**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure that the Provider was contacted regarding a significant change in condition relative to a medication and/or the need to alter treatment for one Resident (#13) out of a total sample of 16 residents. Specifically, for Resident #13, the facility failed to notify the Provider (Physician/Nurse Practitioner [NP]/ Physician Assistant [PA]) when the Resident's scheduled Oxycodone (short-acting opioid medication used to treat moderate to severe pain) was unavailable to be administered, resulting in increased pain and psychosocial upset for the Resident. Findings include: Review of the facility policy titled Medication Orders dated 2006 and revised in January 2018, indicated but was not limited to the following: -Controlled Substance Prescriptions: >The prescriber is contacted for direction when delivery of a medication will be delayed, or the medication is not, or will not be available. Resident #13 was admitted to the facility in July 2024, with diagnoses including dorsalgia (back pain), fibromyalgia (chronic disorder characterized by widespread musculoskeletal pain), low back pain, other chronic pain, and polyneuropathy (disease affecting peripheral nerves resulting in various symptoms including pain). Review of the Minimum Data Set (MDS) assessment dated [DATE], indicated Resident #13: -scored a 15 out of a possible 15 on the Brief Interview for Mental Status (BIMS) exam, indicating the Resident was cognitively intact. -was prescribed a scheduled pain medication regimen. -had presence of pain almost constantly, which frequently affected his/her sleep. -pain interfered with day-to-day activities frequently. -pain intensity was a seven out of 10. During an interview on 5/23/25 at 10:00 A.M., Resident #13 said he/she had issues getting his/her scheduled Oxycodone. Resident #13 said it had been an issue several times that the Oxycodone pain medication was not always available. Resident #13 said that he/she had gone anywhere from 12 to 18 hours without the pain medication at times. At this time, the Resident began to cry and said when he/she went without the scheduled Oxycodone medication, he/she experienced an increase in pain. Resident #13 said no alternate options to manage his/her pain were discussed or offered to him/her at the times when the Oxycodone medication was not available to be administered. Resident #13 said that he/she did not know whether the Nurses had called the Provider or whether the Provider had recommended alternative medication or treatment for pain management at the times when the scheduled Oxycodone was not available to be administered. During an interview on 5/27/25 at 11:55 A.M., Resident #13's Advocate said the concern related to the unavailability of Oxycodone started on 7/31/24. Resident #13's Advocate provided nine dates that he/she documented between 7/31/24 and 4/13/25 on which the Oxycodone was not available to the Resident. Review of Resident #13's Physician orders between 7/29/24 and 12/31/24 indicated the following: -Oxycodone HCl oral tablet 10 milligrams (mg). Give 1 tablet by mouth every 4 hours for pain. Start date 7/29/24, end date 10/18/24. -Oxycodone HCl oral tablet 5 mg. Give 1 tablet by mouth every 12 hours as needed (PRN) for pain. Start date 7/29/24, end date 8/10/24. -Oxycodone HCl oral tablet 5 mg. Give 10 mg by mouth every 4 hours for pain. Give 2 tablets to equal 10 mg dose. Start date 10/19/24, end date 12/3/24. -Oxycodone HCl oral tablet 5 mg. Give 5 mg by mouth every 4 hours as needed (PRN) for moderate pain AND give 10 mg by mouth every 4 hours for pain. Give 2 tablets to equal 10 mg dose. Start date 12/3/24, end date 12/24/24. -Oxycodone HCl oral tablet 10 mg. Give 10 mg by mouth every 4 hours for pain. Start date 12/24/24. -Acetaminophen (analgesic [pain-relieving] medication) tablet 325 mg. Give 2 tablets by mouth every 4 hours as needed for pain do not exceed 3 grams of Acetaminophen in 24 hours. Start date 7/29/24. -Monitor for pain every shift using standard pain scale 0-10 (tool used to assess pain intensity, where zero indicates no pain, and 10 indicates the worst pain imaginable) every shift for Pain Monitoring. Start date 7/29/24, end date 9/7/24. Review of Resident #13's Medication Administration Record (MAR) dated July 2024, and the