Boswell Assisted Living

Based on record review, document review, and interview, the manager failed to ensure that a resident had a service plan that was established, documented, and implemented, which included a description of the resident’s medical or health problems, including physical, behavioral, cognitive, or functional conditions or impairments, for one of four residents sampled. The deficient practice posed a risk if the resident did not receive the care needed. Findings include: 1. A review of R2’s medical record revealed a service plan dated February 3, 2026. The service plan revealed that R2 received directed care services. The service plan included R2’s level of care, emergency contact, cognitive status, skin care, mobility, and nutrition. However, R2’s health problems and functional condition, including allergies, medical diagnosis, vital signs, and weight, were not entered into R2's service plan. 2. A review of the facility’s policies and procedures revealed a policy titled “Service Plans,” which stated, “A. Except as required in subsection (B), a manager shall ensure that a resident has a written service plan that: 1. Is completed no later than 14 calendar days after the resident’s date of acceptance; 3. Includes the following: a. A description of the resident’s medical or health problems, including physical, behavioral, cognitive, or functional conditions or impairments.” 3. In an interview, E1 reported that R2 was diagnosed with Parkinson’s disease and is forgetful, and E1 did not have time to complete R2’s service plan. 4. In the exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on observation and interview, the manager failed to ensure a resident was treated with dignity, respect, and consideration. The deficient practice posed a risk to the health, safety, and well-being of the resident. Findings include: 1. During the environmental tour, the Compliance Officers observed a strong urine smell emanating from R1’s bedroom into the hall. Upon entry, the Compliance Officers observed R1 lying on her bed, and the urine smell was stronger inside the room. The Compliance Officers also observed fecal matter on R1’s bed linens next to R1’s arm where R1 was lying. 2. In an interview, R1 reported that the soiled linen had fecal matter on it. R1 proceeded to rub the fecal matter with R1’s finger. R1 reported that R1 had diarrhea, and it got on the sheet. R1 reported that the caregivers saw the soiled linens when they cleaned R1, but they never changed the sheet. 3. In an interview, E1 reported that E1 was aware that R1 had diarrhea and was bleeding from R1’s rectum, which caused the soiled linens on R1’s bed. 4. In an interview, E2 reported that E2 has a difficult time eliminating the urine smell in R1’s bedroom because the smell came from R1 themselves. E2 reported that E2 purchased a perfume to mask the odor in R1's room. 5. In the exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on observation, document review, and interview, the manager failed to ensure there was a means of exiting the facility for a resident who does not have a key, special knowledge for egress, or the ability to expend increased physical effort that provides access to an outside area from which a resident may exit to a location at least 30 feet away from the facility that was secure and monitored or alerted employees of the egress. The deficient practice posed a risk to the physical health and safety of residents. Findings include: 1. Upon arrival at the facility, the Compliance Officers observed the primary front door and screen door were unmonitored and unalerted. The Compliance Officers peered into the open doors but did not observe anyone in the immediate area inside the facility until the doorbell was rung. 2. During the environmental tour, the Compliance Officers observed an unsecured door into the caregiver’s bathroom, which provided a passageway to an unmonitored and unalerted egress door into the backyard. 3. During the inspection, the Compliance Officers observed several ambulatory residents walking around the facility. 4. A review of the facility’s policies and procedures revealed a policy titled “Wandering” which stated, “4. Caregivers will maintain security of locks on the front door, yards, and hazardous areas at all times.” 5. In an interview, O1 stated the front door was opened for O1 at “ten ‘til 9.” The door remained open until 9:03 AM, at least thirteen minutes. 6. In an interview, E1 reported the front door was left open because the facility’s sprinkler system was being serviced and the workers needed access into the facility. 7. In the exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on observation, document review, and interview, the manager failed to ensure the premises and equipment used at the assisted living facility were cleaned and 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 the residents. Findings include: 1. During an environmental tour, the Compliance Officers observed a urine smell in the common bathroom. Upon closer inspection, the Compliance Officers observed that the floor was sticky to the touch. 2. During the environmental tour, the Compliance Officers observed a urine smell emanating from R1’s bedroom into the hall. Upon entry, the Compliance Officers observed R1 lying on R1's bed, and the urine smell was much stronger inside the room. The Compliance Officers also observed fecal matter on R1’s bed linens next to R1’s arm where R1 was lying. 3. A review of the facility’s policies and procedures revealed a policy titled “Emergency, Safety and Environmental Standards” which stated: · “4. Infection Control policies and procedures will be practiced at all times.” · “6. Soiled clothing and linen will be stored in closed containers and kept away from food storage, kitchen and dining areas. A) Soiled linen and clothing will be placed in closed containers immediately and not placed on the floor or furniture.” · “31. Floors in common areas and common bathrooms are cleaned daily. If reusable cleaning cloths or mops are used, they should be decontaminated regularly to prevent cross contamination.” 4. A review of the facility’s policies and procedures revealed a policy titled “Cleaning and disinfecting” which stated: · “The facility shall be cleaned and disinfected daily to prevent, minimize, and control illness or infection. The manager is responsible for developing, implementing, and ensuring cleaning and housekeeping schedules are maintained and should include the daily, weekly, monthly, and quarterly tasks. Duties or tasks will be in place to ensure the highest level of sanitation of all equipment and work area are maintained at all times.” · “Equipment used by the facility are cleaned on a regular basis as per schedule; disinfect if equipment becomes contaminated with blood or body fluids. Any spills of blood and other potentially infectious materials are promptly cleaned and decontaminated.” · “Surfaces in proximity to the resident and those that are touched frequently are cleaned and disinfected daily. These include surfaces as counters, tabletops, microwave handles, door handles, bathroom fixtures, toilets, toilet handles, sink handles, light switches, door keypad, phones, keyboards, tablets, pens, chair backs and arm rests, remote controls, bedside tables, commodes, beds lifting equipment and other frequently touched surfaces etc.” · “Floors in common areas and common bathrooms are cleaned daily, Resident and private bathrooms are cleaned as scheduled. Any used linen

