Care More Assisted Living

Based on record review and interview, the assisted living home that contacted an emergency responder on behalf of a resident failed to provide to the emergency responder a written document that included the reason the emergency responder was requested for two of two residents sampled. Findings include: 1. A review of R1's medical record revealed an incident report indicating the assisted living home called 911 on November 10, 2024, due to R1 having a fall. 2. A review of R2's medical record revealed an incident report indicating the assisted living home called 911 on November 16, 2024, due to R2 having a fall. 3. The Compliance Officers requested to review the EMS face sheets and corresponding information that was provided to the EMS responders for the aforementioned incidents involving R1 and R2, which E3 provided. A review of the documentation provided to the EMS providers for R1 and R2 included EMS face sheets that failed to include the reason the emergency responder had been requested. 4. In an interview, E1 reported E1 would update the form immediately to include a section to indicate the reason for requesting EMS in the future. E1 acknowledged the assisted living home failed to provide the emergency responders written documentation of the reason for requesting EMS.

Based on observation, documentation review, and interview, for a facility that provided directed care services, the manager failed to ensure there was a means of exiting the facility that provided access to an outside area which controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a risk if the facility was unaware of the general or specific whereabouts of a resident. Findings include: 1. A review of the license issued by the Department revealed the facility was licensed at the directed care level. 2. The Compliance Officers observed a patio door to the backyard did not control or alert employees of the egress of a resident. The door had a non working alarm. R3 was observed to exit the patio door, to the backyard, and the alarm did not sound. 3. The Compliance Officers observed the gate in the backyard, which opened to the front yard and street, had an alarm; however, it was not working at the time of inspection. 4. In an interview, E2 acknowledged the patio door was not controlled and did not alert the employees of the egress of a resident from the facility. 5. In an interview, E2 acknowledged the back gate was not controlled and did not alert the employees of the egress of a resident from the facility.

Based on observation and interview, the manager failed to ensure medications stored by the facility were stored in a separate locked room, closed, or self-contained unit. The deficient practice posed a risk to residents who could access the medication. Findings include: 1. During an environmental inspection of the facility with E3, the Compliance Officers observed 3 boxes of insulin in the door of the unlocked refrigerator. 2. In an interview, E3 acknowledged the medication was stored in an unlocked manner, and accessible to residents.

Based on observation and interview, the manager failed to ensure toxic materials stored by the facility were stored in a locked area and inaccessible to residents. 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 with E3, the Compliance Officers observed an unlocked caregiver bedroom led to an unlocked laundry room. The laundry room contained bottles of Windex, Lysol, Xtra laundry detergent, Comet, Glass Cook Top, Pledge, and an unlabeled bottle with a yellow liquid. The laundry room door had a locking device, however the door was not locked. 2. During an observation, the caregivers were not accessing the toxic materials at the time. 3. In an interview, E3 acknowledged toxic materials were stored in an unlocked manner.