Golden Years Rest Home

The facility failed to ensure that a medication aide (MA) completed required training on the care of diabetic residents prior to administering insulin. Personnel records showed no documentation of training for Staff A, who had been performing blood glucose monitoring since July 2025. The Administrator acknowledged that the required training was not completed within the 30-day window following the staff member's hire date.

The facility failed to ensure that 4 out of 3 sampled medication aides had completed required training on the care of diabetic residents prior to administering insulin. Specifically, Staff A had not completed the necessary training upon returning to work.

The facility failed to ensure that mandatory state-approved training on infection prevention and control policies and procedures was completed for 1 of 3 sampled staff within 30 days of hire. Staff A's personnel record lacked documentation of this required training.

The facility failed to ensure accurate documentation of finger stick blood sugar (FSBS) readings. For Resident #1, the glucometer values did not match the FSBS records for 4 out of 27 opportunities, with staff reporting issues with glucometer accuracy.

The facility failed to allow residents to freely enter or exit the premises because all four gates in the chain-link fence were kept locked with padlocks. This restriction was observed across a vehicle slide gate and three separate walk gates.

The facility failed to administer medications as ordered for one resident, specifically regarding errors with medications intended to treat high blood sugar. A review of the resident's records revealed that the physician's sliding scale insulin orders lacked documented meal time scheduled doses or specific sliding scale parameters.

The document indicates a requirement for tuberculosis testing upon employment or residency, but the provided text is truncated before the specific deficiency details are listed.

The facility failed to maintain hot water temperatures between 100 and 116 degrees Fahrenheit. Observations revealed water temperatures as high as 122°F at a resident bathroom sink and 120°F at a shared bathroom shower, with visible steam present.

The facility failed to provide a required notice of discharge and appeal rights for a resident who was discharged following an incident involving elopement. Documentation in the resident's record and resident register was incomplete, lacking discharge dates, reasons, and proof that notice was provided to an identified person.