Joyful Living Care Home LLC

Based on record review, documentation review, and interview, the manager failed to ensure an individual authorized to administer opioids documented in the resident's medical record an identification of the resident's need for the opioid before the opioid was administered, and the effect of the opioid administered, for one of one resident receiving an opioid and not considered to be end-of-life. Findings include: 1. A review of R1's medical record revealed a current service plan for directed care services. R1's service plan revealed that R1 received medication administration. 2. A review of R1's medical record revealed a medication order (dated July 29, 2025). The medication order stated, "Tramadol HCL 50 mg take one tablet by mouth two times a day." 3. A review of R1's medical record revealed a medication administration record (MAR) for August 2025. Tramadol HCL 50 mg one tablet by mouth two times a day was documented as administered on the following dates: September 1-11, 2025, and August 1-31, 2025. However, documentation of the identification of R1's need for the opioid before the opioid was administered, and the effect of the opioid administered, was not filled out. 4. In an interview, E1 reported that the facility does have a record. E1 presented the effectiveness sheet with only one date signed from August 2, 2025. 5. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review, documentation review, and interview, the manager failed to ensure that caregivers’ and assistant caregivers’ skills and knowledge were verified and documented before providing physical health services, according to policies and procedures, for one of three employees sampled. The deficient practice posed a health and safety risk. Findings include: 1. Upon arrival at the facility, E2 greeted and escorted the Compliance Officers to the dining room. E1 informed the Compliance Officers that E1 is the manager designee. 2. A review of E1’s personnel record revealed no verified skills and knowledge. 3. A review of the September 2025 personnel schedule revealed E1 was not listed on the schedule. 4. A review of the facility’s policies and procedures revealed a policy titled “Employees and Volunteers qualifications.” The policy stated, “To receive the manager delegation authority to act as a manager when the manager is not present at the facility, a caregiver must have at least six months of experience and prove skills and knowledge to act on the manager’s behalf.” 5. In an interview, E1 reported that E1 was on-call and was only at the facility covering. E1 reported E1 only completes the administrative tasks, while E2 completes the physical services.  6. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review, documentation review, and interview, the manager failed to ensure a caregiver received orientation that was specific to the duties to be performed before providing assisted living services to a resident, for one of three caregivers. The deficient practice posed a risk if the employees were unable to meet residents' needs. Findings include: 1. A review of E1’s personnel record revealed E1 did not receive orientation. 2. A review of the September 2025 personnel schedule revealed E1 was not listed on the schedule. 3. In an interview, E1 reported that she is on-call. E1 reported that orientation was not completed.  4. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on observation and interview, the manager failed to ensure that an evacuation path was conspicuously posted in each hallway of each floor of the assisted living facility. 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 no evacuation paths posted in the facility. 2. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on observation, documentation review, and interview, the manager failed to ensure that toxic materials were stored in a locked area and 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 the cabinet under the kitchen cabinet sink was closed. The Compliance Officers opened the cabinet and noticed that the latch was unlocked. The following items were found: -Glade air freshener; -Clorox Multi-Surface Cleaner + Bleach; -Easy Off; -Weiman Stainless Steel Cleaner & Polish; -Lysol Kitchen Pro Antibacterial Cleaner; -Comet with Bleach; -Ajax Powder; -Lysol Cleaning Wipes; -Borax; and -Cascade Complete Dishwasher Pods. 2. A review of the facility’s policies and procedures revealed a policy and procedure titled “Environmental and Physical Plant Safety.” The policy stated, “Poisonous or toxic materials will be stored and maintained in labeled containers in a locked area separated from food preparation and food storage, dining areas, and medications, and are inaccessible to residents.” 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.