18, 4/20/18, 4/23/18 and 4/24/18. h. [MEDICATION NAME] 20 mg QD, 1/4/18, 1/5/18, 1/6/18, 1/7/18, 1/9/18, 1/11/18, 1/12/18, 1/13/18, 1/17/18, 1/20/18, 1/21/18, 1/22/18, 1/23/18, 1/24/18, 1/25/18, 1/27/18, 1/29/18, 1/31/18, 2/2/18, 2/7/18, 2/8/18, 2/10/18, 2/12/18, 2/13/18, 2/16/18, 2/17/18, 2/18/18, 2/21/18, 2/22/18, 2/23/18, 2/24/18, 2/25/18, 2/26/18, 2/27/18, 2/28/18, 4/1/18, 4/3/18, 4/4/18, 4/5/18, 4/7/18, 4/20/18, 4/23/18 and 4/24/18. i. Potassium Chloride 20 mEq BID, 1/4/18, 1/5/18, 1/6/18, 1/7/18, 1/9/18, 1/11/18, 1/12/18, 1/13/18 x 2, 1/17/18, 1/20/18, 1/21/18, 1/22/18, 1/23/18, 1/24/18, 1/25/18, 1/27/18, 1/29/18, 1/31/18, 2/6/18, 2/7/18, 2/8/18, 2/10/18, 2/11/18, 2/12/18, 2/13/18, 2/16/18, 2/17/18, 2/18/18, 2/19/18, 2/21/18, 2/22/18, 2/23/18, 2/24/18, 2/25/18, 2/26/18, 2/27/18, 2/28/18, 3/1/18, 3/2/18, 3/3/18, 3/4/18, 3/8/18, 3/9/18, 3/10/18, 3/12/18, 3/15/18, 3/20/18, 3/22/18, 3/23/18, 3/24/18, 3/26/18, 3/27/18, 3/28/18, 3/29/18, 3/30/18, 3/31/18, 4/1/18, 4/3/18, 4/4/18, 4/5/18, 4/7/18, 4/9/18, 4/12/18, 4/13/18, 4/17/18, 4/19/18, 4/20/18, 4/21/18, 4/23/18 and 4/24/18. j. [MEDICATION NAME] 40 mg QD, 1/4/18, 1/5/18, 1/6/18, 1/11/18, 1/12/18, 1/17/18, 1/18/18, 1/19/18, 1/20/18, 1/21/18, 1/22/18, 1/23/18, 1/24/18, 1/25/18, 1/26/18, 1/27/18, 1/29/18, 1/31/18, 2/2/18, 2/3/18, 2/4/18, 2/5/18, 2/7/18, 2/8/18, 2/9/18, 2/10/18, 3/2/18, 3/3/18, 3/4/18, 3/8/18, 3/9/18, 3/10/18, 3/12/18, 3/15/18, 3/20/18, 3/22/18, 3/23/18, 3/24/18, 3/27/18, 3/29/18, 3/31/18, 4/1/18, 4/3/18, 4/4/18, 4/5/18, 4/7/18, 4/20/18, 4/23/18 and 4/24/18. k. Sprionolactone 25 mg QD, 1/4/18, 1/5/18, 1/6/18, 1/7/18, 1/9/18, 1/11/18, 1/12/18, 1/13/18, 1/17/18, 1/20/18, 1/21/18, 1/22/18, 1/23/18, 1/24/18, 1/25/18, 1/27/18 and 1/29/18. l. [MEDICATION NAME] 50 mcg QD, 1/4/18, 1/5/18, 1/6/18, 1/11/18, 1/12/18, 1/17/18, 1/18/18, 1/19/18, 1/20/18, 1/21/18, 1/22/18, 1/23/18, 1/24/18, 1/25/18, 1/26/18, 1/27/18, 1/29/18, 1/31/18, 2/2/18, 2/3/18, 2/4/18, 2/5/18, 2/7/18, 2/8/18, 2/9/18, 2/10/18, 2/13/18, 2/16/18, 2/17/18, 2/18/18, 2/21/18, 2/22/18, 2/23/18, 2/24/18, 2/25/18, 2/26/18, 2/27/18, 2/28/18, 3/2/18, 3/3/18, 3/4/18, 3/8/18, 3/9/18, 3/10/18, 3/12/18, 3/15/18, 3/20/18, 3/22/18, 3/23/18, 3/24/18, 3/27/18, 3/29/18, 3/31/18, 4/1/18, 4/3/18, 4/4/18, 4/5/18, 4/7/18, 4/20/18, 4/23/18 and 4/24/18. m. [MEDICATION NAME] 200 mg at bedtime, 1/8/18, 1/11/18, 1/12/18, 1/13/18, 1/14/18, 1/18/18, 1/26/18, 1/27/18, 2/5/18, 2/6/18, 2/19/18, 2/22/18, 3/1/18, 3/2/18, 3/3/18, 3/4/18, 3/8/18, 3/9/18, 3/10/18, 3/12/18, 3/15/18, 3/20/18, 3/22/18, 3/23/18, 3/24/18, 3/27/18, 4/13/18, 4/16/18 and 4/22/18. 