Helping Hands Senior Living, LLC

Based on observation and interview, the manager failed to ensure that medications stored by the facility were stored in a locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed a health and safety risk for medications to be stored inappropriately. Findings Included: 1. During an environmental tour with E2, the Compliance Officers observed medication in the refrigerator door that was not locked. The medications were two boxes of “Insulin Lispro Kwik Pen Injection” 2. In an interview, E1 and E2 acknowledged that medication in the refrigerator was not stored in a locked room, closet, cabinet, or self-contained unit used only for medication storage. This is a repeat citation from the inspections conducted on November 7, 2024, and February 7, 2025.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance a resident submitted documentation signed by a medical practitioner or a registered nurse stating whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, for one of two residents reviewed accepted by the assisted living facility on or after October 1, 2013. The deficient practice posed a health and safety risk if the facility was unable to meet the needs of the resident. Findings include: 1. A review of R2's medical record revealed documentation stating R2 did not require continuous medical services and continuous or intermittent nursing services. However this document did not mention if the resident required restraints. Based on R2's acceptance date, this documentation was required. 2. A further look into R2's medical record revealed the aforementioned documentation did not have the date signed from a medical practitioner or a registered nurse. 3. In an interview, E3 acknowledged before or at the time of acceptance, R2 did not provide documentation signed and dated by a medical practitioner or a registered nurse stating whether the resident required restraints.

Based on record review, observation, and interview, the manager failed to ensure a medication was administered in compliance with a medication order, for one of two residents reviewed. 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 current written service plan which indicated R2 received medication administration. 2. A review of R2's medical record revealed signed medication orders dated August 15, 2024. These medication orders stated the following: - "Atenolol 100 MG One time daily take 1 tablet QD" - "Felodipin ER 2.5 MG One time daily take 1 tablet QD" 3. A review of R2's medical record revealed a November 2024 medication administration record (MAR). This MAR stated the following: - "Atenolol 100 MG One time daily take 1 tablet QD" and indicated the medication was administered at 8 AM November 1st-3rd. The MAR included the caregivers initials with a circle around the initials November 4th-7th. - "Felodipin ER 2.5 MG One time daily take 1 tablet QD" and indicated the medication was administered at 8 AM November 1st-3rd. The MAR included the caregivers initials with a circle around the initials November 4th-7th. 4. The Compliance Officers observed R1's medications, the following was observed: - Atenolol 100 MG was not available. - Felodipin ER 2.5 MG was not available. 5. In an interview, E3 reported they were having issues with the pharmacy with the Atenolol and Felodipin ER and reported the circles around the caregivers initials on the MAR indicated the medications were not available. E3 acknowledged R2's medications were not administered in compliance with the available medication order. 6. This is a repeat deficiency from the compliance inspection conducted July 3, 2023 and June 21, 2022.

Based on observation, documentation review, and interview, the manager failed to ensure medication 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 were not prescribed the accessible medication. Findings include: 1. The Compliance Officers observed a cabinet that had a locking mechanism. However, the cabinet was unlocked. Inside the cabinet contained the following: - At least three bottles of Polyethylene Glycol 3350 - At least four bottles of Lactulose Solution, USP 10 g/15 mL - At least three bottles of Rugby Chest Congestion Guaifenesin Oral Solution 16 Fl Oz 2. A review of the facility's policies and procedures revealed a policy titled, "VI. Medication Services" which stated, "1. A resident's medication is stored in the facility's secured cabinet," 3. In an interview, E3 acknowledged medications were not stored in a separate locked room, closet, cabinet, or self-contained unit.

Based on observation and interview, the manager failed to ensure foods requiring refrigeration were maintained at 41\'b0 F or below. The deficient practice posed a risk for potential food borne illnesses. Findings include: 1. The Compliance Officers observed an opened bottle of Kikkoman Teriyaki sauce in the pantry. This container stated, "Refrigerate after opening". 2. In an interview, E2 and E3 acknowledged the food was stored in the pantry and required refrigeration. 3. This is a repeat deficiency from the compliance inspection conducted July 3, 2023.

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. The Compliance Officers observed ambulatory residents in the facility. 2. The Compliance Officers observed Zep Grout Cleaner & Brightener stored inside a cabinet in a shared bathroom. 3. The Compliance Officers observed a spray bottle of glass cleaner in a private bathroom in an empty unlocked resident room. 4. A review of the facility's policies and procedures revealed a policy titled, "X. Security and Safety" which stated, "7. Poisonous and toxic materials stored by the facility are maintained in labeled containers in a locked area separate from food preparation and storage, dining areas, and medications and are inaccessible to residents." 5. In an interview, E3 acknowledged toxic materials were not locked in a secured area inaccessible to residents.

Based on record review and interview, the manager failed to ensure the caregiver documented the services provided in the resident's medical record, for two of two residents reviewed. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. Review of R1's record revealed a current written service plan for personal care services dated March 5, 2023. This service plan stated the following services were needed: "Oral Care - Requires total care - 2x daily and as needed" "Nail Care - Requires total care - daily and trim as needed" "Hair Care/shaving - Requires total care - comb hair daily and as needed" "Dressing - Requires total care - 2x daily and as needed" "Bathing - Requires total care - shower 2x every week and as needed, sponge bath on the days shower is not given, requires total care" "Toileting - Requires total care - brief change in bed daily as needed" However, documentation was not available indicating these services were provided July 1st - present. 2. Review of R2's record revealed a current written service plan for personal care services dated January 12, 2023. This service plan stated the following services were needed: "Nail Care - Requires total care - daily and trim as needed" "Hair Care/shaving - Requires Assistance - comb daily and as needed" "Dressing - Requires Assistance - 2x daily and as needed" "Bathing - Requires Assistance - shower 2x every week and as needed, sponge bath on the days shower is not given" "Toileting - Requires Assistance - daily as needed" However, documentation was not available indicating these services were provided July 1st - present. 3. In an interview, E1 acknowledged R1's and R2's medical records did not include documentation of the above listed services and reported the services were provided as indicated in the service plans. 4. This is a repeat deficiency from the compliance inspection conducted June 21, 2022.

