Cogir of Northgate Memory Care

The facility failed to implement a system to promote safe medication services for 1 resident by failing to notify a primary care provider of blood glucose readings that fell outside of specified ordered parameters on 15 separate occasions.

The facility failed to ensure a staff member with a positive TB blood test completed a chest X-ray within seven days or received a symptom evaluation.

The facility failed to follow the Respiratory Protection Program (RPP) as 3 of 3 sampled staff had either expired or non-existent respirator fit-testing records despite providing care during a COVID outbreak.

Missing documentation for annual fire alarm testing, monthly single station smoke alarm testing, and smoke detector sensitivity testing.

Kitchen door to dining room has a deadbolt that prevents the door from closing/latching automatically.

Missing documentation for annual fire door inspection.

Activity room using an extension cord as permanent wiring for a mini fridge.

Missing documentation for monthly CO detector testing; CO detector in kitchen is non-functional.

Missing documentation for annual inspection, 5-year internal piping inspection, 3-year dry system full flow trip test, FDC hydrostatic test, and annual backflow forward flow test.

Missing documentation for 4-year fire and smoke damper inspection.

Missing required signage on exhaust hood/system cabinet.

Missing documentation for annual fire wall inspection; ceiling tiles missing in back hall by kitchen.

Missing documentation for semi-annual kitchen suppression system service; kitchen system was yellow tagged.

Missing documentation for monthly 30-second activation test and annual 90-minute power test for emergency lights.