Based on observation, document review, and interview, the manager failed to ensure the premises and equipment used at the assisted living facility were free from a condition or situation that may cause a resident or other individual to suffer physical injury. The deficient practice posed a risk to the physical health and safety of the residents. Finding include: 1. During the environmental tour, the Compliance Officers observed an unattended, unraveled garden hose stretched across the length of the back yard. Next to the garden hose was a bucket containing standing water with bird excrement. 2. During the environmental tour, the Compliance Officers observed an untagged rechargeable fire extinguisher stored on the ground in the backyard in a common area used by the residents. 3. A review of the facility’s policies and procedures revealed a policy titled “Environmental Standards” which stated: · “22. Water hoses and garden tools will be put away immediately after use.” · “29. Fire extinguishers rated at least 2A-10-BC will be portable, serviced or replaced every 12 months be tagged specifying the date of recharging and the company performing the work. Fire extinguishers should be reviewed monthly and documented on the Maintenance Log.” 4. In the exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on observation, document review, and interview, the manager failed to ensure that poisonous or toxic materials stored by the assisted living facility were in a locked area and were inaccessible to residents. The deficient practice posed a risk to the physical health and safety of the residents. Findings include: 1. During an environmental inspection, the Compliance Officers observed one bottle of toilet bowl cleaner in an unlocked cabinet under the kitchen sink. 2. During an environmental inspection, the Compliance Officers observed four cans of paint under two beds in a vacant resident room. 3. During an environmental inspection, the Compliance Officers observed three cans of paint on the ground next to the trash bins in the backyard. 4. A review of the facility’s policies and procedures revealed a policy titled " Emergency, Safety and Environmental Standards” which stated, “Poisonous and toxic materials will be in labeled containers and stored in a locked area separate from food preparation and storage areas.” 5. In the exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on observation and interview, the manager failed to ensure 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 could access the medication. Findings include: 1. During the facility tour with E1, the Compliance Officer observed a closet in the kitchen that held ten residents' medications unlocked. This closet was equipped with a lock, however it was not locked. 2. In an interview, E1 and E2 acknowledged medications were not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage.

Based on observation and interview, the manager failed to ensure a food menu was conspicuously posted at least one calendar day before the first meal on the food menu was served. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed a food menu dated June 2 - June 8, 2024. 2. In an interview, E1 reported E1 had forgotten to post the menu for week of June 16 -June 22, 2024. E1 acknowledged the food menu was not conspicuously posted at least one calendar day before the first meal on the food menu was served.

