Brookline Village and Cottage Senior Living

A re-hired direct care staff member was providing unsupervised ADL services without completing the required Department-approved training and competency test.

A copy of the regulations was not posted in a conspicuous and public place in the home.

A direct care staff member's employment file lacked a high school diploma, GED, or active registry status.

The home has not conducted a quality management meeting since March 2022.

The home did not have a staff training plan developed for the 2024 training year.

No signs were posted at the entrances indicating whether smoking is permitted, as required by the Clean Indoor Air Act.

There was no record that the home's written emergency procedures had been submitted annually to the local emergency management agency.

The administrator and staff were not familiar with the local municipality's emergency preparedness plan, and a copy was not present in the home.

During a fire drill, residents were not evacuated to a designated meeting place away from the building.

On several dates in July 2023, no direct care staff certified in First Aid/CPR were present in the home during night shifts.

Staff Member A and B lacked documentation of a high school diploma, GED, or active registry status.

The facility did not have a staff training plan developed for the 2023 training year.

Staff Members A and B provided unsupervised ADL services before completing the required Department-approved training and competency test.

A resident bed featured an enabler bar with a 12-inch vertical opening, creating a potential entrapment hazard.

Staff failed to follow prescriber's orders regarding insulin dosages, administering incorrect units based on discrepancies between glucometer readings and MAR documentation.

A prescribed medication for Resident #1 was not available in the home on the date of inspection.