Casa De Angeles Assisted Living INC

Based on record review and interview, the health care institution failed to ensure the health care institution administered a training program for all staff regarding fall prevention and fall recovery that included initial training for one of two personnel sampled. The deficient practice posed a health and safety risk for residents. Findings Include: 1. A review of E1's personnel file did not include documentation of continued competency training on fall prevention and fall recovery. Given E1's date of hire, this documentation was required. 2. In an exit interview, the findings were reviewed with E3, and no additional information was provided. This is a repeat deficiency from the complaint inspection conducted on May 29, 2024.

Based on documentation review and interview, the manager failed to ensure a disaster drill for employees was conducted on each shift at least once every three months and documented. Findings include: 1. A review of facility staffing schedules revealed the facility operated two twelve-hour shifts. 2. A review of facility documentation revealed documentation of disaster drills for day shift employees conducted on October 31, 2025, August 9, 2025, May 17, 2025, and February 12, 2025, however, further evidence of disaster drills conducted for employees on night shifts, every three months was unavailable for review. 3. In an exit interview, the findings were reviewed with E3. E3 acknowledged a disaster drill for employees was not conducted on each shift at least once every three months and documented as required. This is a repeat deficiency from the compliance/ complaint inspection conducted on November 21, 2023.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were maintained in a locked area, labeled, 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 tour of the facility, the Compliance Officer observed an unlocked cabinet under the kitchen sink, which contained several cleaning products, including a bottle of Lysol spray and a bottle of Comet bleach cleaner. 2. In an exit interview, the findings were reviewed with E3. E3 acknowledged that the poisonous or toxic materials were left in an unlocked area accessible to residents.

Based on observation, record review, and interview, the manager failed to ensure that pets or animals allowed in the facility had documentation of vaccination against rabies. Findings Include: 1. During an environmental inspection of the facility, the Compliance Officer observed two dogs roaming around the facility. 2. A review of the facility's records revealed no current documentation of rabies vaccinations for both dogs. 3. In an exit interview, the findings were reviewed with E3. E3 acknowledged the facility did not have documentation showing that the dogs had current rabies vaccinations.

Based on documentation review, record review, and interview, the health care institution failed to administer a training program for one of three sampled staff regarding fall prevention and fall recovery. Findings include: 1. A review of E3's personnel record revealed training in fall prevention and fall recovery was not available for review. 2. In an interview, E1 acknowledged documented training in fall prevention and fall recovery for E1 had not been completed for E3.

Based on record review and interview, the manager failed to ensure a resident had a written service plan which, when initially developed and when updated, was signed and dated by the resident or resident's representative, the manager, or the nurse or medical practitioner who reviewed the service plan. Findings include: 1. A review of R1's medical record revealed an undated initial service plan, for directed care level of services. The service plan did not include the required signature of the resident or the resident's representative, the manager, or the nurse or medical practitioner. 2. In an interview, E1 acknowledged the service plan provided for R1 was not signed, as required by the resident or resident's representative, the manager, or the nurse or medical practitioner who reviewed the service plan. E1 reported E2 must have the document as E1 knows it was signed, though was unable to locate at the time of the on-site inspection.

Based on record review, documentation review, and interview, the manager failed to ensure a caregiver or an assistant caregiver immediately notified the resident's emergency contact and primary care provider when a resident had an accident, emergency, or injury that resulted in the resident needing medical services. Findings include: 1. During the onsite inspection, the Compliance Officer reviewed R1's medical record. According to the, "Determination for Admission" form, R1 was receiving "Directed Care Services", further defined, "The above individual is incapable of recognizing danger, summoning assistance, expressing needs, or making basic decisions about their care." 2. A review of an incident report dated May 16, 2024, detailed R1 experienced a fall on May 16, 2024 at 5:20 am. The report indicated R1 reported no injuries and refused t go to the emergency room. The document further noted R1's representative was notified via text message by E1, on May 16, 2024 at 4 pm. 3. A review of a document titled, "Nurses Notes from 2024-03-01 through 5/2//2024", revealed documentation on May 18, 2024 by E3 stated, "R1 was trying to get up and down all day but has pain in hip so cant get up ...". On May 19, 2024, E3 noted, " ...still in pan refused Ibuprofen ...". On May 24, 2024, a note was made by E1, "Late entry. R1's lower right extremity presents with edema that was not present at the time of the fall or the day after. After discussing with home health nurse recent symptom and unable to bear weight on right extremity, decision was made to be seen by PCP. Appointment was on May 23, 2024." 4. In an interview, E1 reported being out of town when the fall occurred. E1 reported there was a time difference and that initially delayed contact, though E1 immediately reported to the resident's representative when E1 received the message. E1 reported the edema in R1's lower right extremity, in addition to continuing to not be able to bear weight, was observed on May 20, 2024. E1 reported R1 was seen by R1's medical practitioner on May 23, 2024, and sent to a local hospital for x-rays. 5. E1 acknowledged the delay, for a caregiver or an assistant caregiver immediately notifying the resident's emergency contact and primary care provider when a resident had an accident, emergency, or injury that resulted in the resident needing medical services, was due to E1 being out of the facility and difficult to reach. E1 acknowledged staff should have taken the initiative or contacted E2 rather than waiting for E1 to respond while out of the facility.