2. Resident 4 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 4/26/18 resident 4's medical record was reviewed. physician's orders [REDACTED]. a. 4/17/17, [MEDICATION NAME] 325 mg 2 tablets TID. b. 8/15/18, [MEDICATION NAME] 10 mg QD. c. 4/18/17, Aspirin 81 mg QD. d. 8/15/17, [MEDICATION NAME] 5 mg at bedtime. e. 4/17/17, [MEDICATION NAME] 100 mg BID. f. 8/15/17, [MEDICATION NAME] 40 mg at bedtime. g. 1/30/17, [MEDICATION NAME] 10 mg QD. h. 4/17/18, [MEDICATION NAME] 10 mg QHS (bedtime) hold for systolic (blood pressure (BP)) i. 8/15/17, [MEDICATION NAME] 0.5 mg BID. j. 9/30/17, [MEDICATION NAME] 5 mg every six hours; at 2:00 AM, 8:00 AM, 2:00 PM and 8:00 PM, Hold if asleep. The MAR for (MONTH) (YEAR), (MONTH) (YEAR), (MONTH) (YEAR) and (MONTH) (YEAR) for resident 4 revealed the following: a. [MEDICATION NAME] 0.5 mg administered on 1/27/18 at 10:00 PM, 2/22/18 at 12:00 PM, 3/12/18 at 11:00 PM and 3/27/18 at 10:00 PM. Administration of the [MEDICATION NAME] 0.5 mg were administered two to four hours after they were due. b. [MEDICATION NAME] 0.5 mg was not administered on 2/28/18. c. [MEDICATION NAME] 5 mg administered on 3/24/18 at 10:00 PM, 4/7/18 at 12:00 AM, 4/10/18 at 9:30 AM and 4/23/18 at 4:45 AM. Three administrations of the [MEDICATION NAME] 5 mg were administered 1 1/2 hours to 2 hours and 45 minutes after they were due. The administration of the [MEDICATION NAME] 5 mg at 12:00 AM was administered 2 hours before it was due. d. [MEDICATION NAME] 20 mg was administered on 1/11/18 with a BP of 108/70, 1/18/18 with a BP 112/57, 1/19/18 with a BP 132/56, 2/24/18 with a BP 109/56, 3/22/18 with a BP 120/51, 3/25/18 with a BP 112/58 d. [MEDICATION NAME] 5 mg was not administered on 1/12/18 at 2:00 PM, 1/14/18 at 8:00 PM, 1/16/18 at 2:00 PM, 2/22/18 at 8:00 AM, 2/22/18 at 2:00 PM, 3/8/18 at 8:00 AM, 4/10/18 at 2:00 PM. According to the MAR for (MONTH) (YEAR), (MONTH) (YEAR), (MONTH) (YEAR) and (MONTH) (YEAR), resident 4 had multiple medications administered late including the following dates: a. [MEDICATION NAME] 325 mg TID, 1/5/18, 1/6/18, 1/7/18, 1/8/18, 1/10/18, 1/11/18, 1/12/18, 1/13/18, 1/14/18 x2, 1/16/18, 1/17/18, 1/20/18 x 2, 1/23/18, 1/26/18, 1/27/18 x 2, 1/28/18, 2/2/18 x 2, 2/3/18, 2/4/18, 2/5/18, 2/6/18 x 2, 2/7/18 x 2, 2/9/18, 2/12/18, 2/17/18, 2/19/18, 2/22/18, 2/25/18, 2/26/18, 2/28/18, 3/4/18, 3/5/18 x 2, 3/6/18, 3/8/18, 3/9/18, 3/11/18, 3/12/18 x 2, 3/14/18, 3/17/18, 3/18/18, 3/19/18, 3/24/18, 3/25/18, 3/26/18, 3/27/18, 4/1/18, 4/3/18, 4/4/18 x 2, 4/6/18, 4/9/18 x 2, 4/10/18, 4/11/18 x 3, 4/12/18, 4/13/18 x 2, 4/18/18, 4/20/18, 4/23/18 and 4/24/18. b. [MEDICATION NAME] 10 mg daily, 1/3/18, 1/5/18, 1/6/18, 1/7/18, 1/9/18, 1/10/18, 1/11/18, 1/12/18, 1/13/18, 1/14/18, 1/16/18, 1/26/18, 1/27/18, 1/30/18, 2/1/18, 2/2/18, 