Colonial Woods

A strong odor of urine was noted in a shared bathroom.

Staff member exhibited hostile behavior toward residents and yelled at them during meals, violating their right to dignity and respect.

A resident's annual medical evaluation was not completed within the required timeframe.

The weekly menu for the upcoming week was not posted in a conspicuous and public place.

A new employee's criminal history background check was not requested on or before their start date.

Resident medical evaluations failed to include necessary information regarding emergency diagnosis/treatment, special health or dietary needs, and medication regimens.

The administrator's staff record did not include an updated criminal background check following a return to employment.

An individual listed as an administrator had not successfully completed the required 100-hour Department-approved training course.

The home failed to submit an incident report to the Department regarding a resident fall that resulted in a broken arm and bruised knee.

Only one staff member held a current CPR certification, leaving no certified staff on the premises during daytime hours.

The administrator's staff list was incomplete and did not include Staff Person B.

The staff training plan did not include the dates, times, and locations of scheduled training for the upcoming year.

Two unlabeled, used bars of soap were found in a cabinet above the bathroom sinks.

A black/green substance was present on the shower caulking, and a glucometer was used on the wrong resident.

Resident #3 did not have access to an operable bedside light source.

The mini refrigerator in the upper level living room lacked a thermometer.

No staff person employed by the home had obtained a nationally recognized food manager certification.

An incident of resident-to-resident abuse was not reported to the Department within the required 24-hour timeframe.

Direct care staffing was insufficient to provide the required one hour of personal care per resident on 1/22/22.

Only 61.4 percent of required direct care hours were provided during waking hours, failing to meet the 75 percent requirement.

The resident's support plan assessment failed to document the need for managing irritability, agitation, and aggression.

The home failed to submit an ACT 13 form regarding a resident abuse incident until ten days after the incident occurred.

Medication administration was not recorded at the time of administration, with a delay of over an hour noted.

Weekly menus were not posted in a conspicuous and public place within the home.

A resident's annual assessment was not completed according to the required schedule.

The resident's assessment and support plan failed to document aggressive behavior and how the resident's needs would be met.

A staff member transporting residents had not completed the required initial new hire direct care staff person training.

A resident did not receive required assistance with securing and using transportation as indicated in their assessment and support plan.