Based on observation and interview, the manager failed to ensure food was protected from potential contamination. The deficient practice posed a potential health risk to the residents. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed E2 preparing raw chicken while wearing gloves. The Compliance Officer observed E2 access food in the refrigerator, spices in a cabinet, and water from a water cooler while still wearing the contaminated gloves. 2. In an interview, E2 acknowledged still wearing the gloves after handling the raw chicken, but denied that it was a risk for potential contamination.

Based on observation, record review, and interview, the manager failed to ensure a caregiver provided documentation of completing a caregiver training program approved by the Department or the Board of Examiners for Nursing Care Institution Administrators and Assisted Living Facility Managers (NCIA Board), for two of two caregivers reviewed. The deficient practice posed a risk if the individual was not qualified to provide the required services. Findings include: 1. During the inspection, E1 and E2 were the only employees on-site for nine residents. 2. There was no personnel record for E1, and no documentation that E1 had completed a caregiver training program approved by the Department or the NCIA Board provided. 3. In an interview, E1 reported that E1's caregiver certificate was at another facility. 4. Review of E2's personnel record revealed no documentation that E2 had completed a caregiver training program approved by the Department or the NCIA Board. E2 provided the Compliance Officer with a document that stated "Continuing Education 6 - Units for Assisted Living Facility Caregiver," however the document was a continuing education certificate, not documentation that E2 had completed a caregiver training program approved by the Department or the NCIA Board. 5. In an interview, E2 reported that the continuing education class was the only training E2 had received to become a caregiver. 6. In an interview, E1 and E2 reported E1 and E2 worked as caregivers and acknowledged documentation of completing a caregiver training program approved by the Department or the NCIA Board was not available.

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. The deficient practice posed a risk as there was no documentation to identify the staff that was present each day to ensure the health and safety of residents. Findings include: 1. Review of the posted personnel schedule dated June 2024 revealed it did not contain the names of the caregivers that worked each shift, only letters. However, there was nothing to identify which caregivers were represented by the letters. 2. During an interview, E1 reported that the letters were initials, however, the letters did not correspond to the first and last names provided for the caregivers. E1 acknowledged documentation was not maintained of the caregivers and assistant caregivers working each day.

Based on observation, record review, documentation review, and interview, the manager failed to ensure a trained caregiver was present on the assisted living facility's premises when the manager was not present. The deficient practice posed a risk as no qualified employee was present to meet a resident's needs. Findings include: 1. When the Compliance Officer arrived, the manager was not present. E1 and E2 were the only employees at the facility with nine residents. 2. There was no personnel record for E1, and no documentation that E1 had completed a caregiver training program approved by the Department or the NCIA Board provided. 3. In an interview, E1 reported that E1's caregiver certificate was at another facility. 4. Review of E2's personnel record revealed no documentation that E2 had completed a caregiver training program approved by the Department or the NCIA Board. E2 provided the Compliance Officer with a document that stated "Continuing Education 6 - Units for Assisted Living Facility Caregiver," however the document was a continuing education certificate, not documentation that E2 had completed a caregiver training program approved by the Department or the NCIA Board. 5. In an interview, E2 reported that the continuing education class was the only training E2 had received to become a caregiver. 6. In an interview, E1 acknowledged that there was no evidence that a trained caregiver was present. Therefore, E1 and E2 were not qualified to be left alone with the residents based on the lack of caregiver training.

Based on observation, record review, and interview, the manager failed to ensure a personnel record was available for one of two employees reviewed. The deficient practice posed a risk as required information could not be verified for E1. Findings include: 1. When the Compliance Officer arrived, E1 was present at the facility and providing care to residents. 2. Review of the personnel records revealed no record for E1. 3. During an interview, E1 acknowledged a personnel record was not available for E1.

Based on 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 one resident reviewed. The deficient practice posed a risk as medication could not be verified as administered. Findings include: 1. Review of R1's June 2024 medication administration record (MAR) revealed the following medications were not documented as administered to R1 on June 19, 2024: -8AM-SENNA PLUS 2 TABS; -6AM-INGREZZA 40mg; -6AM, 2PM, 8PM-MIDODRINE 10mg; -8AM-ROSUVASTATIN 10mg; -8AM-MYBERTRIQ 25mg; -8AM, 2PM, 8PM-CARBIDOPA 25mg - LEVODAPA 100mg. 2. In an interview, E1 reported the medications were administered by the med organizer, but not documented. E1 acknowledged R1's medication administration was not documented in R1's medical record.