Good Samaritan Society Estes Park Village

A relicensure survey was completed on 1/7/25. No deficiencies were cited. THIS PORTION OF THE REPORT IS FOR INFORMATIONAL PURPOSES ONLY. No response is necessary. The residence was advised it must review and maintain the following processes in accordance with existing program regulations found at 6 CCR 1011-1, Chapter 7.9.2 The assisted living residence shall have written policies and procedures regarding the visitation rights detailed in Section 25-3-125(3)(a), C.R.S. Such policies and procedures shall: (A) Set forth the visitation rights of the resident, consistent with 42 CFR 482.13(h); 42 U.S.C. 1396r(c)(3)(C); 42 U.S.C. 1395i(c)(3)(C); 42 CFR483.10(a), (b), and (f); and Section 2527-104, C.R.S., as applicable to the facility type; (B) Describe any restriction or limitation necessary to ensure the health and safety of residents, staff, or visitors and the reasons for such restriction or limitation; (C) Be available for inspection at the request of the Department;(D) Be provided to residents and/or family members upon request; and (E) Include the right of each resident of an assisted living residence to have at least one visitor of the resident ' s choosing during their stay at the residence, unless restrictions or limitations under federal law or regulation, other state statute, or state or local public health order apply. This visitation right shall be exercised in accordance with the following: (1) A visitor to provide a compassionate care visit to alleviate the resident' s physical or mental distress. (2) For a resident with a disability:(a) A visitor or support person, designated by the resident, orally or in writing, to support the resident during the course of their residency. The support person may visit the resident and may exercise the resident ' s visitation rights even when the resident is incapacitated or otherwise unable to communicate. (b) When the resident has not otherwise designated a support person and the resident is incapacitated or otherwise unable to communicate their wishes, an individual may provide an advance medical directive designating the individual as the resident ' s support person or another term in..

A licensure complaint, prompted by #CO35399, was completed on 4/23/24. Deficiencies were cited. Based on interview and record review, the residence failed to ensure that each qualified medication administration person documented accurate information in the medication administration record (MAR), including any medication omissions; the residence additionally failed to ensure that, as part of the MAR, the residence maintained a legible list of the names of the persons utilizing the MAR, along with their signatures and initials, affecting three of three sample residents whose medications were reviewed (#1-#3).Findings include:1. Residence PolicyThe residence' s medication errors policy, dated 12/6/23, read in part that the qualified medication administration persons (QMAP) or licensed nurse would document all medications at the time of occurrence, to include what occurred and whether a medication was administered or omitted, along with any resident responses.2. Legible list of qualified medication administration person (QMAP) names on MARsA review of the March and April 2024 MARs for Resident #1-#3 revealed the residence f.. Based on interview and record review, the residence failed to prepare and administer only medications ordered by an authorized practitioner to residents, affecting one of three sample residents whose medications were reviewed (#1).Findings include:1. Reference Chapter VII regulations governing assisted living residences, part 14.17, requires the assisted living residence shall ensure that each authorized practitioner' s order for medication includes ... the signature of the practitioner.2. Resident #1 was admitted to the residence on 10/1/22.a. Doxycycline hyclate The April 2024 medication administration record (MAR) read Resident #1 was administered doxycycline hyclate 100 mg twice daily for ten days, on 4/11-4/20/24, for a total of 20 doses. However, the residence was unable to provide a signed practitioner' s order for the medication. b. Hydrocodone-acetaminophenThe April 2024 MAR read Resident #1 was administered hydrocodone acetaminophen 5 mg-325 mg one tablet on 4/11/24 at 8:00 p.m for a total of one dose. H.. Based on record review and interview the residence failed to comply with authorized practitioner orders associated with medication administration affecting one of three sample residents whose medications were reviewed (#2). Findings include:1. Resident #2 was admitted to the residence on 10/16/23.A written practitioner' s order dated 4/13/24 directed the residence to administer doxycycline hyclate 100 mg twice daily for seven days. However, the April 2024 medication administration record revealed that staff did not administer the medication on the morning of 4/20/24 to complete the course, for a total of one missed dose. A medication error communication report sent from the residence to Resident #2' s practitioner, dated 4/22/24, read Resident #2 was prescribed a seven day course of doxycycline hyclate, and the last dose was missed. On 4/23/24 at approximately 12:51 p.m., the executive manager stated she would expect the residence to comply with practitioner' s orders and would have expected Resident #2 to ..

A revisit survey was completed on 5/4/23 for all previous deficiencies cited on 6/1/22. No deficiencies were cited. Citation coded "0000" or "9999" are initial and final comments of an inspection for informational purposes, this field may also have been left blank intentionally