Review of R1’s Physician’s Report dated March 10, 2026 revealed that R1 is ambulatory, able to communicate their needs, able to follow directions, and can feed themself. R1’s primary diagnosis is prostate cancer. The report also notes that R1 is able to self-administer both prescription and PRN (as needed) medications, though the facility began managing their medications following hospice recommendations. Review of R1’s Care Plan dated January 31, 2026 indicated that R1 elected hospice services due to a change in condition. The plan outlines that facility staff are responsible for coordinating care with hospice and notifying hospice staff of any changes. The plan notes that R1 sometimes needs assistance with activities of daily living (ADLs) when feeling weak. A hospice nurse visits the facility 2–3 times per week. The care plan emphasizes promoting R1’s independence while maintaining dignity and safety and encouraging R1 to participate in their own self-care with minimal cues when appropriate.

Review of the RCD progress notes showed a consistent history of behavioral and communication challenges with R1. Notes from January 2, 2026 document that R1 began insulin and was verbally rude to staff and exhibited repetitive calling behavior. On January 14, R1 expressed confusion and repeatedly called for the RCD, expecting nursing-level care which the RCD explained she could not provide. On February 1, staff reported that R1 continued displaying rude behavior and refused staff assistance with room organization or medication oversight. The RCD involved hospice and R1’s outside medical team to discuss care planning.

During LPA’s interview, R1 stated they were diagnosed with prostate cancer in May of the previous year and were told they had one year to live. R1 stated they work two days a week as security for an auction house and have told staff not to give morphine before work. R1 stated officers informed them that due to their morphine prescription, their work license had been suspended. R1 stated facility staff “give them medications regularly,” but they still experience constant left leg pain.

Executive Director stated R1 was previously self administering their medications. In March, the facility assumed responsibility for R1’s medication management due to observed concerns that suggested R1 may no longer be able to safely self administer. This change was made with physician authorization, in coordination with hospice services, and with R1’s consent. All medications are administered by staff in accordance with physician orders. R1 has expressed concerns about medication frequency; however, staff have reminded them that medications must be administered only as prescribed. Any requests for changes are communicated to hospice and the prescribing physician for review and possible adjustment.

Based on the evidence reviewed, including interviews, record review, and care documentation, there is insufficient evidence to support that the facility failed to administer medications as prescribed or failed to meet R1’s care needs. Records show medications were administered in accordance with physician orders, refusals were documented appropriately, and delays in lidocaine patch application were due to pharmacy delivery and resident refusal, not staff neglect.