Fisher Family Home, LLC

Based on record review and interview, the assisted living home failed to maintain a standardized form for each resident that included the information prescribed in subsection A of this section, except for the information prescribed in subsection A, paragraph 1 of this section, which shall be provided at the time the emergency responder was contacted. Findings include: 1 . A review of R1's and R2's medical record revealed documentation of a maintained standardized form for the emergency responder was not available for review at the time of inspection. 2 . In an exit interview, the findings were discussed with E1 and no additional information was provided.

Based on record review and interview, the manager failed to ensure medication administered to a resident was documented in the resident's medical record, for four of six residents sampled. Findings include: 1 . A review of R3's medical record revealed a signed medication order list for the following medications: -Levothyroxine 200 MCG 1 tablet daily; -Losartan 25 MG 1 tablet daily; -Amlodipine 10 MG 1 tablet daily; -Cetirizine 10 MG 1 tablet daily; -Famotidine 10 MG 1 tablet daily; -Pantoprazole 40 MG 1 tablet twice a day; -Methenamine 1 tablet twice a day; -Memantine 10 MG 1 tablet twice a day; and -Tamsulosin HCI 0.4 MG 1 capsule daily. However, the following medication was not documented as administered on the following dates: -Levothyroxine from November 19, 2025 to November 21, 2025; -Losartan from November 19, 2025 to November 21, 2025; -Amlodipine from November 19, 2025 to November 21, 2025; -Cetirizine from November 19, 2025 to November 21, 2025; -Famotidine from November 19, 2025 to November 21, 2025; -Pantoprazole from November 18, 2025 (PM) to November 21, 2025 (AM); -Methenamine from November 18, 2025 (PM) to November 21, 2025 (AM); -Memantine from November 18, 2025 (PM) to November 21, 2025 (AM); and -Tamsulosin HCI from November 19, 2025 to November 20, 2025.  2 . A review of R4's medical record revealed a signed medication order list for the following medications: -Sertraline 50 MG 1 tablet daily; -Albuterol 0.833 MG twice a day; -Ondansetron 4 MG 1 tablet twice a day; -Mirtazapine 30 MG 1 tablet daily; and -Gabapentin 250 MG 3 times a day. However, the following medication was not documented as administered on the following dates: -Sertraline from November 19, 2025 to November 21, 2025; -Albuterol from November 18, 2025 (PM) to November 21, 2025 (AM); -Ondansetron from November 18, 2025 (PM) to November 21, 2025 (AM); -Mirtazapine from November 19, 2025 to November 20, 2025; and -Gabapentin from November 18, 2025 (12 PM and 4 PM) to November 21, 2025 (8 AM). 3 . A review of R5's medical record revealed a signed medication order list for the following medications: -Ferrous Sulfate 325 MG 1 tablet daily; -Aripiprazole 5 MG 1 tablet daily; -Glipizide 5 MG once daily; -Omeprazole 20 MG once daily; -Apixaban 5 MG 1 tablet twice a day; -Gabapentin 300 MG 2 capsules three times a day; -Furosemide 40 MG 1 tablet twice a day; -Oxybutynin 5 MG three times daily; -Citalopram 10 MG 1 tablet daily; and -Metoprolol 25 MG 1 tablet twice a day. However, the following medication was not documented as administered on the following dates: -Ferrous Sulfate from November 19, 2025 to November 21, 2025; -Aripiprazole from November 19, 2025 to November 21, 2025; -Glipizide from November 19, 2025 to November 21, 2025; -Omeprazole from November 19, 2025 to November 21, 2025; -Apixaban from November 18, 2025 (PM) to November 21, 2025 (AM); -Gabapentin from November 18, 2025 (12 PM and 4 PM) to November 21, 2025 (8 AM); -Furosemide from November 18, 2025 (P

Based on documentation review, observation 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 in a bedroom. The deficient practice posed a risk if residents were unable to summon help from personnel members Findings include: 1. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. The Compliance Officer observed no bell, intercom, or other mechanical means to alert employees to a resident's needs or emergencies in one resident bedroom. 3. In an interview, E2 reported no bell, intercom, or other mechanical means to alert employees to a resident's needs or emergencies was available in the bedroom because R4 did not know how to use it and R1 had moved it out of the room. 4. In an interview, E2 acknowledged the resident bedroom had not included a bell, intercom, or other mechanical means to alert employees to a resident's needs or emergencies.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials stored by the facility were stored in a locked area and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of residents with access to the materials. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed a bottle of "Xtra plus Oxi Clean" detergent sitting on a washer in the backyard of the facility. The area was accessible by residents. 2. In an interview, E2 acknowledged the aforementioned poisonous or toxic materials were not stored in a locked location and inaccessible to residents.

