Family Care Assisted Living Home

Based on observation and interview, the manager failed to ensure a list of resident rights was conspicuously posted. Findings include: 1. During a tour of the facility with E1, the Compliance Officer observed a posting titled "Resident Rights". However the posted list of rights was not the current resident rights listed in R9-10-810.C. 2. In an interview, acknowledged the required list of resident rights was not conspicuously posted.

Based on record review and interview, the manager failed to ensure a written service plan was updated at least once every three months, for one of two residents reviewed who received directed care services. The deficient practice posed a health and safety risk to the resident if the employees did not know what services the resident needed. Findings include: 1. Review of R2's medical record revealed a current written service plan for directed care services dated December 1, 2023. However, a service plan after December 1, 2023 was not available for review. 2. In an interview, E1 acknowledged R2 received directed care services and the service plan was not updated at least once every three months.

Based on record review and interview, the manager failed to ensure a resident's medical record contained documentation of medication administered to the resident that included the correct strength, for one of two residents reviewed. Findings include: 1. A review of R1's medical record revealed a medication order (dated November 9, 2023) which stated "Discontinue Celexa 10mg. Start Celexa 20mg, 1 tab PO daily for depression." 2. A review of R1's medication revealed a bottle of Citalopram [generic equivalent for Celexa] 20mg tabs. 3. A review of R1's Medication Administration Record (MAR) showed "Citalopram 10mg 1 tb P.O. QD" recorded as administered every day from March 1, 2024 to March 24, 2024. 4. In an interview, E1 acknowledged the resident's medical record did not contain documentation of medication administered to the resident that included the correct strength.

Based on observation, record review, and interview, the manager failed to ensure a bell, intercom, or other mechanical means to alert employees to a resident's needs or emergencies was available and accessible in a bedroom being used by a resident receiving directed care services. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During a tour of the facility with E1, the Compliance Officer observed R1's and R2's bedrooms did not have a bell, intercom, or other mechanical means to alert employees to a residents needs or emergencies accessible to a resident in bed. However, there was a bell on a side table on the other side of the room, not within reaching distance to either resident's bed. 2. Review of R1's and R2's medical records revealed both receive directed care services. 3. In an interview, E1 acknowledged the bells were not accessible to alert employees to a resident's needs or emergencies in a bedroom being used by a resident receiving directed care services.

Based on documentation review, observation, and interview, the manager failed to ensure the 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, controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a risk to the health and safety of the residents. Findings include: 1. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. A review of facility policies and procedures revealed a document titled "Wandering", which states: "If alarms are being used on doors and/or windows, the caregiver will check them daily for operation and security." 3. During the facility tour with E1, the Compliance Officer observed the door leading out to the backyard. The outside area, in the backyard, allowed residents to be at least 30 feet away from the facility. The door leading out to the backyard had a device that was intended to alert employees to the egress of a resident to the outside area. However, the device did not work. 4. In an interview, E2 reported the alarm does work, but the battery was dead. 5. In an interview, E1 acknowledged there was not a means of exiting the facility that controlled or alerted employee of the egress of the resident.

Based on observation and interview, the manager failed to ensure hot water temperatures were maintained between 95\'b0 F and 120\'b0 F in the areas of a facility used by residents, which posed a health and safety risk to the residents. Findings include: 1. During the facility tour with E1, the Compliance Officer observed the hot water temperature at 127.3\'b0 F in the hall bathroom near resident bedrooms. 2. Review of facility documentation revealed a policy titled "Emergency, Safety and Environmental Standards." The policy stated "Hot water temperature will be maintained between 95\'b0F and 120\'b0F at all times." 3. In an interview, E1 acknowledged the hot water temperatures were not maintained between 95\'b0 F and 120\'b0 F in the areas of a facility used by residents.

Based on record review and interview, the manager failed to ensure a medication administered to a resident was documented in the resident's medical record for two of two residents reviewed. The deficient practice posed a risk as medication could not be verified as administered. Findings include: 1. A review of R1's March 2024 medication administration record (MAR) revealed the following medications were not documented as administered to R1 from March 25 to March 28: -Quetipoine 25mg -Senna Plus 8.6 50mg -Celexa 10mg -Trazadone 100mg 2. A review of R2's March 2024 MAR revealed the following medications were not documented as administered to R2 from March 25 to March 28: -Citalopram 10mg -Senna Plus 8.6 50 mg -Quetiapine 100mg -Quetiapine 25mg -Olanzapine 10mg -Lactulose 10gm/15 5ml -Trazadone 50mg 3. In an interview, E1 acknowledged R1's and R2's medication administration was not documented in R1's and R2's medical record.

Based on observation and interview, the manager failed to ensure a current drug reference guide was available for use by personnel members. Findings include: 1. The Compliance Officer observed the facility's drug reference guide shows "The Pill Book - 15th Edition (published 2012)." No other editions have been published for this book. However, other current edition of a pill books are available. 2. In an interview, E1 acknowledged the need to purchase a current drug reference guide for use by personnel members.

Based on observation and interview, the manager failed to ensure that a current toxicology reference guide was available for use by personnel members. Findings include: 1. The toxicology guide available for use by personnel members was the CRC Handbook of Toxicology, 1st edition. 2. Review of the web site for the toxicology guide revealed that a more current edition was available for distribution. 3. During an interview, E1 acknowledged that a current toxicology reference guide was not available for use by personnel members.

Based on observation and interview, the manager failed to ensure medication stored by the assisted living facility was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed a risk to residents who could access the medication. Findings include: 1. During the facility tour with E1, the Compliance Officer observed Trazodone tablets prescribed to R2 on a dresser in an unlocked caregiver bedroom. In addition, the Compliance Officer observed Equate Nasal Spray on a shelf in the resident-accessible garage. 2. During an observation, the caregivers were not accessing the medications at the time of arrival. 3. In an interview, E1 acknowledged the medication was not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage.

