American Assisted Living, LLC

Based on record review and interview, the manager failed to ensure that a resident had a service plan reviewed and updated at least once every three months for a resident receiving directed care services, for two of two residents sampled. Findings include: 1 . A review of R1's medical record revealed a service plan dated October 22, 2024. However, documentation of a service plan completed after October 22, 2024 was not available for review at the time of inspection. 2 . A review of R2's medical record revealed a service plan dated February 27, 2025. However, documentation of a service plan completed after February 27, 2025 was not available for review at the time of inspection. 3 . In an interview, E1 reported multiple service plans have been sent to the representative for R1, but they have not been signed and it has been difficult to contact the representative. However, there was no documentation available for review of efforts to contact the representative. In an exit interview, the findings were discussed with E1 and no additional information was added.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance of an individual, the individual submitted documentation dated within 90 calendar days before the individual was accepted by the assisted living facility; signed and dated by a physician, registered nurse practitioner, registered nurse or physician assistant for one of three residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R3's (admitted in 2023) medical record revealed no documentation to ensure before or at the time of R3's acceptance, R3 submitted documentation dated within 90 calendar days before the individual was accepted by the assisted living facility; signed and dated by a physician, registered nurse practitioner, registered nurse or physician assistant. 2. In an interview, E1 and O1 reviewed R3's medical record. E1 reported E1 believed the documentation was completed however at the time of the inspection E1 could not locate the identified documentation. E1 and O1 acknowledged the record did to contain documentation signed and dated by a physician, registered nurse practitioner, registered nurse or physician assistant that stated whether the R3 required continuous medical services, continuous or intermittent nursing services, or restraints.

Based on record review and interview, the manager failed to ensure a resident's written service plan accurately reflected the amount, type, and frequency of assisted living services provided to a resident, including medication administration or assistance in the self-administration of medication for one of three residents sampled. The deficient practice posed a risk as the service plan did not reinforce and clarify services to be provided to a resident. Findings include: 1. A review of R1's medical record revealed a service plan for "Supervisory" care dated June 25, 2023. The service plan however identified personal care services were provided to R1. R1's services plan reflected "assistance with self-admin" and "Residents skin is checked during toileting and showers for any bruising, injuries or sores. Topical preventive cream barriers are applied each time that a resident is toileted." 2. In an interview, E1 reported the caregivers store and administer resident medications daily. E1 reported E1 believed this to be assistance with self-administration. E1 acknowledged the residents do not retrieve the medications themselves. E1 acknowledged R1 received medication administration along with all of the current residents. E1 acknowledged R1's service plan did not accurately reflect the level of medication assistance provided to R1.

Based on record review and interview, the manager failed to ensure a written service plan was reviewed and updated at least once every three months, for one resident sampled who received directed care services. The deficient practice posed a risk as a service plan reinforces and clarifies services to be provided to a resident. Findings include: 1. A review of R5's medical record revealed a directed care service plan dated January 1, 2021. No additional service plans were available for review. 2. In an interview E1 reviewed R5's medical record and acknowledged the directed care service plan dated January 1, 2021, was the most current service plan found in R5's record and available for the Departments review. E1 acknowledged at the time of the inspection no additional service plans were provided for review.

Based on record review and interview, the manager failed to ensure a written service plan was available for one of two residents sampled. The deficient practice posed a health and safety risk if the caregivers did not know the services the resident needed to receive. Findings include: 1. A review of R3's medical record revealed no documentation of a written service plan since R3's acceptance (2023) into the facility. Based on R3's date of acceptance, a service plan was required. 2. In an interview, E1 and O1 reviewed R3's medical record. E1 and O1 acknowledged the medical record did not contain a service plan.

Based on observation, record review, and interview, the manager failed to ensure that a bell, intercom, or other mechanical means to alert employees to a resident's needs or emergencies was available and accessible in a bedroom being used by a resident receiving personal care services. Findings include: 1. During a facility tour with E1, the Compliance Officers observed that R1's bedroom did not have a bell, intercom, or other mechanical means to alert employee to a resident's needs or emergencies that was accessible. E1 and E2 searched R1's room for a bell, however the bell could not be located. 2. A review of documentation provided by E1 revealed R1 required personal care services to include medication administration. A review of R1's service plan revealed the following "Resident reminded often to use bell and to not try to do things without a caregiver being present." 3. In an interview, E1 acknowledged a bell, intercom, or other mechanical means to alert employees to a resident's needs or emergencies was not available and accessible in R1's bedroom.

Based on documentation review, observation, and interview, the manager failed to ensure there was a means of exiting the facility for a resident who did not have a key, special knowledge for egress, or the ability to expend increased physical effort, that provided access to an outside area that 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. Review of the license issued by the Department revealed the facility was authorized to provide directed care services. 2. During an environmental inspection of the facility with E1, the Compliance Officers observed an exit door that led to the backyard of the facility that did not have a device that alerted employees to the egress of a resident to the outside area. The Compliance Officers observed the backyard led to a gate that was unlocked and led directly to the city street. 3. In an interview, E1 acknowledged there was a means of exiting the facility to an outside area which did not control or alert employees of the egress of a resident from the facility.

