Advantage Adult Healthcare LLC

Based on observation and interview, the manager failed to ensure that medications stored by the facility were stored in a locked area. The deficient practice posed a risk to residents who were not prescribed the accessible medication. Findings Included: 1. During an environmental tour with E1, the Compliance Officers observed an open bedroom door. Upon walking in, the closet was found open with a box on the floor and items on top of the box. A medication bottle of 100 mg “Nitrofurantoin” was on top of the box. 2. In an interview, E1 reported that the room was an empty resident room that caregivers use while they are working. 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review and interview, the manager failed to ensure a caregiver or an assistant caregiver documented the services provided to a resident in the resident's medical record, for three of three residents sampled. The deficient practice posed a health and safety risk as services could not be verified as provided against a service plan. Findings include: 1. A review of R1's, R2's and R3's medical records revealed service plans that stated "Fluids encourage 6-8 glasses per day." However, a review of R1's, R2's and R3's activities of daily living (ADL) sheets revealed "Fluids encourage:" was not documented as provided daily to R1, R2, and R3 from September 1, 2024 to September 8, 2024. 2. In an interview, E2 acknowledged "Fluids encourage 6-8 glasses per day" was not documented as provided for R1, R2, and R3.

Based on interview and record review, the manager failed to ensure a medication administered to a resident was documented in the resident's medical record, for one of three residents sampled who received medication administration services. The deficient practice posed a risk if a resident experienced a change in condition due to improper administration of medication. Findings include: 1. In an interview, E2 reported all residents received medication administration. 2. A review of R1's medical record revealed a signed medication order for Atorvastatin 40 milligrams (mg) tablet taken once at bedtime daily, prescribed on August 31, 2024. However, a review of R1's medication administration record (MAR) sheet for September revealed Atorvastatin was not listed as a medication administered from September 1, 2024 to September 8, 2024. 3. In an interview, E2 reported R1 had been receiving the medication, and had forgotten to list the medication on the MAR for R1. 4. In an interview, E2 acknowledged Atorvastatin was not documented as administered in R1's medical record.

Based on record review and interview, the manager failed to ensure a resident medical record contained a medication order from a medical practitioner for each medication that was administered, for one of three residents reviewed. The deficient practice posed a health and safety risk. Findings include: 1. Review of R3's medical record revealed a current written service plan dated January 10, 2024. This service plan indicated R3 received medication administration. 2. Review of R3's medical record revealed a document titled "Report Of Unusual Occurrence" dated December 29, 2023. This document stated "...Patient was being repositioned in the wheelchair and (R3) sustained bruises under the armpit on the left side...Ensured patient had no pain. Pain medication (Tylenol) was given." 3. Review of R3's medical record revealed no documentation of a signed medication order or verbal medication order for Tylenol. 4. Review of R3's medical record revealed a December 2023 medication administration record (MAR). This MAR did not include documentation Tylenol was administered on December 29, 2023. 5. In an interview, E1 acknowledged a signed medication order or a verbal order was not available for Tylenol and acknowledged R1's medical record did not contain a medication order from a medical practitioner for each medication that was administered.

Based on record review, observation, and interview, the manager failed to ensure a written order verifying the verbal order was obtained from the medical practitioner within 14 calendar days after receipt of the verbal order, for one of three residents reviewed. The deficient practice posed a health risk to the resident. Findings include: 1. Review of R1's medical record revealed a current written service plan dated January 10, 2024. This service plan indicated R1 received medication administration. 2. Review of R1's medical record revealed a verbal medication order dated July 15, 2023. This order stated "Omeprazole Oral Tablet delayed Release 20mg Give 1 tablet by mouth one time a day" and "Keppra Oral Tablet 500mg Give 2 tablet by mouth two times a day". However, documentation was not available that showed a written order was obtained from the medical practitioner within 14 days. 3. Review of R1's medical record revealed a January 2024 medication administration record (MAR). This MAR stated the following: "Omeprazole 20mg Take 1 tablet by mouth daily" and indicated one tab was administered at 8am January 1st - 31st. "Keppra 500mg Take 2 tablet by mouth BID" and indicated two tabs were administered at 8am and 8pm January 1st - 31st. 4. During an observation of R1's medications, Omeprazole 20mg and Keppra 500mg were observed. 5. In an interview, E1 reported the medications were administered per the verbal medication orders and acknowledged R1's medical record did not include written orders from the medical practitioner within 14 days.