correlating Controlled Substance Log indicated the following: -Oxycodone HCl oral tablet 10 mg. Give 1 tablet by mouth every 4 hours for pain (scheduled for 12:00 A.M., 4:00 A.M., 8:00 A.M., 12:00 P.M., 4:00 P.M., and 8:00 P.M.) was not administered at 12:00 A.M., 4:00 A.M., and 8:00 A.M. on 7/31/24 due to the medication not being available. >Resident #13's pain scale was documented as follows on 7/31/24: -At 12:00 A.M. (Resident reported pain level: zero out of 10) -At 4:00 A.M. (Resident reported a pain level of 10 out of 10) -At 8:00 A.M. (Resident reported a pain level of 10 out of 10) -Review of the medical record failed to indicate that the Provider was notified that the Oxycodone medication was unavailable or that any alternative medication or that non-pharmacological intervention was offered to the Resident. -The first dose of Oxycodone medication was administered to the Resident on 7/31/24 at 10:00 A.M. (14 hours after the last administered dose). Review of Resident #13's MAR dated November 2024 and the correlating Controlled Substance Log indicated the following: -Oxycodone HCl oral tablet 5 mg. Give 10 mg by mouth every 4 hours for pain (scheduled for 12:00 A.M., 4:00 A.M., 8:00 A.M., 12:00 P.M., 4:00 P.M., and 8:00 P.M.). Give 2 tablets to equal 10 mg dose was not administered at 8:00 P.M. on 11/13/24, and 12:00 A.M. and 4:00 A.M. on 11/14/24, due to the medication not being available. >Resident #13's pain scale was documented as follows on 11/13/24 and 11/14/24: -At 8:00 P.M. on 11/13/24 (Resident reported a pain level of zero out of 10) -At 12:00 A.M. on 11/14/24 (Resident reported a pain level of zero out of 10) -At 4:00 A.M. on 11/14/24 (Resident reported a pain level of zero out of 10) -At 8:00 A.M. on 11/14/24 (Resident reported a pain level of 10 out of 10) -Review of the medical record failed to indicate that the Provider was notified that the scheduled Oxycodone medication was unavailable, or that non-pharmacological intervention was offered to the Resident. -The first dose of Oxycodone medication was administered to the Resident on 11/14/24 at 9:15 A.M. (17 hours after the last administered dose). Review of Resident #13's MAR dated December 2024 and the correlating Controlled Substance Logs indicated the following: -Oxycodone HCl oral tablet 5 mg. Give 10 mg by mouth every 4 hours for pain (scheduled for 12:00 A.M., 4:00 A.M., 8:00 A.M., 12:00 P.M., 4:00 P.M., and 8:00 P.M.). Give 2 tablets to equal 10 mg dose was not administered at 8:00 A.M. on 12/24/24 due to the medication not being available. >Resident #13's pain scale was documented as follows on 12/24/24: -At 8:00 A.M. (Resident reported a pain level of eight out of 10) -Oxycodone HCl oral tablet 10 mg. Give 1 tablet by mouth every 4 hours for pain (scheduled for 12:00 A.M., 4:00 A.M., 8:00 A.M., 12:00 P.M., 4:00 P.M., and 8:00 P.M.). was not administered at 12:00 P.M. on 12/24/24 due to the medication not being available. >Resident #13's pain scale was documented as follows on 12/24/24: -At 12:00 P.M. (Resident reported a pain level of nine out of 10) -Review of the medical record failed to indicate that the Provider was notified that the scheduled Oxycodone medication was unavailable, or that non-pharmacological intervention was offered to the Resident. -The first dose of Oxycodone medication was administered to the Resident on 12/24/24 at 4:00 P.M. since the first missed dose at 8:00 A.M. (10 hours after the last administered dose). During an interview on 5/27/25 at 11:51 A.M., Nurse Practitioner (NP) #1 said when a medication was not available to administer as ordered the Nurse should notify the Provider. NP #1 said the Provider can then give an order to hold if appropriate or can provide an order to administer an alternative medication from the emergency supply. NP #1 said she was not aware of a chronic issue regarding the unavailability of Resident #13's prescribed Oxycodone. During an interview on 5/28/25 at 10:35 A.M., the DON said if a scheduled pain medication was not available for administration, the resident should be assessed for pain and asked whether they wanted to wait for the ordered medication to be delivered from the pharmacy or whether they wanted the Nurse to contact the Provider to request an alternative medication. During an interview on 5/28/25 at 11:06 