Based on record review and interview, the health care institution failed to develop and administer a training program for all staff regarding fall prevention and fall recovery. Findings include: 1. A review of E1's and E3's personnel records revealed initial training and continued competency training in fall prevention and fall recovery was not available for review. 2. In an interview, E1 reported a fall prevention and recovery training program was developed and administered to some staff, but confirmed not all staff were trained at the time of the inspection.

Based on observation, documentation review, record review, and interview, the manager failed to ensure a caregiver's or assistant caregiver's skills and knowledge were verified and documented before the caregiver or assistant caregiver provided physical health services, for one of three sampled caregivers and assistant caregivers. Findings include: 1. The Compliance Officer arrived at the facility at approximately 11:00 AM. At the time of arrival, the Compliance Officer observed E1 performing yard work in the front yard, and E2 and E3 were working inside the facility with the residents. 2. A review of facility documentation revealed a daily staffing schedule dated July 2023. The July 2023 schedule indicated the facility operated on two shifts: 7:00 AM to 7:00 PM, and 7:00 PM to 7:00 AM. 3. A review of the June 2023 daily staffing schedule revealed E1 was scheduled to work on July 3, 10, 17, and 24, 2023 from 7:00 AM to 7:00 PM. 4. A review of E1's personnel record revealed no documented verification of E1's skills and knowledge. 5. In an interview, E1 reported E1 thought a skills and knowledge verification document was in each personnel file, and stated E1 would "get it corrected."

Based on observation, documentation review, and interview, the manager failed to ensure documentation was maintained of the caregivers and assistant caregivers who worked each day, including the hours worked by each. Findings include: 1. The Compliance Officer arrived at the facility at approximately 11:00 AM. At the time of arrival, the Compliance Officer observed E1 performing yard work in the front yard, and E2 and E3 were working inside the facility with the residents. 2. A review of facility documentation revealed a daily staffing schedule for July 2023. The July 2023 schedule indicated E1 was scheduled to work on July 3, 10, 17, and 24, 2023 from 7:00 AM to 7:00 PM. The July 2023 schedule did not indicate E3 was scheduled to work on July 25, 2023, the day of the inspection. E3 was not included on the July 2023 work schedule. 3. In an interview, E1 stated E3 was a new employee and E1 had not revised the work schedule. E1 acknowledged the manager failed to ensure accurate documentation of the caregivers and assistant caregivers who worked each day, including the hours worked by each, was not maintained.

Based on documentation review, observation, and interview, the manager of a facility authorized to provide directed care services failed to ensure a means of exiting the facility, allowing the resident to be at least 30 feet away from the facility, was controlled or alerted employees 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, the Compliance Officer observed three doors exiting the facility allowing the resident to be at least 30 feet away from the facility. Alarms were installed on the doors, however, none of the alarms observed controlled or alerted employees of the egress of a resident from the facility. 3. In an interview, E1 acknowledged the doors exiting the facility did not control or alert employees of the egress of a resident from the facility at the time of the inspection. E1 immediately changed the batteries in the door alarms and turned the units on to alert staff of any resident egress.

Based on observation and interview, the manager failed to ensure equipment used at the assisted living facility was free from a condition or situation that may cause a resident or other individual to suffer physical injury. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed the flooring in the dining room was lifting off of the floor in two different locations, presenting a tripping hazard. 2. In an interview, E1 acknowledged the flooring lifting away from the floor and reported E1 previously contacted the home owner to get the flooring fixed. E1 contacted the home owner again while The Compliance Officer was onsite.