Angela's Assisted Living II, LLC

Based on record review and interview, the manager failed to ensure medication administered to a resident is administered in compliance with a medication order for one of three residents sampled. Findings include: 1. A review of R2's medical record revealed a service plan which indicated R2 received personal care, and medication administration services. The medical record contained a doctor's order, dated May 21, 2024, directing R2 take loratadine 10 mg tablet, Take 1 tablet(s) every day by oral route." 2. A review of R2's Medication Administration Record (MAR) for June 2024 revealed a section documenting the administration of Loratadine, however entries in the MAR reflected R2 refused the medication every day after June 10, 2024 through July 10, 2024. 3. In an interview, E3 advised they had contacted R2's primary care physician's office before July 4, 2024 requesting the doctor change or discontinue the order for Loratadine. E3 reported the doctor's office did not provide a verbal order and the doctor did not provide a written order modifying or discontinuing the order for Loratadine. E3 indicated they did not document the contact with R2's primary care doctor. 4. In an interview E1 acknowledged that R2 was not being administered Loratadine as ordered.

Based on observation and interview, the manager failed to ensure that poisonous or toxic materials were stored in a locked area, separate from medications and inaccessible to residents. Findings include: 1. During a tour of the facility, the Compliance Officer observed no fewer than two ambulatory residents. The Compliance Officer also observed a cabinet inside a common bathroom which was not equipped with a locking mechanism. Inside the cabinet, the Compliance Officer observed a bottle of, "Clorox Cleaner + Bleach," which was marked, "KEEP OUT OF REACH OF CHILDREN." The Compliance Officer observed a cabinet inside a resident's room which was not equipped with a locking mechanism. The Compliance Officer was able to open the cabinet with little effort. Inside were two one liter bottles of "Tide" laundry detergent. Each bottle was marked "KEEP OUT OF REACH OF CHILDREN." The Compliance Officer observed a cabinet on the outside patio which was equipped with a clasp for locking the doors. However, there was no lock and the Compliance Officer was able to open the cabinet with little effort. Inside, the Compliance Officer observed a one gallon bottle of commercial "No Rinse Floor Cleaner," and a one gallon bottle of "Fabuloso Multi-Purpose Cleaner," each labeled "KEEP OUT OF REACH OF CHILDREN." 2. In an interview, E1 acknowledged the poisonous and toxic materials were not kept, in a locked area, inaccessible to residents.

Based on observation and interview the manager failed to ensure a resident was treated with dignity, respect and consideration. Findings include: 1. During a tour of the facility the Compliance Officer observed no fewer than two residents who were ambulatory with the assistance of a walker, and no fewer than two residents who were able to propel a wheelchair unassisted. the interior of the facility was in the process of having the flooring replaced. However, the flooring at or just inside the threshold of several doorways was missing and there was approximately a 1/2 inch to 3/4 inch space between the foundation and newly installed or pre-existing flooring. Pieces of construction board, approximately 1/2 inch thick, had been placed in the threshold of several resident's doors, between the newly installed flooring in the hallway, and the pre-existing flooring in the resident's rooms. However, the construction board was not flush with the flooring and in one instance, did not span the width of the threshold thereby leaving considerable gaps between the board and the newly installed or pre-existing flooring. The Compliance Officer observed a common bathroom in the hallway available for use by both residents and visitors to the facility. The bathroom floor was in the process of being replaced, however was unfinished around the toilet and sink, leaving the building's foundation exposed and creating a difference in height of approximately 1/2 to 3/4 of an inch between the foundation and the installed flooring. The Compliance Officer observed several pieces of flooring, measuring approximately one square foot, in the corner of a hallway leaned against the wall. The Compliance Officer observed a patio just outside the kitchen which was used by residents. The patio was filled and appliances, such as a washing machine, stove and refrigerator, as well as a manual Hoyer lift, wheel chair, mop and mop bucket, metal cart, broken down cardboard boxes, portable air conditioner, electric fireplace, and approximately thirty-six boxes of flooring, among other items, surrounding a small patio table used by residents who smoked. 2. In an interview E2 advised the facility had been undergoing interior remodeling for approximately ten weeks and the flooring had been in the process of being replaced for approximately eight weeks. E2 reported having twisted their ankle on more than one occasion after having misstepped into a gap between the entranceway threshold, the exposed foundation and the newly installed flooring. E2 also reported residents using walkers and wheelchairs getting stuck or having to exert considerable effort in order to avoid being stuck in the gaps between the exposed foundation and existing flooring. 3. In an interview, R1 reported wheelchair bound residents were getting stuck in the gaps between the exposed foundation and the existing flooring. R1 stated they had become stuck in the gap at the threshold of R1's room and other residents or caregivers

Based on documentation review and interview, the manager failed to ensure an evacuation drill for employees and residents was conducted at least once every six months and documented. Findings include: 1. A review of facility documentation revealed documentation of evacuation drills conducted in August 2022 and August 2023. However, evidence of documentation of an evacuation drill for employees and residents conducted in February 2023 was not available for review. 3. In an interview, E2 acknowledged an evacuation drill for employees and residents was not conducted at least once every six months and documented as required.

Based on observation and interview the manager failed to ensure the premises at the assisted living facility was free from a condition or situation which may cause a resident or other individual to suffer physical injury. Findings include: 1. During a tour of the facility the Compliance Officer observed no fewer than two residents who were ambulatory with the assistance of a walker, and no fewer than two residents who were able to propel a wheelchair unassisted. the interior of the facility was in the process of having the flooring replaced. However, the flooring at or just inside the threshold of several doorways was missing and there was approximately a 1/2 inch to 3/4 inch space between the foundation and newly installed or pre-existing flooring. Pieces of construction board, approximately 1/2 inch thick, had been placed in the threshold of several resident's doors, between the newly installed flooring in the hallway, and the pre-existing flooring in the resident's rooms. However, the construction board was not flush with the flooring and in one instance, did not span the width of the threshold thereby leaving considerable gaps between the board and the newly installed or pre-existing flooring. The Compliance Officer observed a common bathroom in the hallway available for use by both residents and visitors to the facility. The bathroom floor was in the process of being replaced, however was unfinished around the toilet and sink, leaving the building's foundation exposed and creating a difference in height of approximately 1/2 to 3/4 of an inch between the foundation and the installed flooring. The Compliance Officer observed several pieces of flooring, measuring approximately one square foot, in the corner of a hallway leaned against the wall. The Compliance Officer observed a patio in the back yard of the facility which was used by residents. The patio was made of approximately one foot square, concrete pavers which were laid on the ground and held in place by dirt and a wood frame boarder on one side. However, the dirt at the corner of the patio had eroded, allowing for the pavers to slide out of place, thereby leaving gaps between the pavers of between one and approximately three to four inches. 2. In an interview, E2 reported having twisted their ankle on more than one occasion after having misstepped into a gap between the entranceway threshold, the exposed foundation and the newly installed flooring. E2 indicated no residents or other caregivers had fallen or suffered an injury due to the conditions of the facility during the remodeling. 3. In an interview, E1 acknowledged the premises at the assisted living facility was not free from a condition or situation which may cause a resident or other individual to suffer physical injury.