A.M., by the Physician said he did not know if he was notified of Resident #13's scheduled Oxycodone being unavailable. The Physician said that the facility should be notifying the Provider when a medication was not available for administration, and the Nurse should inform the Provider of similar medication that is available on-hand that may be administered alternatively. The Physician said if multiple doses in a row of a scheduled short-acting pain medication were not administered to a resident, he would expect the resident to have increased pain. During an interview on 5/28/25 at 1:10 P.M., Resident #13 said that most of the time, his/her pain level was between a seven and nine out of 10. Resident #13 said when he/she swells it really hurt, and sometimes he/she curled up in a little ball. Resident #13 said he/she was hurting all the time, and that his/her body was in pain from his/her head to his/her feet, that was why he/she needed pain medication every four hours. Resident #13 said it took at least one hour for any pain medication administered to bring down his/her pain level. Please Refer to F697.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure that pain management was provided in accordance with the individual goals for care and preferences for one Resident (#13) out of a total sample of 16 residents. Specifically, for Resident #13, the facility failed to administer scheduled Oxycodone (short-acting opioid medication used to treat moderate to severe pain) medication as ordered by the Physician, and failed to provide any other pain relieving measures, resulting in an increase in physical pain and psychological upset for the Resident. Findings include: Review of the facility policy titled Administering Medications version 2.1, dated 2001 and revised April 2019, indicated but was not limited to the following: -Policy Statement: >Medications are administered in a safe and timely manner, and as prescribed. >Medications are administered in accordance with prescriber orders, including any required time frame. >Medications are administered within one (1) hour of their prescribed time, unless otherwise specified . Review of the facility policy titled Pain-Clinical Protocol version 2.2, dated 2001 and revised October 2022, indicated but was not limited to the following: -Assessment and Recognition: <The physician and staff will identify individuals who have pain or who are at risk for having pain. <The nursing staff will assess each individual for pain .whenever there is a significant change in condition, and when there is onset of new pain or worsening of existing pain. -Treatment/Management: <With input from the resident to the extent possible, the physician and staff will establish goals of pain treatment . -The physician will order .medication interventions to address the individual's pain. Review of the facility policy titled Medication Orders, dated 2006 and revised January 2018, indicated but was not limited to the following: -Controlled Substance Prescriptions: >The prescriber is contacted for direction when delivery of a medication will be delayed, or the medication is not, or will not be available. Resident #13 was admitted to the facility in July 2024, with diagnoses including dorsalgia (back pain), fibromyalgia (chronic disorder characterized by widespread musculoskeletal pain), low back pain, other chronic pain, and polyneuropathy (disease affecting peripheral nerves resulting in various symptoms including pain). Review of the Minimum Data Set (MDS) assessment dated [DATE], indicated Resident #13: -was cognitively intact as evidenced by a Brief Interview for Mental Status (BIMS) Assessment score of 15 out of a possible score of 15. -was prescribed a scheduled pain medication regimen. -had presence of pain almost constantly, which frequently affected his/her sleep. -pain interfered with day-to-day activities frequently. -pain intensity was a seven out of 10. During an interview on 5/23/25 at 10:00 A.M., Resident #13 said he/she had issues getting his/her scheduled Oxycodone medication. Resident #13 said it had been an issue that the pain medication was not always available several times. Resident #13 said that he/she had gone anywhere from 12 to 18 hours without the pain medication at times. At this time, the Resident began to cry and