Bella's Care Home, LLC

Based on documentation review and interview, the manager failed to ensure personnel provided appropriate first aid before the arrival of emergency medical services to a resident who had fallen, appeared to be uninjured, and was unable to recover independently. Findings include: 1. A review of facility documentation revealed an incident report dated August 7, 2023. The incident report indicated R2 had fallen, appeared to be uninjured, and was unable to recover independently. The incident report indicated staff contacted emergency medical services and did not provide first aid by assisting R2 off the floor before emergency services arrived. 2. In an interview, E1 reported R2 "have dead weight and are heavy" and E1 and E2 struggled to assist R2 in recovery when they have fallen but are uninjured. E1 reported when staff are unable to assist uninjured residents who have fallen, the staff will contact emergency medical services for assistance.

Based on record review and interview, the manager failed to ensure documentation required by this Article 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. On September 1, 2023, at 11:00 AM, the Compliance Officer requested to review documentation of completion of a caregiver training program approved by the Department or the Board of Examiners for Nursing Care Institution Administrators and Assisted Living Facility Managers for E2. However, the required documentation was not provided for review within two hours after a Department request. The documentation was provided at 2:02 PM, approximately three hours after the request. 2. In a joint interview, E1 and E2 acknowledged the requested documentation was not provided to the Department within two hours of the request.

Based on observation, documentation review, and interview, the manager failed to ensure documentation was maintained of the caregivers and assistant caregivers working each day, including the hours worked by each. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed E1 and E2 working on the premises. 2. A review of facility documentation revealed no documented staffing schedule. 3. In an interview, E1 reported E1 and E2 are the only staff for the facility and did not have a staffing schedule.

Based on record review and interview, the manager failed to ensure a resident's written service plan included the amount, type, and frequency of assisted living services being provided to the resident, for one of three residents sampled. Findings include: 1. A review of R3's medical record revealed a service plan dated July 2023. The service plan indicated R3 required assistance with showers, nail care, shaving, teeth/denture care, and dressing. However, the service plan did not indicate the frequency at which the facility would provide assistance with the aforementioned services. 2. In an interview, E1 acknowledged R3's service plan did not include a frequency for the aforementioned services.

Based on record review and interview, the manager failed to ensure medication administered to a resident was in compliance with a medication order, for two of three 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. A review of R1's medical record revealed a medication order dated August 22, 2023 for "Calcium Antacid 500 mg (milligrams) CH, 1 Tab PO QD Every 3 days." 2. Further review of R1's medical record revealed a medication administration record (MAR) dated August 2023. The MAR indicated "Calcium Antacid" was administered daily on August 17-31, 2023. 3. A review of R2's medical record revealed a medication order dated August 23, 2023 for "Senna-S 8.6 mg - 50 mg Tablet, Take two tablets every day by oral route in the evening." 4. Further review of R2's medical record revealed a MAR dated August 2023. The MAR indicated "Senna-S" was only administered on August 24, 2023. 5. In an interview, E1 acknowledged the aforementioned medications administered to R1 and R2 were not administered in compliance with medication orders.

Based on observation and interview, the manager failed to ensure potentially hazardous foods requiring refrigeration were maintained at 41 \'b0F or below. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed a refrigerator in the kitchen containing food items. The refrigerator contained a thermometer and the thermometer measured the temperature at 50.0 \'b0F. 2. In an interview, E1 acknowledged the kitchen refrigerator temperature was not maintained at 41 \'b0F or below.

Based on documentation review and interview, the manager failed to ensure the disaster plan required in subsection (A)(1) was reviewed at least once every 12 months. The deficient practice posed a risk as a disaster plan reinforces and clarifies standards expected of employees. Findings include: 1. A review of facility documentation revealed a documented disaster plan. However, there was no documentation to indicate the disaster plan was reviewed at least once every 12 months. 2. In an interview, E1 acknowledged the disaster plan required in subsection (A)(1) was not reviewed at least once every 12 months.