The Frequently-Cited Violations Report is a useful tool to help you focus on common areas that can be problematic, and to help you avoid violations and improve your compliance in your care home. 

The top violations for the first quarter of 2024 are related to medication administration, and the majority were repeat frequently-cited violations.

See our summary below of the report: ​

Resident Records

• Care Plans: Initial care plans must be completed within 14 days after admission. The initial care planning is critical because it is during this time the licensee or administrator is learning about the resident and how to best provide person-centered resident care. 

Medication Administration - General

• PRN parameters must be ordered and documented for all PRN (as needed) medications, including what the medication is for (what symptoms), specific dose, and specific frequency. Any instructions must be available to the caregivers to review before administration of the medication.
• Medication supplies must be available, including scheduled, PRN, and OTC medications. Refills must be obtained before current supplies run out. Attempts to order refills must be documented.
• Carry out all orders, including all medications (supplements, scheduled, PRN and OTC medications), treatments, and therapies, as prescribed. All orders must be signed and kept in the resident’s record. As a reminder, the resident, or their legal guardian, has the right to decline to receive medications, treatments or therapies. In these cases, this needs to be documented and the doctor should be notified.
• Changes to a written orders: Changes to orders may not be made without a signed order from a prescribing practitioner and must be correctly documented on the MAR. Phone orders must be followed up with a written order within seven (7) calendar days. Changes require a new, properly labeled medication container or a separate label attached to the original container. 
• Medications must be disposed of properly, this includes outdated, discontinued, recalled or contaminated medications. They must be disposed of within 10 calendar days and the disposal documented. Medications for residents who have died must be disposed of within 24 hours. Transdermal patches must be disposed of property, as they pose a serious health risk if not disposed of properly.  Patches are to be folded in half sticky side together to prevent accidental exposure.
• Psychotropic Medications - Care Plan: If a resident has been prescribed psychotropic medications, the resident's care plan must identify and describe the behavioral symptoms for which the psychotropic medications are prescribed. Additionally, the care plan must list all interventions used for the behaviors, including all non medication-based interventions.

Medication Administration Record (MAR)

• MAR: a current MAR/e-MAR must be kept for each resident and list the names of all medications prescribed for each resident, including OTC meds and prescribed dietary supplements. The MAR must identify dosage, route, date, and time of each medication and supplement to be administered.
• Initial the MAR immediately after administering a medication. This practice significantly lowers the risk of double dosing since there is clear documentation of the medication having been given. A MAR must contain a legible signature that identifies each set of initials.
• PRN medications on the MAR: All prescribed, as needed (PRN) medications must be documented on the resident’s MAR when administered noting the time given, dose, reason the medication was given and the outcome.