Highland Assisted Living LLC

Based on record review and interview, the manager failed to ensure that before or at time of acceptance of an individual submitted documentation that was dated within 90 calendar days before the individual was accepted by an assisted living facility and included whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints and was signed and dated by a medical practitioner, for one of two residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R2's medical record revealed a document titled "Determination for Residency or Continued Residency." This document contained whether or not R2 required continuous medical services, continuous or intermittent nursing services, or restraints and was signed and dated by a registered nurse or medical practitioner. However, the form was not signed before R2’s date of admission to the facility. 2. In an interview, E1 acknowledged R2's medical record did not contain the required documentation that was dated 90 days before R2 was accepted by the facility.

Based on record review and interview, the manager failed to ensure that a resident had a written service plan that included the amount, type, and frequency of assisted living services being provided to the resident, for one of two residents sampled. Findings include: 1. A review of R1’s medical record revealed a service plan, dated March 10, 2025. R1’s service plan revealed R1 required the following services: Standby assistance with dressing; Full assistance with dressing; Standby assistance with socks and shoes; Full assistance with socks and shoes; Standby assistance with clothing; Full assistance with clothing; Standby assistance with picking out clothes; Full assistance with picking up clothes; Independent with grooming; and Dependent with grooming. 2. In an interview, E1 reported R1 required the full assistance indicated on R1’s service plan. E1 acknowledged R1’s service plan did not include the amount and type of assisted living services provided to R1.

Based on documentation review and interview, the manager failed to ensure that a current toxicology reference guide was available for use by personnel members. Findings include: 1. A review of the facility's toxicology reference guide revealed a publishing year of 2015. However, documentation of a current toxicology reference guide was not available for review. 2. In an interview, E1 acknowledged a current toxicology reference guide was not available for use by personnel members.

Based on observation, documentation review, and interview, the manager failed to ensure the premises were free from a condition or situation that may cause a resident or other individual to suffer physical injury. The deficient practice posed a health and safety risk to the residents. Findings include: 1. During an environmental inspection of the facility, the Compliance Officers observed a garden hose in the backyard walkway. 2. During an environmental inspection of the facility, the Compliance Officers observed a Hoyer lift in the backyard area. 3. During an environmental inspection of the facility, the Compliance Officers observed a wooden structure, that had nails and staples sticking out. 4. A review of the facility's policies and procedures titled "Environmental Safety" revealed "A manager shall ensure that the premises and equipment used at the assisted living facility are free from a condition or situation that may cause a resident or other individual to suffer physical injury;"  5. In an interview, E1 acknowledged the backyard area was not free from a condition or situation that may cause a resident or other individual to suffer physical injury.

Based on observation, documentation review, and interview, the manager failed to ensure combustible or flammable liquids and hazardous materials were stored by the assisted living facility in the original labeled containers or safety containers 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. During an environmental inspection of the facility, the Compliance Officers observed two propane tanks in the backyard area. 2. A review of the facility's policies and procedures titled "Environmental Safety" revealed "Combustible or flammable liquids and hazardous materials stored by the assisted living facility are stored in the original labeled containers or safety containers in a storage area that is locked and inaccessible to residents."  3. In an interview, E1 acknowledged combustible or flammable liquids were accessible to residents.

Based on documentation review and interview, the manager failed to ensure the health care institution administered a training program for all staff regarding fall prevention and fall recovery which posed a health and safety risk to residents, for one of three sampled personnel records reviewed. Findings include: 1. Review of the facility's documents revealed no documented evidence the fall prevention and fall recovery training program had been implemented for all staff. 2. Reviewed of the sampled employee personnel records revealed there was no documentation that E3 had completed the required training. 3. In an interview, E2 acknowledged the facility did not have documentation that E3 had completed the required fall prevention and fall recovery training as required.

Based on observation, documentation review, and interview, the manager failed to establish, document, and implement a policy and procedure to protect the health and safety of a resident that cover methods by which an assisted living facility was aware of the general or specific whereabouts of a resident, based on the level of assisted living services provided to the resident and the assisted living services the assisted living facility was authorized to provide which is a health and safety risk. Findings include: 1. The compliance officer observed residents residing at the facility. 2. The compliance officer requested and was not provided with the facility's policy and procedure that cover the methods by which the facility was aware of the general whereabouts of a resident. 3. In an interview, E2 reported that E2 could not locate a policy and procedure that covered the whereabouts of all the assisted living residents.

Based on documentation review and interview, the manager failed to establish and document a policy and procedure as part of the policies and procedure required in R9-10-803(C)(1)(h) to ensure the manager or a caregiver was available as a back-up to provide assisted living services to a resident if the manager or a caregiver assigned to work was not available or not able to provide the required assisted living services; which posed a health and safety risk. Findings include: 1. Review of the facility's documentation revealed the facility had not established, documented, and implemented as needed a policy and procedure regarding back-up staffing to provide assisted living services to a resident. The facility had five residents residing at the facility. 2. In an interview, E2 acknowledged the facility had no policy and procedure that covered back-up staffing.

Based on record review and interview, the manager failed to ensure that for one of three sampled residents who were unable to ambulate even with assistance, the residents' primary care provider (PCP) or other medical practitioner signed a determination stating that the residents' needs were being met. This determination was to be completed at the time of acceptance or within 30 days prior to acceptance and at least once every six months throughout the duration of the residents' condition to determine if the resident's needs could be met based upon a current resident examination and the assisted living facility's scope of services which posed a health and safety risk. The facility is licensed to provided directed care services. Findings include: 1. In an interview, E2 reported R2 had been unable to ambulate even with assistance since accepted to the facility. 2. In review of R2's medical record found there was a documented determination dated April 12, 2022 and January 30, 2023. The determination was not updated at least every six months throughout the duration of the resident's condition. This determination should have been based on a resident's examination and the facility's scope of services that the resident's needs could be met. 3. In an interview, E2 acknowledged there was no determination completed as required for R2 who was unable to ambulate even with assistance. This is a repeat deficiency for the compliance inspection conducted on March 22, 2022.

Based on observation and interview, the manager failed to ensure there was a current drug reference guide that was available for use by personnel members which posed a health and safety risk to the resident if the caregiver was unable to reference a medication a resident was taking. Findings include: 1. During the compliance inspection the compliance officer observed the facility was providing medication administration services. The facility's current drug reference guide was the Lippincott 2022 Pocket Drug Guide for Nurses. 2. A Google search found on Amazon. com "Lippincott 2023 Pocket Drug Guide for Nurses". 3. In an interview, E2 and E3 acknowledged the facility's drug reference guide was not current.

Based on observation and interview, the manager failed to ensure the premises and equipment used at the assisted living facility were cleaned according to policies and procedures designed to prevent, minimize, and control illness or infection. Findings include: 1. During a facility tour, E2 and the compliance officer observed R3's bedroom had a pungent urine odor which gave the impression R3's bedroom was not kept clean. 2. In an interview, E2 acknowledged the urine odor in R3's bedroom and that the bedroom did not seem to have been kept clean.. This is a repeat deficiency from the compliance inspection conducted on March 22, 2022.