2/3/18, 2/4/18, 2/5/18, 2/6/18, 2/7/18, 2/11/18, 2/18/18, 2/25/18, 2/26/18, 3/4/18, 3/5/18, 3/6/18, 3/8/18, 3/12/18, 3/17/18, 3/18/18, 3/20/18, 3/28/18, 4/2/18, 4/3/18, 4/4/18, 4/6/18, 4/9/18, 4/10/18, 4/11/18, 4/13/18, 4/16/18, 4/18/18, 4/23/18 and 4/24/18. c. Aspirin 81 mg daily, 1/5/18, 1/6/18, 1/11/18, 1/12/18, 1/13/18, 1/16/18, 1/17/18, 1/20/18, 1/26/18, 1/27/18, 1/30/18, 2/2/18, 2/3/18, 2/4/18, 2/5/18, 2/6/18, 2/7/18, 2/25/18, 2/26/18, 3/4/18, 3/5/18, 3/8/18, 3/12/18, 3/17/18, 3/18/18, 4/3/18, 4/4/18, 4/6/18, 4/9/18, 4/10/18, 4/11/18, 4/13/18, 4/16/18, 4/18/18, 4/23/18 and 4/24/18. d. [MEDICATION NAME] 5 mg at bedtime, 1/7/18, 1/8/18, 1/14/18, 1/20/18, 1/27/18, 1/29/18, 3/5/18, 3/9/18, 3/11/18, 3/12/18, 3/19/18, 3/24/18, 3/27/18, 4/1/18, 4/6/18 and 4/11/18. e. [MEDICATION NAME] 100 mg twice daily, 1/5/18, 1/6/18, 1/7/18, 1/8/18, 1/11/18, 1/12/18, 1/13/18, 1/14/18, 1/16/18, 1/17/18, 1/20/18, 1/26/18, 1/27/18 x 2, 1/29/18, 1/30/18, 2/2/18, 2/3/18, 2/4/18, 2/5/18, 2/6/18, 2/7/18, 2/25/18, 2/26/18, 3/6/18, 3/14/18, 3/25/18, 3/26/18, 3/4/18, 3/5/18 x 2, 3/8/18, 3/9/18, 3/11/18, 3/12/18 x 2, 3/17/18, 3/18/18, 3/19/18, 3/24/18, 3/27/18, 4/1/18, 4/3/18, 4/4/18, 4/6/18 x 2, 4/9/18, 4/10/18, 4/11/18 x 2, 4/13/18, 4/16/18, 4/18/18, 4/20/18, 4/23/18 and 4/24/18. f. [MEDICATION NAME] 40 mg at bedtime, 1/7/18, 1/8/18, 1/14/18, 1/20/18, 1/27/18, 1/29/18, 3/5/18, 3/9/18, 3/11/18, 3/12/18, 3/19/18, 3/24/18, 3/27/18, 4/1/18, 4/6/18, 4/11/18 and 4/20/18. g. [MEDICATION NAME] 10 mg daily, 1/5/18, 1/6/18, 1/11/18, 1/12/18, 1/13/18, 1/16/18, 1/17/18, 1/20/18, 1/26/18, 1/27/18, 1/30/18, 2/2/18, 2/3/18, 2/4/18, 2/5/18, 2/6/18, 2/7/18, 2/25/18, 2/26/18, 3/4/18, 3/5/18, 3/8/18, 3/12/18, 3/17/18, 3/18/18, 4/3/18, 4/4/18, 4/6/18, 4/9/18, 4/10/18, 4/11/18, 4/13/18, 4/16/18, 4/18/18, 4/23/18 and 4/24/18. h. [MEDICATION NAME] 20 mg at bedtime, 1/7/18, 1/8/18, 1/14/18, 1/15/18, 1/27/18, 1/29/18, 3/5/18, 3/9/18, 3/11/18, 3/12/18, 3/19/18, 3/24/18, 4/1/18, 4/6/18 and 4/20/18. i. [MEDICATION NAME] 0.5 mg twice daily, 1/5/18, 1/6/18, 1/7/18, 1/8/18, 1/11/18, 1/12/18, 1/13/18, 1/14/18, 1/16/18, 1/17/18, 1/20/18, 1/26/18, 1/27/18 x 2, 1/29/18, 1/30/18, 2/2/18, 2/3/18, 2/4/18, 2/5/18, 2/6/18, 2/7/18, 2/25/18, 2/26/18, 3/4/18, 3/5/18 x 2, 3/9/18, 3/11/18, 3/12/18 x 2, 3/17/18, 3/18/18, 3/19/18, 3/24/18, 3/27/18, 4/1/18, 4/3/18, 4/4/18, 4/6/18 x 2, 4/9/18, 4/10/18, 4/11/18 x 2, 4/13/18, 4/16/18, 4/18/18, 4/20/18 and 4/23/18. j. [MEDICATION NAME] 5 mg every 6 hours, 1/5/18 x 2, 1/6/18, 1/7/18, 1/8/18, 1/9/18, 1/10/18, 1/11/18, 1/12/18, 1/13/18, 1/14/18, 1/15/18, 1/17/18, 1/20/18, 1/22/18, 1/23/18 x 2, 1/24/18, 1/25/18, 1/26/18, 1/27/18 x 2, 1/29/18 x 2, 1/30/18 x 2, 2/2/18, 