Avista Senior Living North Mountain

Based on documentation review and interview, the manager failed to ensure that a caregiver's or assistant caregiver's skills and knowledge were verified and documented according to policies and procedures. Findings Include: 1. A review of the facility’s policy and procedure revealed that there was no policy documented for verification of skills and knowledge for a caregiver or assistant caregiver. 2. In an interview, E11 reviewed the facility’s policy and procedure and revealed there was no policy and procedure that covered verification and documentation of a caregiver's or assistant caregiver's skills and knowledge.

Based on record review, observation, documentation review, and interview, the manager failed to ensure that a caregiver provided a resident with the assisted living services in the resident's service plan for one of six sampled residents. Findings include: 1. A review of R6’s medical record revealed a service plan that reflected R6 required the following assistance: Grooming twice daily, dressing daily, bathing twice weekly, and toileting three times daily. A review of R6’s documentation of services provided from March 1, 2025, through March 31, 2025, and April 1, 2025, through April 31, 2025, revealed R6 was not provided with assistance with toileting three times daily or grooming twice daily. 2. In an interview, E11 reviewed R6’s medical record and acknowledged that the services were not provided according to R6’s service plan.

Based on documentation review and interview, the manager failed to ensure the disaster plan was reviewed at least every 12 months. Findings include: 1. A review of the facility’s documentation revealed the latest disaster plan annual review was December 8, 2023. 2. In an interview, E11 acknowledged that a more recent annual disaster plan review was not given for review.

Based on observation review and interview, the manager failed to ensure that poisonous or toxic materials stored by the assisted living facility were maintained in a locked area and were inaccessible to residents. Findings include: 1. During a facility tour, the compliance officer observed the following toxin unlocked in the facility’s cabinet inside the directed care unit: a container of nail polish. 2. In an interview, E11 acknowledged that the nail polish was not stored locked.

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 one of two residents sampled. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. A review of R1's medical record revealed an undated service plan. The service plan included the following services: -Skin integrity checks 2 times a day; -Grooming 2 times a day; and -Hydration assistance with meals 2 times a day. However, a review of R1's activities of daily living (ADL) sheets revealed the following services not documented as administered on the following dates and times: -Grooming from November 22, 2024 to November 24, 2024 on the evening shift (2:00 PM to 10:00 PM) and November 23, 2024 to November 25, 2024 on the day shift (6:00 AM to 2:00 PM); -Skin integrity checks from November 1, 2024 to November 24, 2024 on the evening shift and November 1, 2024 to November 25, 2024 on the day shift; and -Hydration assistance with meals from November 1, 2024 to November 24, 2024 on the evening shift and November 1, 2024 to November 25, 2024 on the day shift. 2. In an interview, E2 and E3 reported the online system has a malfunction and are unsure why the services are not initialed as provided. 3. In an interview, E2 and E3 acknowledged services on R1's ADL sheet were not documented as provided.

Based on documentation review, record review, and interview, the manager failed to ensure a caregiver's or assistant caregiver's skills and knowledge were documented and verified before the caregiver or assistant caregiver provided services and according to policy and procedures, for one of three sampled caregivers and assistant caregivers. The deficient practice posed a risk if the employees were unable to meet a resident's needs. Findings include: 1. A review of facility policies and procedures revealed policies titled, "Caregiver Employment Requirements" and "Assistant caregiver employment Requirements." Both policies stated, "...Needed skills and knowledge will be verified and documented prior to the caregiver providing services." 2. A review of E3's personnel record revealed E3 was hired as a caregiver. E3's personnel record contained a document used to verify skills and knowledge. However, the document was not dated, and the front page was left blank. 3. In an interview, E2 acknowledged E3's skills and knowledge verification documentation was incomplete.

Based on record review and interview, the manager failed to ensure a medication was administered to a resident in compliance with a medication order, for one of three sampled residents. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. A review of R2's medical record revealed a signed medication order for "Metformin 500 mg" (milligrams). Further review of R2's medical record revealed a medication administration record (MAR). The MAR revealed R2's "Metformin" was withheld at 8:00 AM on October 1-3, 2023. However, "Metformin" was documented as administered at 8:00 PM on October 1-3, 2023. 2. In an interview, E2 reported R2's "Metformin" was on hold on October 1-3, 2023 because the facility ran out of the medication and was waiting on the resident representative to provide the refill, and the documented administration of "Metformin" at 8:00 PM on October 1-3, 2023 was an error. 3. In an interview, E2 acknowledged R2's "Metformin" was not administered in compliance with an order on October 1-3, 2023.