said that when he/she went without the scheduled Oxycodone medication, he/she experienced an increase in pain. Resident #13 said no alternate options to manage his/her pain were discussed or offered to him/her at the times when the Oxycodone medication was not available to be administered. Resident #13 also said he/she wanted to receive the Oxycodone medication as prescribed and did not want to experience any more missed doses. During an interview on 5/27/25 at 11:55 A.M., Resident #13's Advocate said the concern related to the unavailability of Oxycodone medication started on 7/31/24. The Resident's Advocate provided nine dates that he/she documented between 7/31/24 and 4/13/25 on which the Oxycodone medication was not available to the Resident. The Resident's Advocate said he/she had attended care plan meetings and had discussed the concern regarding the unavailability of Oxycodone medication with nursing staff. The Resident's Advocate said the most recent care plan meeting during which the concern was discussed was on 2/11/25. The Resident's Advocate said the facility did not state what actions were going to be taken to address the concern regarding the availability of the Resident's Oxycodone medication. Review of Resident #13's current active Care Plans failed to indicate any care plans relative to pain management. Review of Resident #13's Physician Orders between 7/29/24 and 12/31/24 indicated the following: -Oxycodone HCl oral tablet 10 milligrams (mg). Give 1 tablet by mouth every 4 hours for pain. Start date 7/29/24, End date 10/18/24. -Oxycodone HCl oral tablet 5 mg. Give 1 tablet by mouth every 12 hours as needed (PRN) for pain. Start date 7/29/24, End date 8/10/24. -Oxycodone HCl oral tablet 5 mg. Give 10 mg by mouth every 4 hours for pain. Give 2 tablets to equal 10 mg dose. Start date 10/19/24, End date 12/3/24. -Oxycodone HCl oral tablet 5 mg. Give 5 mg by mouth every 4 hours as needed (PRN) for moderate pain AND give 10 mg by mouth every 4 hours for pain. Give 2 tablets to equal 10 mg dose. Start date 12/3/24, End date 12/24/24. -Oxycodone HCl oral tablet 10 mg. Give 10 mg by mouth every 4 hours for pain. Start date 12/24/24. -Acetaminophen tablet 325 mg. Give 2 tablets by mouth every 4 hours as needed (PRN) for pain. Do not exceed 3 grams of Acetaminophen in 24 hours. Start date 7/29/24. -Monitor for pain every shift using standard pain scale 0-10 (commonly used tool to assess pain intensity, where zero indicates no pain, and 10 indicates the worst pain imaginable) every shift for pain monitoring. Start date 7/29/24, End date 9/7/24. -Monitor for pain every shift using standard pain scale 0-10 every shift for pain monitoring. Start date 7/29/24. Review of Resident #13's Medication Administration Record (MAR) dated July 2024 and the correlating Controlled Substance Log indicated the following: -Oxycodone HCl oral tablet 10 mg. Give 1 tablet by mouth every 4 hours for pain (scheduled for 12:00 A.M., 4:00 A.M., 8:00 A.M., 12:00 P.M., 4:00 P.M., and 8:00 P.M.) was not administered at 12:00 A.M., 4:00 A.M., and 8:00 A.M. on 7/31/24 due to the medication not being available. >Resident #13's pain scale was documented as follows on 7/31/24: -At 12:00 A.M. (Resident reported pain level: zero out of 10) -at 4:00 A.M. (Resident reported a pain level of 10 out of 10) -at 8:00 A.M. (Resident reported a pain level of 10 out of 10) -Review of the medical record failed to indicate that the Provider was notified that the Oxycodone medication was unavailable to administer to Resident #13, or that any non-pharmacological intervention was offered. -The first dose of Oxycodone medication was administered to the Resident on 7/31/24 at 10:00 A.M. (14 hours since the last administered dose). Review of Resident #13's MAR dated September 2024, correlating Controlled Substance Logs, On-call Provider Log, and Nursing Notes indicated the following: -Oxycodone HCl oral tablet 10 mg. Give 1 tablet by mouth every 4 hours for pain (scheduled for 12:00 A.M., 4:00 A.M., 8:00 A.M., 12:00 P.M., 4:00 P.M., and 8:00 P.M.) was not administered at 8:00 P.M. on 9/20/24, and 12:00 A.M., and 4:00 A.M. on 9/21/24 due to the medication not being available. >Resident #13's pain scale was documented as follows on 9/20/24 and 9/21/24: -At 8:00 P.M. on 9/20/24 (Resident reported a pain