2/3/18, 2/4/18, 2/5/18 x 2, 2/6/18 x 2, 2/7/18, 2/11/18, 2/14/18, 2/15/18, 2/18/18, 2/20/18, 2/23/18, 2/25/18 x 2, 2/26/18, 2/17/18 x 2, 3/3/18, 3/4/18 x 2, 3/5/18 x 3, 3/6/18, 3/8/18, 3/9/18, 3/10/18, 3/11/18, 3/12/18 x 3, 3/15/18, 3/17/18 x 2, 3/18/18 x 2, 3/19/18 x 2, 3/23/18 x 2, 3/24/18, 3/27/18, 3/30/18, 4/1/18 x 2, 4/2/18, 4/3/18, 4/4/18 x 2, 4/6/18 x 2, 4/9/18, 4/10/18, 4/11/18 x 2, 4/13/18 x 2, 4/14/18, 4/15/18, 4/16/18 x 2, 4/18/18, 4/20/18, 4/21/18, 4/22/18, 4/23/18 x 2 and 4/24/18. On 4/24/18 at 1:20 PM, an interview was conducted with the facility DON (Director of Nursing). The facility DON stated that at times the internet will go down and is the reason that the MAR's show that medications were administered on time but charted late. The facility DON stated that when the internet goes down, they have a backup computer that will print off a MAR for the night and that is how the nursing staff know what medications are due and will administer the medications on time. The facility DON stated that the paper MAR's were then shredded. The facility DON stated that they thought the medication administration had improved, obviously we need to do some training with the nursing staff. On 4/24/18 at 2:30 PM, an interview was conducted with RN 7. RN 7 stated that if the internet goes down, there was a computer on the West side of the facility that they could go to and print off a list of medications that were due. RN 7 stated that the list included all residents of the hall and included all medications as well as all treatments. RN 7 stated that they had to go through the report by hand to see which medications were due so that the medications could be administered. RN 7 stated that the internet did not go down too often. On 4/24/18 at 2:40 PM, an interview was conducted with RN 8. RN 8 stated that if the internet went down, she would then look at the desktop and write down every medication that was due. RN 8 stated that she could then pass the medications. RN 8 stated that the internet did not go down often. On 4/24/18 at 3:00 PM, an interview was conducted with the medical records director (MRD). The MRD stated that the server had to be replaced about a month ago. The MRD stated that she shredded the MAR's from administration if the internet was down because she had been taught to do so. The MRD stated that she could start saving them now if we wanted. On 4/26/18 at 10:10 AM, interview with the facility contracted pharmacist. The facility contracted pharmacist stated that he had noticed the many documentation's of the late charting but medications given on time and had talked with previous DON about this. The facility contracted pharmacist