Based on record review, observation, and interview, the manager failed to ensure a medication was administered in compliance with a medication order, for one of two residents reviewed. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. Review of R1's medical record revealed a current written service plan dated March 5, 2023. This service plan indicated R1 received medication administration. 2. Review of R1's medical record revealed signed medication orders dated March 20, 2023. These medication orders stated the following: "Donepezil (10mg oral tablet) 1 tab(s) oral once every day" "Trazodone 50 milligram oral daily at bedtime" 3. Review of R1's medical record revealed a June 2023 medication administration record (MAR). This MAR stated the following: "Donepezil HCL 10mg 1 oral tablet QD" and indicated one tab was administered at 8am June 1st - 16th. The MAR included the caregivers initials with a circle around the initials June 17th - 30th. A MAR was not available for July 2023. "Trazodone 50mg 1 oral tablet HS" and indicated one tab was administered at 8pm June 1st - 6th. The MAR included the caregivers initials with a circle around the initials June 7th - 30th. A MAR was not available for July 2023. 4. During an observation of R1's medications, the following was observed: Donepezil 10mg was not observed. Trazodone 50mg was not observed. 5. In an interview, E1 reported they were having insurance issues with the Donepezil and Trazodone and reported the circles around the caregivers initials on the MAR indicated the medications were not available. E1 acknowledged R1's medications were not administered in compliance with the available medication order. 6. This is a repeat deficiency from the compliance inspection conducted June 21, 2022.

Based on record review, observation, 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 against a medication order. Findings include: 1. Review of R1's medical record revealed a current written service plan dated March 5, 2023. This service plan indicated R1 received medication administration. 2. Review of R1's medical record revealed signed medication orders dated March 20, 2023. These medication orders stated the following: "Donepezil (10mg oral tablet) 1 tab(s) oral once every day" "Lithium 300mg 2 cap oral daily at bedtime" "Quetiapine 200mg 1 tab(s) oral daily at bedtime" "Quetiapine 25mg 1 tab(s) oral twice a day" "Trazodone 50 milligram oral daily at bedtime" 3. During an observation of R1's medications, the following was observed: Donepezil 10mg was not observed. Lithium 300mg was observed. Quetiapine 200mg was observed. Quetiapine 25mg was observed. Trazodone 50mg was not observed. 4. Review of R1's medical record revealed a June 2023 medication administration record (MAR). However a MAR was not available for July 2023. 5. Review of R2's medical record revealed a current written service plan dated January 12, 2023. This service plan indicated R2 received medication administration. 6. Review of R2's medical record revealed signed medication orders dated December 29, 2022. These medication orders stated the following: "Budesonide Suspension 0.5mg/2ml 2ml inhale orally every 12 hours" "Metoprolol Tartrate Tablet 25mg give 1 tablet by mouth every 12 hours" "Omeprazole Capsule Delayed Release 40mg give 1 capsule by mouth one time a day" "Paroxetine HCL tablet 20mg give 1 tablet by mouth one time a day" "Phenobarbital tablet 32.4mg give 2 tablet by mouth at bedtime and give 3 tablets by mouth in the morning" "Tamsulosin Capsule 0.4mg give 1 capsule by mouth one time a day" In addition, review of R2's medical record revealed a signed medication order dated March 27, 2023. This medication order stated "Gabapentine 100mg Capsule 1 capsule orally three times a day". 7. During an observation of R1's medications, the following was observed: Budesonide Suspension 0.5mg/2ml was observed. Metoprolol Tartrate 25mg was observed. Omeprazole 40mg was observed. Paroxetine HCL 20mg was observed. Phenobarbital 32.4mg was observed. Tamsulosin 0.4mg was observed. Gabapentine 100mg was observed. 8. Review of R2's medical record revealed a June 2023 MAR. However a MAR was not available for July 2023. 9. In an interview, E1 acknowledged R1's and R2's medical records did not include documentation the medications were administered to R1 and R2 in July 2023. 10. This is a repeat deficiency from the compliance inspection conducted June 21, 2022.

Based on observation and interview, the manager failed to ensure foods requiring refrigeration were maintained at 41\'b0 F or below. The deficient practice posed a risk for potential food borne illnesses. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed an open container of Heinz ketchup in the kitchen pantry. This container stated "Refrigerate after opening". 2. In an interview, E1 acknowledged the food was stored in the pantry and required refrigeration. 3. Technical assistance was provided on this Rule during the compliance inspection conducted June 21, 2022.

Based on record review and interview, the manager failed to ensure a resident received orientation to the exits from the assisted living facility and the route to be used when evacuating the assisted living facility within 24 hours of acceptance, for two of two residents reviewed. The deficient practice posed a health and safety risk if the resident needed to exit the facility in an emergency. Findings include: 1. Review of R1's medical record revealed documentation of orientation to the facility's evacuation plan. However, the orientation was not completed within 24 hours of acceptance. Based on R1's date of acceptance, this documentation was required. 2. Review of R2's medical record revealed documentation of orientation to the facility's evacuation plan. However, the orientation was not completed within 24 hours of acceptance. Based on R2's date of acceptance, this documentation was required. 3. In an interview, E1 acknowledged documentation was not available showing R1 and R2 were oriented to the facility's evacuation plan within 24 hours of acceptance.