Advantage Home Care LLC

Based on documentation review, observation, and interview, for a facility authorized to provide directed care services, the manager failed to ensure there was a means of exiting the facility that provided access to an outside area from which a resident could exit to a location at least 30 feet away from the facility and controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a risk if the facility was unaware of the general or specific whereabouts of a resident. Findings include: 1. A review of Department records revealed the facility was licensed to provide directed care services. 2. Upon arrival at the facility, the Compliance Officers observed the front door leading to the street was wide open. The door had a device that was intended to alert employees of the egress of a resident to the outside area; however, the door chime was turned off. When the Compliance Officers entered the facility, E1 closed the door and reactivated the chime. 3. While on-site, the Compliance Officers observed two ambulatory residents. 4. During the environmental tour, the Compliance Officer observed a sliding glass door leading to the backyard. The door had a device that was intended to alert employees of the egress of a resident to the outside area; however, the door was not secured and the door chime was turned off. 5. A review of facility documentation revealed a policy titled "Wandering Residents." The policy stated, "A manager of an assisted living facility authorized to provide directed care services shall ensure that: ... 2. There is a means of exiting the facility for a resident...that: ... ii. Controls or alerts employees of the egress of a resident from the facility." 6. In an interview, E1 reported that the alert devices were deactivated earlier that morning to allow ventilation, noting that the devices continuously triggered alarms while doors remained open. E1 further reported that the facility conducts twice-daily checks of these alert systems and documents the maintenance status on a maintenance log. E1 and E2 acknowledged at the time of the inspection a means of exiting the facility to an outside area did not control or alert employees of the egress of a resident from the facility.

Based on observation and interview, the manager failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed a risk to residents who were not prescribed the accessible medication. Findings include: 1. The Compliance Officers observed two ambulatory residents on the premises. 2. During the environmental tour, the Compliance Officers observed an unlocked bedroom (Room #2) belonging temporarily to a caregiver. The Compliance Officers observed an open travel bag on the floor in the closet containing the following medications: - One bottle of "Tylenol Extra Strength"; and - Two boxes of Metformina 850 milligrams. 3. In an interview, E1 reported E1 was unaware that E3 took medication. E1 acknowledged medication was not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. 4. This is a repeat deficiency from the compliance investigation conducted on April 26, 2023.

Based on observation, record review, and interview, the manager failed to ensure the premises were free from a condition or situation that may cause a resident or other individual to suffer physical injury. The deficient practice posed potential dangers to residents. Findings include: 1. During the environmental tour, the Compliance Officers observed R2 lying in bed. R2's bed had half bedrails at the head of the bed on both sides of the bed. The rail up against the wall was in the upright position. The rail on the open side of the bed was down. 2. A review of R2's medical record revealed a current service plan for directed care services. The service plan reported R2 was "Bed Bound" and "Cannot Self Propel." 3. In an interview, E1 reported R2 was unable to communicate verbally. 4. In an interview, E1 acknowledged R2 could not move the rails up or down and could not call out for assistance if necessary. E1 and E2 acknowledged the situation may cause the resident to suffer physical injury.

Based on observation, documentation review, record review, and interview, the health care institution failed to administer a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the documentation was not in the personnel record during the inspection, and the documentation was not provided within two hours after a Department request. Findings include: 1. The Compliance Officer observed E3 preparing meals. The Compliance Officer observed E3 serving meals to residents seated around the dining table. 2. A review of the facility's policies and procedures revealed a policy titled "Fall Prevention" (dated December 1, 2021). The policy stated "All employees upon hire will take part in an in-service training program regarding buff [sic] Prevention and ... Recovery, which will include initial training and continued competency at least every 12 months." 3. A review of E3's (hired in 2022) personnel record revealed E3 was hired as a volunteer housekeeper and cook. However, documentation of initial training and continued competency training in fall prevention and fall recovery was not available for review. 4. In an interview, E1 reported E1 believed the requirement only applied to caregivers. E1 acknowledged a training program for E3 regarding fall prevention and fall recovery was not administered.

Based on record review and interview, the manager failed to ensure documentation required by Article 8 was provided to the Department within two hours after a Department request. The deficient practice posed a risk as the Department was unable to determine substantial compliance. Findings include: 1. The Compliance Officer requested, on April 26, 2023 at 11:14AM, the following documentation to be provided to the Department: -Fall prevention and fall recovery training for E3. However, the required documentation was not provided for review within two hours after a Department request. 2. In an interview, E1 acknowledged documentation required by Article 8 was not provided to the Department within two hours after a Department request and no additional information was provided.

Based on observation and interview, the manager failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed a risk to residents who were not prescribed the accessible medication. Findings include: 1. The Compliance Officer observed two ambulatory residents on the premises. 2. The Compliance Officer observed an unlocked bedroom belonging to a caregiver. The Compliance Officer observed one bottle of "Tylenol Extra Strength" unlocked on a nightstand in the bedroom belonging to a caregiver. 3. In an interview, E1 acknowledged medication was not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage.