Dignified Assisted Living

Based on documentation review, record review, and interview, the manager failed to ensure the health care institution developed and administered a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk if facility staff were not properly trained to assist a resident who had fallen and was unable to recover independently. Findings include: 1. A review of facility documentation revealed no documentation of a developed and administered fall prevention and fall recovery training program. 2. A review of E1's, E2's, and E3's personnel records revealed no documentation of fall prevention and fall recovery training. 3. In an interview, the Compliance Officer requested the facility's fall prevention and fall recovery training program and documentation of training of staff. However, no documentation of a fall prevention and recovery training program was provided for review. E1 acknowledged there was no documented fall prevention and fall recovery training program available for review.

Based on documentation review, record review, and interview, the manager failed to ensure a personnel record for each employee included documentation of the individual's completed in-service education required by policies and procedures, for three of three personnel records sampled. The deficient practice posed a risk if the employees were unable to meet a resident's needs. Findings include: 1. A review of facility policies and procedures revealed a policy and procedure which stated "Policy Statements: 1. The Governing Authority / Manager shall ensure that each manager and caregiver completes every 12 months from the starting date of employment, or for a manager or caregiver hired before the effective date of this Article, every 12 months from the effective date of this Article...Procedures: 1. A minimum of six hours of ongoing training in the following areas will be accomplished..." 2. A review of E1's, E2's, and E3's personnel records revealed E1, E2, and E3 were employed at the facility for more than 24 months. However, E1's, E2's, and E3's personnel records did not contain documentation of a minimum of six hours of completed in-service education. 3. In an interview, E1 reviewed E1's, E2's, and E3's personnel records and acknowledged the records did not contain documentation indicating E1, E2, and E3 received in-service education as required per the facility's policies and procedures.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance, an individual submitted documentation dated within 90 calendar days before the individual was accepted by the facility, to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant, for two of two sampled residents. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R1's medical record revealed a determination letter dated June 6, 2023, which reflected R1 did not require continuous medical services, continuous nursing services, or restraints. R1's determination letter was completed after R1's date of acceptance. 2. A review of R2's medical record revealed a determination letter dated April 30, 2023, which reflected R2 did not require continuous medical services, continuous nursing services, or restraints. R2's determination letter was completed after R1's date of acceptance. 3. In an interview, E2 acknowledged R1's and R2's determination letters were completed after R1's and R2's admission dates. This is a repeat citation from the previous compliance inspection conducted on September 7, 2022.

Based on record review and interview, the manager failed to ensure a resident's written service plan was signed and dated by the resident or resident's representative, for one of two sampled residents. Findings include: 1. A review of R2's medical record revealed a service plan dated April 30, 2023. However, R2's service plan did not contain the signature of R2 or R2's representative. 2. In an interview, E1 acknowledged R2's service plan did not contain the signature of R2 or R2's representative.

Based on record review, observation, and interview, the manager failed to ensure a resident's medical record included the dosage for a medication administered, for one of two sampled residents. Findings include: 1. A review of R1's medical record revealed a medication order dated August 2, 2023 for "Insulin Lispro injection solution 100 unit/ML (milliliters) inject per sliding scale: if 70 through 150 administer zero units, 151 through 200 administer two units, 201 through 250 administer four units, 251 through 300 administer four, 301 through 350 administer six units, 351 through 400 administer eight units; 401 plus administer 10 units if blood glucose is greater than 400 administer 10 units and notify provider." 2. A review of R1's medical record revealed a document titled "Medication Administration Sheet" which was a log sheet used to measure R1's blood glucose levels. R1's blood glucose levels ranged from 132 through 349 on various days in September and October of 2023. However, R1's "Medication Administration Sheet" did not reflect the amount of insulin given or withheld from R1. 3. A review of R1's medical record revealed a medication administration record (MAR) dated September 2023. The MAR reflected R1 was administered "Insulin Lispro" from September 1, 2023 through September 30, 2023. However, R1's September MAR did not reflect the amount of insulin given or withheld from R1. 4. In an interview, E1 reviewed and acknowledged R1's medical record did not include the dosage administered to R1.

Based on documentation review, observation, and interview, the manager failed to ensure for a facility authorized to provide directed care services, there was a means of exiting the facility for a resident who does not have a key, special knowledge for egress, or the ability to expend increased physical effort and provided access to an outside area which allowed the resident to be at least 30 feet away from the facility and 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 egress of a resident from the facility. Findings include: 1. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. During the environmental inspection of the facility with E2, the Compliance Officer observed when exiting from the patio door to the backyard, no alarm sounded to alert employees of the egress of a resident from the facility. There was also no way to control a residents' egress from the facility. 3. In an interview, E2 acknowledged the patio door did not alert employees of the egress of a resident from the facility.

Based on record review, observation, and interview, the manager failed to ensure medication administered to a resident was administered in compliance with a medication order, for one of two sampled residents. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. A review of R2's medical record revealed a medication order dated August 5, 2023 for "Omeprazole 20 mg (milligrams) one tablet by mouth before breakfast and before evening meal do not crush, chew or split." 2. The Compliance Officer observed R2's "Omeprazole 20 mg" inside R2's medication bin. 3. A review of R2's medical record revealed a medication administration record (MAR) dated September 2023. The MAR reflected "Omeprazole 20 mg 1/2 tab" was administered daily at 8:00 AM from September 1, 2023 through September 30, 2023. 4. In an interview, E1 reported being under the impression "Omeprazole" was an "as-needed" medication. E1 reported E1 would review the order.

Based on observation and interview, the manager failed to ensure hot water temperatures were maintained between 95 \'b0F and 120 \'b0F in areas of the assisted living facility used by residents. The deficient practice posed a potential burn risk to residents. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed a shared resident bathroom. Using a Department-issued thermometer, the Compliance Officer measured the hot water temperature and observed it to be 135.7 \'b0F in the sink of the shared resident bathroom. 2. In an interview, E2 acknowledged the hot water temperature was not maintained between 95 \'b0F and 120 \'b0F.

Based on observation and interview, the manager failed to ensure oxygen containers were secured in an upright position. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed two oxygen tanks upright but unsecured inside R3's bedroom closet. 2. In an interview, E2 acknowledged the oxygen tanks were not secured.