Based on record review and interview, the manager failed to ensure a written service plan was updated at least once every three months, for a resident receiving directed care services. Findings include: 1. A review of R2's (admitted 2019) medical record revealed a service plan for directed care services dated July 19, 2023. However, evidence of an updated service plan on or after October 19, 2023, was unavailable for review. 2. In an interview, E1 acknowledged R2's service plan was not updated at least once every three months.

Based on documentation review, record review, and interview, the manager failed to ensure entries in the medical record were not changed to make the initial entry illegible for one of two resident records sampled. Findings include: 1. A review of R1's medical record revealed a medication administration authorization form, signed by a medical provider and dated October 12, 2023. At the top of the form was a place to enter a "Resident's Name," however, the name initially written in the space had been covered with white correction tape, and R1's name was written over the top. 2. In an interview, E1 acknowledged the entry in R1's medical record had been changed to make the initial entry illegible.

Based on record review and interview, the manager failed to ensure that resident medical records contained documentation of assisted living services provided for two of two residents sampled. Findings include: 1. A review of R1's medical record revealed a service plan, dated June 19, 2023. The service plan indicated R1 was to receive Personal Care services for a variety of daily services to include the following: "Dressing: Morning & Bedtime, Total assist;" "Lotions: Lotion Applied to Skin during AM & HS care;" and "Skin Hygiene: Skin cleansed & checked with incontinence care daily." 2. A review of R1's medical record revealed a document used for tracking services and activities of daily living, dated "November, 2023." The document contained sections for documenting various services listed in the service plan, however there was no place to document the service "Dressing," "Lotions" or "Skin Hygiene." In addition, the document included areas for documenting services provided during the day and night hours, however the section for documenting night time services was blank. Further, the area for documenting services provided during day time hours contained no evidence of documentation of any services provided on November 2 or 15, 2023. 3. A review of R2's medical record revealed a service plan, dated July 19, 2023. The service plan indicated R2 was to receive Directed Care services for a variety of daily services to include the following: "Dressing: Morning & Bedtime, Needs assistance with shoes. [R2] can dress [themselves] if clothing laid out;" and "Hygiene:" Oral care supplies must be set up by staff." 4. A review of R2's medical record revealed a document used for tracking services and activities of daily living, dated "November, 2023." The document contained sections for documenting various services listed in the service plan, however there was no place to document the service "Dressing." In addition, the document included areas for documenting services provided during the day and night hours, however the section for documenting night time services was blank. Further, the area for documenting services provided during day time hours contained no evidence of documentation of any services provided on November 2, 13, 14 or 15, 2023. 5. In an interview E1 acknowledged there was no documentation of Dressing, Lotions or Skin Hygiene services provided to R1 and no documentation of Dressing or oral hygiene services provided to R2. E1 also acknowledged there was no documentation of any services provided to R1 or R2 in the night time hours, or for R1 on November 2 or 15, 2023, and for R2 on November 2, 13, 14 or 15, 2023.

Based on documentation review and interview, the manager failed to ensure a disaster drill for employees was conducted on each shift at least once every three months and documented. Findings include: 1. A review of facility staffing schedules revealed the facility operated two twelve hour shifts. 2. A review of facility documentation revealed documentation of disaster drills for day shift employees conducted on June 23 and November 10, 2023, and for night shift employees conducted on May 29, 2023. However, further evidence of disaster drills conducted for employees on both shifts, every three months was unavailable for review. 3. In an interview, E1 acknowledged a disaster drill for employees was not conducted on each shift at least once every three months and documented as required.