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. The deficient practice posed a risk if employees were unable to implement the disaster plan. Findings include: 1. Review of the March 2024 personnel schedule revealed two shifts; AM and PM. 2. Review of the facility's employee disaster disaster drills revealed the most current disaster conducted August 2, 2023 on the AM and PM shift. No other disaster drills were available after August 2, 2023. 3. Review of facility policies revealed a policy titled "Emergency and Safety Standards" which stated "Staff evacuation drills will be conducted at least every three months on each shift. 4. In an interview, E1 acknowledged a disaster drill for employees was not conducted on each shift at least once every three months and documented.

Based on observation and interview, the manager failed to ensure the premises at the assisted living facility were free from a condition or situation that may cause a resident or other individual to suffer physical injury. Findings include: 1. During the facility tour with E1, the Compliance Officer observed the following: -The side yards, accessible by residents, were lined with several objects that obstructed the walkway and presented tripping hazards, including: broken bicycles, broken lamps, stacked household objects, a motorcycle. -An unlocked and open shed, accessible to residents, containing several sharp hazards, including: a hatchet hanging on the wall by a nail, saw blades, power tools. 2. In an interview, E2 reported R1 was ambulatory. 3. In an interview, E1 acknowledged the premises at the assisted living facility was not free from a condition or situation which may cause a resident or other individual to suffer physical injury.

Based on documentation review and interview, the manager failed to ensure a pest control program in compliance with R3-8-201(C)(4) was implemented and documented. Findings include: 1. The Compliance Officer requested documentation of the facility's pest control program. However, documentation was not available for review. 2. In an interview, E1 acknowledged documentation of the facility's pest control program had not been provided for review.

Based on observation, documentation review, and interview, the manager failed to ensure garbage and refuse were stored in covered containers lined with plastic bags. Findings include: 1. During a tour of the facility with E1, the Compliance Officer observed an open plastic bag on the kitchen counter containing: eggs shells, banana peels and soiled napkins. In addition, the Compliance Officer observed several flies flying around the bag. 2. The Compliance Officer observed a trash can in the kitchen with out a cover, and a trash can in the common are bathroom without a cover. 3. A review of facility policies revealed a policy titled "Emergency, Safety, and Environmental Standards" which states "All garbage and refuse will be stored in covered containers inside and outside the main facility." 4. In an interview, E1 reported the trash was left on the counter the day before the inspection. E1 acknowledged garbage was not stored in covered containers.

Based on observation, documentation review, and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were maintained in a locked area inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. In an interview, E2 reported R1 was ambulatory. 2. During the facility tour with E1, the Compliance Officer observed the following: -One bottle of Downy Wrinkle Release in an unlocked garage; -One bag of Miracle Grow on the ground in the back yard; -Two bottles of Castrol Edge motor oil on the ground in the back yard; -One can of WD-40 on the ground in the back yard; -Two cans of Glidden Essentials exterior paint on the ground in the back yard; -One can of Pentosin CHF 11S on the ground in the back yard; -Two cans of WD-40 in an unlocked and open shed in the back yard; -One can of oven cleaner in an unlocked and open shed in the back yard; -One container of Clorox wipes on a table in the common area; -One bottle of GooGone in an unlocked cabinet under the kitchen sink; -One bottle of Windex in an unlocked cabinet under the kitchen sink; -One bottle of Lysol in an unlocked cabinet under the kitchen sink; -One unlabeled spray bottle of blue liquid in an unlocked cabinet under the kitchen sink. 3. A review of facility documentation revealed a policy titled "Emergency, Safety, and Environmental Standards". The policy stated "Poisonous and toxic materials will be in labeled containers and stored in locked areas separate from food preparation and storage areas." 4. In an interview, E1 acknowledged poisonous or toxic materials stored by the assisted living facility were not maintained in a locked area inaccessible to residents.

Based on observation, documentation review, and interview, the manager failed to ensure combustible or flammable liquids and hazardous materials stored by the assisted living facility were stored in a locked area inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. In an interview, E2 reported R1 was ambulatory. 2. During the facility tour with E1, the Compliance Officer observed the following: -One bottle of Lucas Injector Cleaner in an unoccupied, unlocked resident bedroom; -One container of FlameKing propane on the ground in the back yard; -Two lighters in an unlocked cabinet in the kitchen. 3. A review of facility documentation revealed a policy titled "Emergency, Safety, and Environmental Standards". The policy stated "Combustible, flammable, and other hazardous materials will be stored in safety approved containers outside the facility in a locked secure area that is inaccessible to residents." 4. In an interview, E1 acknowledged combustible or flammable materials stored by the assisted living facility were not maintained in a locked area inaccessible to residents.

Based on observation and interview, the manager failed to ensure the bathroom accessible from the common area contained paper towels in a dispenser or a mechanical air hand dryer. Findings include: 1. During the facility tour with E1, the Compliance Officer observed a roll of paper towels balanced on the toilet tank. However, the paper towels were not in a dispenser. 2. In an interview, E1 acknowledged the bathroom accessible from the common area did not contain paper towels in a dispenser or a mechanical air hand dryer.

Based on observation and interview, the manager failed to ensure a resident bathroom contained a slip-resistant surface in the shower. Findings include: 1. During a tour of the facility with E1, the Compliance Officer observed the facility's common area bathroom contained a shower. However, the shower did not contain a slip-resistant surface. 2. In an interview, E1 acknowledged the shower in the common area bathroom did not contain a slip-resistant surface.