Better Living Home, LLC

Based on documentation review and interview, the health care institution failed to ensure that the health care institution established, documented, and implemented tuberculosis (TB) infection control activities that included annually assessing the health care institution's risk of exposure to infectious TB. The deficient practice posed a TB exposure risk to residents. Findings include: 1. A review of the facility's documentation records revealed no facility risk assessment for infectious tuberculosis was documented and available during the inspection. 2. In an exit interview, the findings were reviewed with E1 and no additional information was provided. 3. Technical assistance was provided on this Rule during the inspection conducted on April 20, 2023.

Based on record review, documentation review, and interview, the manager failed to ensure an individual authorized to administer opioids documented in the resident's medical record an identification of the resident's need for the opioid before the opioid was administered and the effect of the opioid administered for one of nine residents sampled. Findings include: 1. A review of R2's medical record revealed a service plan indicating R2 received personal care services and medication administration. 2. A review of R2’s medical record revealed a narcotic administration record dated October 2025. This record revealed “Oxycodone HCL 10 MG Tablet, take 1 tablet po every 6 hours as needed for pain” and indicated Oxycodone was administered as ordered every day between October 3, 2025 and October 14, 2025. Documentation was not available showing the need for the opioid, the response to the opioid, and the effect of the opioid administered. 3. A review of facility documentation revealed a policy last revised June 19, 2024, titled "Opioid Medications." The policy stated "...An assessment of a resident's pain will be identified prior to administering an opioid medication using the "0 to 10" scale where "0" is no pain at all and "10" is the worst pain the resident can imagine. Once the pain medication is given, the individual providing the medication, or another individual authorized to administer medications will monitor the resident's response to the opioid medication to include how effective the opioid medication was to resolve the pain. This will be accomplished by reassessing the pain level approximately 30 minutes but no more than one hour after the medication is delivered. ili. Each time the above pain level assessments are taken they will be recorded in the resident's medical record on the MAR, a PRN-MAR or an Opioid MAR. iv. The effectiveness of the opioid medication will be determined and document on the Opioid PRN MAR.” 4. In an interview, E1 reported R2 did not have an end-of-life condition or an active malignancy and was not receiving hospice services. 5. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on record review and interview, the manager failed to ensure that a resident provided evidence of freedom from infectious tuberculosis (TB) before or within seven calendar days after the resident’s date of occupancy and as specified in R9-10-113, for two of two residents sampled. The deficient practice posed a TB exposure risk to residents. Findings include: 1. A review of R1 and R2's medical records revealed no documentation of evidence of freedom from infectious TB. Based on the residents' date of acceptance, this documentation was required. 2. In an exit interview, the findings were reviewed with E2 and no additional information was provided.

Based on documentation and interview, the manager failed to ensure that a disaster plan included a plan to ensure each resident’s medication would be available to administer to the resident during a disaster. The deficient practice posed a risk as there was no plan to ensure the health and safety of residents in an emergency. Findings include: 1. A review of the facility’s documentation revealed a disaster plan for the facility; however, the plan did not include a plan to ensure each resident’s medication would be available to administer to the resident during a disaster. 2. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on record review and interview, the manager failed to ensure that the caregiver documented the services provided in a resident’s medical record, for two out 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 activities of daily living sheet revealed the following missing documentation of services required to be provided to R1 in accordance with the services stated in the service plan: No documentation of checks every 3-4 hours at night. 2. A review of R2’s activities of daily living sheet revealed the following missing documentation of services required to be provided to R2 in accordance with the services stated in their service plan: No documentation of showers and shampoo between October 13-20, 2025. No documentation of dressing resident Oct 16-20, 2025. No documentation of checks every 3-4 hours at night. 3. In an interview, E1 reported the services were provided but just not documented. 4. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on observation and interview, the manager failed to ensure that residents' medical records were protected from loss, damage, or unauthorized use. The deficient practice posed a risk of protected, sensitive resident health information being disclosed without the resident's consent or knowledge. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed medical records sitting out on a table with the resident's name and private health information inside. 2. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on record review and interview, the manager failed to ensure a medication was administered to a resident in compliance with a medication order. 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 signed medication orders dated July 24, 2025. These medication orders stated the following: "Acetaminophen 500mg, po 2 tabs three times daily for pain." 2. A review of R1’s October 2025 medication administration record (MAR) revealed the following: Acetaminophen 500mg, 2 tabs two times daily and indicated Acetaminophen was administered two times a day during the month of October 2025. 3. A review of R2’s medical record revealed a signed medication order dated September 25, 2025. This order stated the followig: “Lyrica oral cap 50mg po, 1 cap po three times a day, every day for nerve pain anti convulsant.” 4. A review of R2’s October 2025 MAR revealed no documentation of Lyrica or administration of the medication during the month of October 2025. 5. During an observation of R2's medications, Lyrica was not observed. 6. There was no documentation of discontinuation of the medication available in R2's medical record. 7. In an exit interview, the findings were reviewed with E3 and no additional information was provided.

Based on observation and interview, the manager failed to ensure that 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. During an environmental inspection of the facility, the Compliance Officer observed the following unlocked medications inside a bag sitting in the bedroom of R3: Bactrim, 1 tab po twice daily for 7 days; Cephalexin 500 mg, 1 capsule po 4 times daily for 7 days; and Esomeprazole Magnesium 20 mg capsules. 2. In an interview, E1 reported that the unlocked medication belonged to a caregiver, E2, and was not supposed to be left in the room. 3. In an exit interview, the findings were reviewed with E1 and no additional information was provided. 4. This is a repeat deficiency from the inspection conducted on April 20, 2023.

Based on observation and interview, the manager failed to ensure that the premises were cleaned and, if applicable, disinfected according to policies and procedures designed to prevent, minimize, and control illness or infection. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer CO observed spoiled and sticky food particles at the bottom of a drawer inside the kitchen refrigerator. A green/gray fuzzy substance was observed on a cucumber, and lemons and limes that were coated in the sticky food particles sitting inside the drawer. 2. In an exit interview, the findings were reviewed with E1, and no additional information was provided. 3. This is a repeat deficiency from the inspection conducted on April 20, 2023.