stated that he had not been made aware that it was a wifi/IT issue and that the facility nursing staff were not able to always follow med (medication) pass on the computers nor did he know that the facility nursing staff had to pull a hallway report with all medications and treatments and go through each page to see what medication was currently due and then double documenting on medications as charting had to be done later. On 4/30/18 at 3:25 PM, an interview was conducted with RN 9. RN 9 stated that it is a pain to look through the printed material to figure out what medications are due and when. RN 9 stated that if you hadn't looked at the amount of insulin after a blood sugar taken, you're screwed. RN 9 stated that medications were hard to get administered on time because of the hotspots in the building that were not available. RN 9 stated that they had to reset the system 3 times today. RN 9 further stated that she had not reported the issue to administrative staff, what's the point? They know it's happening. Cross Refer F-760 3. Resident 25 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 4/30/18 resident 25's medical record was reviewed. physician's orders [REDACTED]. a. 11/25/17, [MEDICATION NAME] 2000 units to be given QD. b. 12/5/17, [MEDICATION NAME] 0.5 mg BID. c. 2/23/18, [MEDICATION NAME] 0.5 mg BID. d. 12/29/18, [MEDICATION NAME] 15 mg at QHS. e. 11/25/18, [MEDICATION NAME] Inhaler QD. f. 2/23/18, [MEDICATION NAME] inhaler BID. According to the MAR for (MONTH) (YEAR) and (MONTH) (YEAR), resident 25 had multiple medications administered late including the following dates: a. [MEDICATION NAME] 0.5 mg on 3/1/18, 3/2/18, 3/3/18, 3/5/18, 3/6/18, 3/7/18, 3/8/18, 3/9/18, 3/12/18, 3/14/18, 3/16/18, 3/17/18, 3/18/18, 3/19/18, 3/22/18, 3/27/18, 3/29/18, 4/4/18, 4/12/18, 4/17/18, 4/20/18, 4/23/18 and 4/24/18. b. [MEDICATION NAME] 0.5 mg on 3/6/18, 3/19/18, 3/27/18, 4/4/18, 4/12/18, 4/17/18, 4/20/18, 4/23/18, and 4/24/18. c. [MEDICATION NAME] Inhaler on 3/6/18, 3/19/18, 3/27/18, 4/4/18, 4/12/18, 4/20/18, and 4/23/18. 4. Resident 45 was admitted on [DATE] with [DIAGNOSES REDACTED]. On 4/30/18, resident 45's medical record was reviewed. physician's orders [REDACTED]. a. Humalog sliding scale insulin before meals and at HS. b. [MEDICATION NAME] 50 units BID. c. [MEDICATION NAME] 20 mg QD. d. [MEDICATION NAME] 40 mg QD. e. [MEDICATION NAME] 50 mg BID. According to the MAR for (MONTH) (YEAR), (MONTH) (YEAR), (MONTH) (YEAR) and (MONTH) (YEAR), resident 45 had multiple medications administered late including the following dates: a. Humalog sliding scale insulin on 1/2/18, 1/3/18, 1/4/18, 1/8/18, 1/9/18, 1/10/18, 1/11/18, 1/12/18, 