King Assisted Living II

Based on record review and interview, the manager failed to ensure there was a documented residency agreement with the assisted living facility that included the policy and procedure for a resident to terminate residency, for five of five total residents. The deficient practice posed a risk if the resident was not informed of the terms of residency. Findings include: R9-10-807(G)(1) states, "A manager may terminate residency of a resident as follows: Without notice, if the resident exhibits behavior that is an immediate threat to the health and safety of the resident or other individuals in an assisted living facility." 1. A review of the medical records of R1, R2, R3, R4, and R5 revealed residency agreements for R1, R2, R3, R4, and R5. Each of the agreements stated the following: "The management will terminate the Residency Agreement without notice if: The Resident exhibits behavior that is an immediate threat to the health and safety of the Resident or other individuals in the assisted living facility; The Resident's medical or health needs require immediate transfer to another health care institution; [or] The Resident's care and service needs exceed the services the facility is licensed to provide." The review revealed the termination policy in the residency agreements was not in compliance with R9-10-807(G)(1). 2. In an interview, E1 stated, "All of them [are] like that." E1 acknowledged the termination policy in the residency agreements was not in compliance with R9-10-807(G)(1). Technical assistance was provided on this rule during the compliance inspection conducted on March 28, 2022.

Based on documentation review, record review, observation, and interview, the manager failed to ensure medication administered to a resident was administered in compliance with a medication order, for two of four residents sampled. The deficient practice posed a risk if a resident experienced a change in condition due to improper administration of medication. Findings include: 1. A documentation review revealed a policy and procedure titled "R9-10-816(B)." The policy and procedure stated, "Medications will be administered in compliance with a medication order." 2. A review of R2's medical record revealed a service plan dated June 20, 2023. The service plan revealed R2 was to receive medication administration. The review revealed a medication order for "Methenamine Hippurate 1 gr 1tbl QD" dated April 2023. The review further revealed a medication administration record dated July 2023. The document revealed R2 received "Methenamine Hipp 1 gm" each day in July 2023 at 8:00 AM and 5:00 PM, even though the order was for once a day and not twice a day. 3. The Compliance Officer observed R2's pharmacy bottle of methenamine 1 G as well as R2's medication cups for 8:00 AM and 5:00 PM. Both medication cups contained one tablet of R2's methenamine 1 G. 4. A review of R4's medical record revealed a service plan dated May 4, 2023. The service plan revealed R4 was to receive medication administration. The review revealed a medication order for "Baclofen 10 mg take \'bd tbl (5 mg) QD" dated April 21, 2023. The review further revealed a medication administration record dated July 2023. The document revealed R4 was in the hospital on July 14-25, 2023. The document further revealed R4 received "Baclofen 10 mg 1 tbl BID" on July 1-13 and 26-31, 2023, even though the order was for one half tablet (5 mg) and not one full tablet (10 mg). 5. The Compliance Officer observed R4's pharmacy bottle of baclofen 10 mg as well as R4's medication cup for 8:00 AM. The medication cup contained one full tablet of R4's baclofen 10 mg. 6. In an interview, E1 stated, "I made a mistake" regarding the aforementioned medication orders for R2 and R4. E1 reported R2 was supposed to receive methenamine 1 G at 8:00 AM and 5:00 PM and R4 was supposed to receive baclofen 10 mg. However, E1 acknowledged the manager failed to ensure medication administered to R2 and R4 was administered in compliance with a medication order.

Based on documentation review, record review, and interview, the manager failed to ensure medication administered to a resident was documented in the resident's medical record, for two of four residents sampled. The deficient practice posed a risk to the health and safety of a resident as emergency personnel would not have correct health data to make decisions regarding a resident's treatment in an emergency and as the Department was provided false or misleading information. Findings include: 1. A documentation review revealed a policy and procedure titled "Documenting Medication Administration and Self-administration of Medication." The policy and procedure stated, "Immediately after giving medication document the administration on the Medication Administration Record." The review revealed a policy and procedure titled "Medication administration." The policy and procedure stated, "Medication administration is not documented until the resident has been given the medication." 2. A review of R1's medical record revealed a service plan dated June 20, 2023. The service plan revealed R1 was to receive medication administration. The review revealed a medication order for "Amlodipine 5 mg 1 tbl QD" and "Ozempic (semaglutide) injection. Inject 0.5 mg weekly" dated April 21, 2023. The review further revealed a medication administration record dated July 2023. The document revealed documentation demonstrating R1 received R1's amlodipine each day in July 2023 at 8:00 AM and 8:00 PM, but no documentation of R1's Ozempic. 3. In an interview, E1 reported R1 received R1's Ozempic and amlodipine as ordered. Regarding the amlodipine, E1 reported E1 made a mistake on the medication administration record by putting it down as needing to be administered at both 8:00 AM and 8:00 PM. E1 reported E2 had the tendency to document a medication as administered if it was on the medication administration record, regardless of whether it was truly administered. E1 reported E2 often went by the medication administration record and not the medication order when documenting administration. 4. A review of R2's medical record revealed a service plan dated June 20, 2023. The service plan revealed R2 was to receive medication administration. The review revealed a medication order for "Oxybutynin CL ER 10 mg 1 tbl 1xday" and "Omeprazole DR 20 mg 1 cap QD AM" dated April 2023. The review further revealed a medication administration record dated July 2023. The document revealed documentation demonstrating R2 received R2's oxybutynin two separate times each day in July 2023 at 8:00 AM, but no documentation of R2's omeprazole. 5. In an interview, E1 reported R2 received R2's oxybutynin and omeprazole as ordered. Regarding the oxybutynin, E1 reported E1 made a mistake on the medication administration record by putting it down as needing to be administered twice at 8:00 AM. E1 reported E2 had the tendency to document a medication as administered if it was on the medication administration r

Based on documentation review and interview, the manager failed to ensure a disaster plan was developed and documented that included how a resident's medical record would be available to individuals providing services to the resident during a disaster and a plan to ensure each resident's medication would be available to administer to the resident during a disaster. The deficient practice posed a risk as there was no adequate plan to ensure the health and safety of residents in an emergency. Findings include: 1. A documentation review revealed a policy and procedure titled "Disaster Plan" dated March 17, 2020. The disaster plan stated: "Resident records will be relocated along with each resident [and] Medication for each resident will be relocated with the resident." However, the disaster plan did not include a procedure stating how a resident's medical record would be available to individuals providing services to the resident during a disaster or a plan to ensure each resident's medication would be available to administer to the resident during a disaster. 2. In an interview, when the Compliance Officer asked if the facility's disaster plan had been updated since the last compliance inspection to include the items required by this rule, E1 stated, "I cannot find that." E1 acknowledged the disaster plan did not include all items required by this rule. Technical assistance was provided on this rule during the compliance inspection conducted on March 28, 2022.

Based on documentation review and interview, the manager failed to ensure the disaster plan required in R9-10-818(A)(1) was reviewed at least once every 12 months. The deficient practice posed a risk as a disaster plan reinforces and clarifies standards expected of employees. Findings include: 1. A documentation review revealed documentation of a disaster plan review. However, the documentation revealed the last disaster plan review was conducted on March 17, 2020. 2. In an interview, E1 reported having no documentation of a disaster plan review after March 17, 2020. E1 acknowledged the manager failed to ensure the disaster plan required in R9-10-818(A)(1) was reviewed at least once every 12 months. Technical assistance was provided on this rule during the compliance inspection conducted on March 28, 2022.