Based on record review and interview, the manager failed to ensure a medication was administered in compliance with a medication order, for one of three residents reviewed. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. Review of R3's medical record revealed a current written service plan dated January 10, 2024. This service plan indicated R3 received medication administration. 2. Review of R3's medical record revealed a document titled "Report Of Unusual Occurrence" dated December 29, 2023. This document stated "...Patient was being repositioned in the wheelchair and (R3) sustained bruises under the armpit on the left side...Ensured patient had no pain. Pain medication (Tylenol) was given." 3. Review of R3's medical record revealed no documentation of a signed medication order or verbal medication order for Tylenol. 4. Review of R3's medical record revealed a December 2023 medication administration record (MAR). This MAR did not include documentation Tylenol was administered on December 29, 2023. 5. In an interview, E1 acknowledged a signed medication order or a verbal order was not available for Tylenol and acknowledged the medication was not administered in compliance with an available medication order. 6. This is a repeat deficiency from the compliance inspection conducted May 30, 2023.

Based on documentation review, record review, and interview, the manager failed to ensure the health care institution developed and administered a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. Review of facility documents revealed a policy and procedure titled "Employee orientation and In-service Training" that stated "...7. In-service Fall Prevention and Recovery training will be provided upon hire and at least every 12 months thereafter." 2. Review of E4's personnel record revealed no documentation indicating E4 completed fall prevention and fall recovery training. 3. During an interview, E1 acknowledged E4 had not completed a training program for fall prevention and fall recovery.

Based on record review and interview, the manager failed to ensure a written service plan included a current summary of the resident's medical or health problems, including physical, behavioral, cognitive, or functional conditions or impairments, for two of two residents reviewed. The deficient practice posed a risk if medical or health problems were not addressed by the assisted living facility. Findings include: 1. Review of R1's medical record revealed a written service plan dated April 11, 2023. This service plan stated "Requires positioning Q 2-3 hrs," "Nutritional Supplements - Jevity 1.5 2/day via G-tube," and "Wound Care - Home Health RN, Caregiver". 2. During an interview, E1 reported R1 had not required assistance with repositioning, needed G-tube feedings, or had wounds for approximately one year. 3. Review of R2's medical record revealed a written service plan dated January 6, 2023. This service plan stated "Requires positioning Q 2-3 hrs". 4. During an interview, E1 reported R2 did not require assistance with repositioning. 5. During and interview, E1 acknowledged R1's and R2's service plans did not include a current summary of R1's and R2's medical or health problems.

Based on record review and interview, the manager failed to ensure the facility did not retain a resident who was confined to a bed or chair because of an inability to ambulate even with assistance, unless the facility obtained a written determination from a medical practitioner, every six months thereafter, stating the resident's needs could be met by the facility and the resident's needs were within the facility's scope of services, for one of one resident reviewed who was confined to a bed or chair. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. Review of R1's medical record revealed a current written service plan dated April 11, 2023. This service plan stated "Wheelchair". 2. Review of R1's medical record revealed a written determination from R1's medical practitioner signed and dated October 20, 2022. However, documentation was not available stating R1's needs were met by the facility and R1's needs were within the facility's scope of services, at least once every six months. 3. During an interview, E1 reported R1 was unable to ambulate even with assistance since acceptance and acknowledged R1's medical practitioner did not provide a written determination at least once every six months. 4. Technical assistance was provided on this Rule during the compliance inspection conducted May 9, 2022.

Based on record review, observation, and interview, the manager failed to ensure a medication was administered in compliance with a medication order, for one of one resident reviewed. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. Review of R1's medical record revealed a current written service plan dated April 11, 2023. This service plan indicated R1 received medication administration. 2. Review of R1's medical record revealed a signed medication order dated October 22, 2022. This medication order stated "Hydralazine 100mg 1 tabl PO QD TID". 3. Review of R1's medical record revealed a May 2023 medication administration record (MAR). This MAR stated "Hydralazine 25mg Take 1 tabl by mouth every 8 hours" and indicated one tab was administered at 7am, 2pm, and 10pm May 1st - present. 4. During an observation of R1's medications, Hydralazine 25mg was observed. 5. During an interview, E1 reported the medication was administered per the MAR and acknowledged R1's medication was not administered in compliance with the available medication order.

Based on observation and interview, the manager failed to ensure a rechargeable fire extinguisher was serviced at least once every 12 months. The deficient practice posed a health and safety risk to the residents if a fire extinguisher was needed and did not work properly. Findings include: 1. During the facility tour with E1, the surveyor observed a rechargeable fire extinguisher. This fire extinguisher had a service tag attached dated February 4, 2022. 2. During an interview, E1 acknowledged the rechargeable fire extinguisher was not serviced at least once every 12 months.

Based on observation and interview, the manager failed to ensure oxygen containers were secured in an upright position. The deficient practice posed a potential explosion or leak of a compressed gas. Findings include: 1. During the facility tour with E1, the Compliance Officer observed four large oxygen tanks unsecured in R3's closet. 2. During an interview, E1 acknowledged oxygen tanks were not secured in an upright position in R3's closet.