Based on record review and interview, the manager failed to ensure a medication was administered in compliance with a medication order for one of four residents sampled. 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 R5's medical record revealed R5 received medication administration. 2. Review of R5's medical record revealed a signed medication order dated May 4, 2023. This medication order stated "Lantus Insulin 40 units daily in am before breakfast, 25 units daily before bed." 3. Review of R5's medical record revealed a March 2024, medication administration record (MAR). This MAR reflected Lantus Insulin 40 units was administered daily at 7 am. The MAR reflected "Lantus 100 units/ml 25 units PM" with no documentation of administration for the month of March 2024. 4. In an interview, E1 reported R5 received medication administration. E1 reported E1 made the decision to not administer the PM dosage based on E1's medical judgement of R5's daily blood sugar readings. E1 acknowledged R5 was not on a sliding scale and the identified medication order reflected "daily." E1 reported the current medication order provided to the Compliance Officers was the only order available for review. E1 acknowledged R5's medication was not administered in compliance with the available medication order.

Based on observation, record review, and interview, the manager failed to ensure a medication administered to a resident was documented in the resident's medical record for one of four residents sampled. The deficient practice posed a risk as the medical record inaccurately indicated a medication was administered and false or misleading information was provided to the Department. Findings include: 1. The Compliance Officers observed R2 not to be present at the facility at the time of the inspection. R2 was admitted to the hospital and remained since February 2024. 2. A review of R2's medical record revealed a medication administration record (MAR) was not available for review for February 2024. A review of R2's March 2024 MAR revealed that on March 1, 2024, medication administration was documented as provided by E2 for the following medications: Allopurinol 100 mg IT po qAM at 7 am Jardiance 10 mg IT po qAM at 7 am Losartan Potassium 50 mg IT po qAM at 7 am Nifedipine ER 90 mg IT po qAM at 7am Senna 8.6 mg 2T po qd at 7 am Icosapent Ethyl 1 gm 2 cap po bid at 7am and 7pm Tylenol 500 mg 2T po TID, at 7am, 1 pm, and 7 pm Docusate Sodium 100 mg 1 cap qhs, at 7pm Nifedipine ER 30 mg IT po qhs at 7 pm Daptomycin 575 mg IV 11.5 slow push, at 2 pm However, R2 was not present at the facility on March 1, 2024 and did not receive medication administration as identified. 3. In an interview, E1 reported E1 administered medication to R2 in February 2024 however E1 could not locate the February 2024 medication record. E1 acknowledged R2 was not present at the facility on March 1, 2024, and did not receive medication administration as R2's medical record documented. E1 reported E1 believed the identified administration was a documentation error. This is a repeat deficiency from the Compliance Inspection conducted November 14, 2022.

Based on documentation review and interview, the manager failed to ensure an employee disaster drill was conducted on each shift at least once every three months and documented. The deficient practice posed a risk if employees were unable to implement the disaster plan. Findings include: 1. Review of the March 2024 personnel schedule revealed two shifts; 7 am -7:30 pm (day shift) and 7 pm - 7:30 am (night shift). 2. Review of the facility's employee disaster drills revealed the following drills: February 2, 2024, at 1:25 pm November 2, 2023, at 9:30 am and 1:25 pm August 2, 2023, at 6:07 am and 8:03 pm May 1, 2023, at 11:37 am and 3:01 am No other employee disaster drills were available for review. 3. In an interview, E1 acknowledged no other drills were available for review. E1 acknowledged the employee disaster drills were not conducted on each shift at least once every three months.

Based on observation and interview, the manager failed to ensure toxic materials stored by the facility were maintained in labeled containers and stored in a locked area and inaccessible to residents. Findings include: 1. During the facility tour with E2 and then joined by E1, the Compliance Officers observed the following toxic materials stored by the facility unlocked and accessible to the residents: -R2's bathroom cabinet contained Clorox Wipes -A hallway bathroom cabinet contained two bottles of purple liquid in an unlabeled spray bottle identified by E2 a cleaning product "Fabuloso." The bathroom cabinet did not contain a means of locking. -Bags of opened steer manure and potting mix located on the ground next to a shed in the backyard accessible to residents 2. During an interview E2 reported the two bottles of purple liquid found in the bathroom cabinet unlocked were "Fabuloso." E2 acknowledged the spray was unlabeled and a toxic materials. E2 acknowledged the toxic materials were stored unlocked. 3. During an interview E1 acknowledged the toxic materials identified were stored unlocked.

Based on observation and interview, the manager failed to ensure a resident's sleeping area was not used as a common area. Findings include: 1. The Compliance Officers observed R4's bedroom locked. Once unlocked by E1, R4's bed contained multiple bins of medications belonging to various current residents spread over the residents bed and night table. 2. In an interview, E2 reported E2 completed medication administration with all of the residents and returned their medications to R4's bedroom for processing. 3. In an interview, E1 reported R4 stayed in the living room during the day and the facility used R4's bedroom "weekly" as an office to complete their medication processes. E1 acknowledged R4's bedroom was used for purposes other than R4's bedroom.