level of eight out of 10) -At 12:00 A.M. on 9/21/24 (Resident reported a pain level of 10 out of 10) -At 4:00 A.M. on 9/21/24 (Resident reported a pain level of 10 out of 10) -The facility staff contacted the on-call Provider on 9/20/24 at 10:38 P.M., regarding the need to obtain a new prescription of Oxycodone. The medical record documentation failed to indicate that a discussion occurred with the Provider regarding the Resident's pain assessment or the unavailability of the Resident's scheduled Oxycodone medication at the time the Provider was contacted. -A Nursing Note written on 9/21/24 at 3:30 A.M., indicated that the on-call Provider was to contact the pharmacy to provide an order to obtain the Oxycodone medication from the pyxis (machine that is utilized to dispense an emergency supply of medication). The Nursing documentation failed to indicate that the facility accessed the pyxis at that time and administered the scheduled Oxycodone medication to the Resident. -The first dose of Oxycodone medication was administered to the Resident on 9/21/24 at 9:40 A.M. (17 hours since the last administered dose). Review of Resident #13's MAR dated October 2024, correlating Controlled Substance Logs, and Nursing Notes indicated the following: -The Resident's supply of Oxycodone was exhausted at 8:15 P.M. on 10/17/24. -Oxycodone HCl oral tablet 10 mg. Give 1 tablet by mouth every 4 hours for pain (scheduled for 12:00 A.M., 4:00 A.M., 8:00 A.M., 12:00 P.M., 4:00 P.M., and 8:00 P.M.) was not administered at 12:00 A.M., 4:00 A.M., and 8:00 A.M. on 10/18/24 due to the medication not being available. >Resident #13's pain scale was documented as follows on 10/18/24: -At 12:00 A.M. (Resident reported a pain level of two out of 10) -At 4:00 A.M. (Resident reported a pain level of five out of 10) -At 8:00 A.M. (Resident reported a pain level of 10 out of 10) -A Nursing Note written on 10/18/24 at 4:44 A.M., indicated the on-call Provider was contacted at that time for a new Oxycodone prescription and pyxis access. (Five hours since the Resident's missed dose of scheduled Oxycodone) -The first dose of Oxycodone medication was administered to the Resident on 10/18/24, and documented for the 8:00 A.M. dose (12 hours since the last administered dose). Review of Resident #13's MAR dated November 2024, and the correlating Controlled Substance Log indicated the following: -Oxycodone HCl oral tablet 5 mg. Give 10 mg by mouth every 4 hours for pain (scheduled for 12:00 A.M., 4:00 A.M., 8:00 A.M., 12:00 P.M., 4:00 P.M., and 8:00 P.M.). Give 2 tablets to equal 10 mg dose was not administered at 8:00 P.M. on 11/13/24, and 12:00 A.M., 4:00 A.M., and 8:00 A.M. on 11/14/24 due to the medication not being available. >Resident #13's pain scale was documented as follows on 11/13/24 and 11/14/24: -At 8:00 P.M. on 11/13/24 (Resident reported a pain level of zero out of 10) -At 12:00 A.M. on 11/14/24 (Resident reported a pain level of zero out of 10) -At 4:00 A.M. on 11/14/24 (Resident reported a pain level of zero out of 10) -At 8:00 A.M. on 11/14/24 (Resident reported a pain level of 10 out of 10) -Review of the medical record failed to indicate that the Provider was notified that the scheduled Oxycodone medication was unavailable, or that any non-pharmacological intervention was offered to the Resident. -Acetaminophen 650 mg was administered as needed (PRN) on 11/14/24 at 8:08 A.M. -The first dose of Oxycodone medication was administered to the Resident on 11/14/24 at 9:15 A.M. (17 hours since the last administered dose.) -The Resident reported a pain level of three out of 10 on 11/14/24 at 12:58 P.M. Review of Resident #13's MAR dated December 2024, and the correlating Controlled Substance Logs indicated the following: -Oxycodone HCl oral tablet 5 mg. Give 10 mg by mouth every 4 hours for pain (scheduled for 12:00 A.M., 4:00 A.M., 8:00 A.M., 12:00 P.M., 4:00 P.M., and 8:00 P.M.). Give 2 tablets to equal 10 mg dose was not administered at 8:00 A.M. on 12/24/24 due to the medication not being available. -Oxycodone HCl oral tablet 10 mg. Give 1 tablet by mouth every 4 hours for pain (scheduled for 12:00 A.M., 4:00 A.M., 8:00 A.M., 12:00 P.M., 4:00 P.M., and 8:00 P.M.). was not administered at 12:00 P.M. on 12/24/24 due to the medication not being available. >Resident #13's pain scale was documented as follows on 12/24/24: -At 8:00 A.M. on 12/24/24 (Resident reported a pain level of eight out of 10) -At 12:00 P.M. on 12/24/24 (Resident reported a pain level of nine out of 10) -The Resident was offered Acetaminophen as needed (PRN) on 12/24/24 at 10:42 A.M., and declined. -Review of the medical record failed to indicate that the Provider was notified that the scheduled Oxycodone medication was unavailable, or that any non-pharmacological intervention was offered to the Resident. -The first dose of Oxycodone medication was administered to the Resident on 12/24/24 at 4:00 P.M. since the first missed dose at 8:00 A.M. (10 hours since the last administered dose.) During an interview on 5/27/25 at 11:51 A.M., Nurse Practitioner (NP) #1 said when a medication was not available to administer as ordered the Nurse should notify the Provider. NP #1 said the Provider can then give an order to hold if appropriate or can provide an order to administer an alternative medication from the emergency supply. NP #1 said she was not aware of a chronic issue regarding the unavailability of Resident #13's prescribed Oxycodone medication. NP #1 said nursing staff informed NP #1 when the Resident was admitted to the facility that the Resident's pain management interventions were not effective. NP #1 said she discussed with the Resident the option to be prescribed long-acting Oxycodone, but the Resident declined the long-acting Oxycodone order and stated that his/her stomach could not tolerate this medication. NP #1 said the Resident is very particular about what medications he/she wanted and at what time he/she wanted to take the prescribed medications. During an interview on 5/27/25 at 4:30 P.M., the Director of Nursing (DON) said she was not aware of any times that Resident #13 did not have Oxycodone medication available for administration. The DON further said she also found that residents' medications were not always re-ordered timely. During an interview on 5/28/25 at 9:10 A.M., the DON said the expectation is that medications are re-ordered by licensed nursing staff when the medication reached the red line (indicates medication level is running low and should be re-ordered) on the blister pack to allow the pharmacy time to refill the medication so that residents' medications were available to administer as ordered. During an interview on 5/28/25 at 10:35 A.M., the DON said if a scheduled pain medication was not available for administration, the resident should be assessed for pain and asked whether they wanted to wait for the ordered medication to be delivered from the pharmacy or whether they wanted the Nurse to contact the Provider to request an alternative medication. During an interview on 5/28/25 at 11:06 A.M., the Physician said that the facility should be notifying the Provider when a medication was not available for administration. The Physician also said if multiple doses in a row of a scheduled short-acting pain medication were not administered to a resident, he would expect the resident to have increased pain. During an interview on 5/28/25 at 1:10 P.M., Resident #13 said that most of the time, his/her pain level was between a seven and nine out of 10. Resident #13 said when he/she swells it really hurt, and sometimes he/she curled up in a little ball. Resident #13 said he/she was hurting all the time, and that his/her body was in pain from his/her head to his/her feet, that was why he/she needed medication every four hours. Resident #13 said it depended on which Nurse cared for him/her as to whether he/she would be offered as needed pain medications. Resident #13 said it took at least one hour for any pain medication being administered to bring down his/her pain level. Please Refer to F842.