1/13/18, 1/14/18, 1/15/18, 1/16/18, 1/18/18, 1/19/18, 1/20/18, 1/21/18, 1/25/18, 1/26/18, 1/27/18, 1/28/18, 1/29/18, 2/2/18, 2/5/18, 2/6/18, 2/7/18, 2/9/18, 2/10/18, 2/12/18, 2/16/18, 2/17/18, 2/21/18, 2/22/18, 2/23/18, 2/25/18, 2/26/18, 2/27/18, 2/28/18, 3/5/18, 3/9/18, 3/10/18, 3/12/18, 3/17/18, 3/18/18, 3/19/18, 3/20/18, 3/21/18, 3/22/18, 3/23/18, 3/25/18, 3/26/18, 3/29/18, 3/30/18, 3/31/18, 4/1/18, 4/3/18, 4/6/18, 4/9/18, 4/10/18, 4/12/18, 4/19/18, and 4/20/18. b. [MEDICATION NAME] Insulin on 1/2/18, 1/4/18, 1/8/18, 1/9/18, 1/10/18, 1/11/18, 1/13/18, 1/14/18, 1/15/18, 1/16/18, 1/18/18, 1/19/18, 1/20/18, 1/21/18, 1/25/18, 1/26/18, 1/28/18, 1/29/18, 2/2/18, 2/5/18, 2/7/18, 2/9/18, 2/18/18, 2/21/18, 2/22/18, 2/23/18, 2/25/18, 2/28/18, 3/4/18, 3/5/18, 3/9/18, 3/12/18, 3/17/18, 3/18/18, 3/19/18, 3/21/18, 3/22/18, 3/23/18, 3/25/18, 3/26/18, 3/29/18, 3/30/18, 3/31/18, 4/1/18, 4/6/18, 4/9/18, 4/10/18, 4/12/1/18, and 4/20/18. c. [MEDICATION NAME] 20 mg on 1/3/18, 1/7/18, 1/8/18, 1/9/18, 1/10/18, 1/14/18, 1/16/18, 1/17/18, 1/20/18,2/7/18, 2/11/18, 2/21/18, 2/25/18, 2/26/18, 3/5/18, and 4/9/18. d. [MEDICATION NAME] 40 mg on 1/16/18, 1/17/18, 1/20/18, 2/7/18, 2/25/18, 2/26/18, 3/5/18, 4/9/18, and 4/13/18. e. [MEDICATION NAME] 50 mg on 1/7/18, 1/8/18, 1/9/18, 1/17/18, 1/15/18, 1/16/18, 1/17/18, 1/20/18, 1/21/18, 1/26/18, 1/29/18, 1/30/18, 2/1/18, 2/7/18, 2/25/18, 2/26/18, 3/5/18, 3/9/18, 3/12/18, 3/19/18, 3/22/18, 3/25/18, 3/26/18, 4/1/18, and 4/9/18. 5. Resident 59 resident was originally admitted on [DATE], and readmitted on [DATE] with [DIAGNOSES REDACTED]. substance dependence. On 4/30/18 resident 59's medical record was reviewed. physician's orders [REDACTED]. a. [MEDICATION NAME] 55 units QHS. b. [MEDICATION NAME] Insulin 15 units TID. c. [MEDICATION NAME] 2 grams/100 ml (milliliters) Q 8 hours. d. [MEDICATION NAME] 40 QD. e. [MEDICATION NAME] 20-25 mg QD. f. Carvedilol 6.25 mg BID. g. [MEDICATION NAME] 500 mg BID. h. [MEDICATION NAME] 20 mg QD. i. [MEDICATION NAME] 40 mg QD. According to the MAR for (MONTH) (YEAR), (MONTH) (YEAR) and (MONTH) (YEAR), resident 59 had multiple medications administered late including the following dates: a. [MEDICATION NAME] 55 units on 1/29/18, 1/30/18,1/3/18, 2/9/18,2/11/18, 2/14/18 and 4/17/18. b. [MEDICATION NAME] Insulin 15 units on 1/29/18, 2/1/18, 2/2/18, 2/5/18, 2/8/18, 2/9/18, 2/15/18, 2/16/18, 2/20/18, 2/22/18. c. [MEDICATION NAME] 2 gm/100 ml on 2/1/18 X 2, 2/2/18, 2/5/18, 2/8/18, 2/9/18 x 2, 2/10/18, 2/11/18, 2/12/18, 2/15/18, 2/16/18, 2/17/18, 2/18/18, 2/19/18 x 2, 2/21/18 x 2, 2/22/18 x 2, and 2/23/18. d. [MEDICATION NAME] 40 mg on 1/30/18, 1/31/18,2/1/18, 2/2/18, 2/5/18, 2/7/18, 2/8/18, 2/9/18, 2/10/18, 