Brookdale North Mesa

Based on record review and interview, the manager failed to ensure service plans included the amount, type, and frequency of assisted living services and ancillary services being provided, for five of eight sampled residents. Findings include: 1. A review of R3's service plan dated May 19, 2025, reflected R3 required assistance with dressing and grooming, showering or bathing, bathroom, assistance due to R3's inability to stand independently during dressing or grooming, however R3's service plan did not include the amount, type and frequency of dressing services that would be provided. 2. A review of R4's service plan reflected R4 required assistance with showering and bathing Tuesday and Friday, however there was no frequency R4 would be provided showers or baths. R4's service plan also reflected R4 required assistance with dressing and grooming, as states "dates and times of showers, laundry, and housekeeping may vary depending on resident preferences and as needed"; However, the amount, type, and frequency of services was not noted. 3. A review of R5's service plan reflected R5 required assistance with toileting, dressing, grooming and showering and assistance, however, the amount, type, and frequency of services was not noted. 4. A review R6's service plan dated April 24, 2025, reflected R6 required assistance with toileting, dressing, grooming and showering and escorts, however, the amount, type, and frequency of services was not noted. 5. A review of R8's service plan dated May 16, 2025, reflected R8 required assistance with dressing, grooming, and showering, however the amount, type, and frequency of services was not noted. 6. In an interview, E1 reviewed the above service plans and acknowledged being unable to locate the amount, type and frequency of the above service plan at the time of the survey.

Based on record review, observation, documentation review, and interview, the manager failed to ensure a caregiver provided a resident with the assisted living services in the resident's service plan, for one of eight sampled residents. Findings include: 1. A review of R4's service plan reflected R4 required assistance with showering and bathing Tuesday and Friday. A review of documentation of provided services reflected R4 was not provided a shower on Friday, June 6, 2025. 2. In an interview, E1 reviewed and acknowledged a review of R4's documentation reflected R4 was not provided a shower on Friday, June 6, 2025, as required by R4's service plan.

Based on the record review and interview, the manager failed to ensure that medication was administered to a resident in compliance with a medication order for three of three residents sampled. Findings include: 1. A review R1's medical record revealed a service plan dated November 12, 2024, that reflected R1 received medication administration services. 2. A review of R2's medical record revealed a medication order dated October 31, 2023 for Losartan Potassium 100 mg administer one tablet daily for HTN hold for systolic blood pressure less than 100 and pulse less than 60 bpm. 3. A review of R2's December 2024 medication administration record (MAR) revealed the following: on December 4, 2025, R2's blood pressure was 131/75 and R2 was not administered Losartan; on December 7, 2025, R2's blood pressure was 99/57, R2 was administered Losartan; on December 10, 2025, R2 blood pressure was 135/79, R2 was not administered Losartan; on December 14, 2025, R2 blood pressure was not documented and R2's Losartan was not administered. 4. In an interview, E1 reviewed and acknowledged there was no additional documentation R2's Losartan medication was given in compliance with an order.

Based on observation and interview, the manager failed to ensure food was protected from potential contamination which posed a health and safety risk. Findings include: 1. During an environmental tour of the facility's kitchen, the Compliance Officer observed the dry storage area. The dry storage area contained plastic containers of flour, sugar, and brown sugar with the lids not attached. The uncovered and opened food items were not protected from the potential contamination. 2. In an interview, E2 acknowledged food was not protected from potential contamination.