Based on observation, interview and record review, the facility failed to ensure its staff provide behavioral health care and services for one Resident (#26), out of 17 sampled residents. Specifically, the facility staff failed to follow up on behavioral health recommendations for the Resident who was experiencing symptoms of depression. Findings include: Resident #26 was admitted to the facility in September 2021 with diagnoses including Major Depressive disorder (MDD), Anxiety disorder, and Adjustment disorder. Review of the Minimum Data Set (MDS) Assessment, dated 8/25/22, indicated a Behavioral Interview for Mental Status (BIMS) score of 13 out of 15, indicating he/she was cognitively intact. Review of a Nurses Progress Note, dated 9/29/22, indicated the following in part: -the Resident did not eat dinner or the snacks that were offered -he/she was crying incessantly and was unable to be redirected -PRN (as needed) Ativan (antianxiety medication) was given with very little affect -PRN Ultram (medication for pain) -the Resident continued to cry Review of the Psychiatric Evaluation and Consultation Note, with a service date of 9/29/22, indicated that the chief complaint for the Resident encounter was for agitation, not sleeping and crying. Further recommendations were made, in part; for depression and anxiety, and it was recommended to start Sertraline (antidepressant) 25 milligrams by mouth once a day. Review of the October 2022 Medication Administration Record (MARs) indicated no evidence that the Resident was taking or had been prescribed Sertraline, as recommended by the behavioral health team. Review of the Physician Progress Note, dated 10/10/22, indicated no evidence that the Physician was aware of the recent recommendation(s) made by the behavioral health team. Review of a Nurses Progress Note, dated 10/16/22, indicated the Resident was very anxious and crying and that he/she wanted to go home. During an observation and interview on 10/26/22 at 8:43 A.M., Resident #26 was observed to be fully clothed and was laying in bed, covered by blankets. Two untouched drinks and a banana were on the bed side table. The Resident greeted the surveyor however was very sleepy. When asked if he/she had breakfast, the Resident said that he/she was not hungry. The Resident then closed his/her eyes to indicate he/she was done talking. On 10/31/22 at 11:03 A.M. the surveyor observed Resident #26 to be sleeping in bed. The Resident did not wake when surveyor said hello. During an interview on 10/31/22 at 1:54 P.M., Certified Nursing Assistant (CNA) #6 said the Resident had been declining recently and that he/she used to come out more during the day. During an observation and interview on 10/31/22 at 2:55 P.M., the surveyor observed the Resident lying in bed, covered by blankets. The room was dark and there was no television (TV) or music on. The Resident said that he/she didn't feel normal today and that maybe tomorrow would be better. He/she further said some days are just like that and that the next day, hopefully will be a little better. The Resident continued to say that he/she was sleepy and did not have an appetite. When asked if he/she would be participating in the Halloween festivities that the facility was having today, he/she said that he/she was not interested in celebrating. The surveyor noted a mood change in the Resident when he/she began talking about horses and traveling. When asked if he/she enjoyed watching TV or listening to music he/she said that he/she did not care much for TV but liked classical music. The surveyor did not observe a TV or radio to be available in the room for the Resident. During an interview on 11/01/22 at 10:10 A.M., the Director of Nursing (DON) said that the behavioral health clinician would provide both himself and/or the Administrator a copy of the encounter notes from a resident visit, as well as put one in the Physician's binder. Next, the Physician would let the facility know in person, whether to make the recommended changes made by the behavioral health team. The DON additionally said that the facility staff would receive a list the day the behavioral health team was in the facility, with any recommendations that were made so that they would able to act on them accordingly. At that time, the surveyor requested evidence that the facility received and/or acknowledged the recommendations that were made for Resident #26 by the behavioral health team on 9/29/22. During an interview on 11/02/22 at 10:47 A.M., the Clinical Reimbursement Nurse said that there was no documented evidence that the facility staff or Physician followed up on the behavioral health recommendations for Resident #26. During an interview on 11/02/22 at 2:35 P.M., the DON said that the recommendations for Resident #26 made by the behavioral health team should have been followed up on and were not.