2/12/18, 2/13/18, 2/15/18, 2/16/18, 2/17/18, 2/19/18, 2/22/18, 2/23/18, 4/15/18, 4/20/18, and 4/24/18. e. [MEDICATION NAME] 20-25 mg on 2/1/18, 2/2/18, 2/4/18, 2/5/18, 2/7/18, 2/8/18, 2/9/18, 2/12/18, 2/13/18, 2/15/18, 2/16/18, 2/17/18, 2/19/18, 2/22/18, and 2/23/18. f. Carvedilol 6.25 mg on 4/13/18, 4/19/18, 4/20/18, and 4/24/18. g. [MEDICATION NAME] 500 mg on 4/15/18, 4/17/18, 4/20/18, and 4/24/18. h. [MEDICATION NAME] 20 mg on 4/13/18, 4/15/18, 4/20/18, and 4/24/18. i. [MEDICATION NAME] 40 mg on 4/13/18, 4/15/18, 4/20/18, and 4/24/18. On 4/24/18 at 2:00 PM, an interview was conducted with the facility Director of Nursing (DON) and the facility administrator. The facility DON stated that the problem with the late medications was that the internet keeps going down, then the facility nursing staff are still giving the medications on time but documenting late that they were administered. The facility Administrator confirmed this and stated that they had notified their corporate IT person in California. The facility Administrator and DON stated they would tell the staff to reset the system and wait for it to come on line again. The facility DON stated that they were unable to get help with the internet system and was frustrated as well with the problems that were occurring because of it. On 4/24/18 at 2:30 PM, an interview was conducted with Registered Nurse (RN) 7. RN 7 stated that if the internet goes down, there was a computer that they could go to and print off a list of medications and treatments and the times that they were due. RN 7 stated that the list was not for just one resident but that it was for the entire unit. RN 7 stated that they had to go through the entire report to see what medications and treatments were due and that it would delay the administration of the medications to the residents on the hall. RN 7 stated that it was rare that the internet would go down. On 4/24/18 at 2:40 PM, an interview was conducted with RN 8. RN 8 stated that if the internet goes down, then she would look at the desktop and write down the medications that were due and then administer the medications. RN 8 stated that the internet did not go down often. On 4/26/18 at 10:10 AM, an interview was conducted with the facility pharmacist. The facility pharmacist stated that he has had the internet go down about three times in the last year. The facility pharmacist stated that usually the facility would shut it down and restart the internet and he could continue on. The facility pharmacist stated that there was one time when he had to work from his home office to look at resident medical records because the internet was having problems.	2020-09-01