Las Palmas Assisted Living Home LLC

Based on record review and interview, the manager failed to ensure that a caregiver’s skills and knowledge were verified and documented before the caregiver provided physical health services for one of the three personnel records reviewed. The deficient practice posed a risk if the employees were unable to meet residents’ needs. Findings include: 1. A review of E4's personnel record revealed there was no documentation of skills and knowledge prior to E4 providing services to the residents. 2. A review of the facility's staff schedule revealed E4 was listed to work three days per week in July 2025 and August 2025. A review of resident records revealed E4 provided medication administration and personal care to R1 in July 2025. 3. In an exit interview, the findings were reviewed with E1, and E1 believed the documented verification of E4’s skills and knowledge was completed, though E1 was unable to locate the documentation.

Based on documentation review, record review, and interview, the manager failed to ensure documentation was maintained for at least 12 months after the last date on the documentation of the caregivers and assistant caregivers working each day, including the hours worked by each. Findings include: 1. A review of facility documentation revealed a staff schedule dated July 2025, which stated E1 was scheduled to work every Saturday and Sunday, E3 was scheduled to work every Monday and Tuesday, and E4 was scheduled to work every Wednesday, Thursday, and Friday. 2. A review of resident records revealed E1 documented providing medication administration every day in July 2025 for R1. The documentation revealed E3 provided personal care or medication administration to R1 on July 5, 6, 12, 25, 26, and 27, 2025, when E3 was not scheduled to work. The documentation revealed E4 provided personal care and medication administration on July 28 and 29, 2025 when E4 was not scheduled to work. 3. In an interview, E1 acknowledged the schedule did not reflect the correct hours worked by each caregiver because it was not updated to reflect changes to the schedule.

Based on record review and interview, the manager failed to ensure that a caregiver received orientation that was specific to the duties to be performed by the caregiver before they provided assisted living services to a resident for one of the three personnel records reviewed. The deficient practice posed a risk if the employees were unable to meet residents’ needs. Findings include: 1. A review of E4's personnel record revealed there was no documented orientation prior to E4 providing services to the residents. 2. A review of the facility's staff schedule revealed E4 was listed to work three days per week in July 2025 and August 2025. A review of resident records revealed E4 provided medication administration and personal care to R1 in July 2025. 3. In an exit interview, the findings were reviewed with E1 and E1 believed the orientation was complete, though E1 was unable to locate the documentation.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance of an individual, the individual submitted documentation dated within 90 calendar days before the individual was accepted by the facility, to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant, for one of three sampled residents. Findings include: 1. A review of R3's medical record revealed a document titled "DETERMINATION FOR ADMISSION". This document contained whether or not R3 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 on or before R3’s date of admission to the facility. 2. In an interview, E1 acknowledged R3's medical record did not contain the required documentation that was dated within 90 days before R3 was accepted by the facility.

Based on record review and interview, the manager accepted an individual requiring continuous medical services or continuous nursing services, for one of three resident records reviewed. The deficient practice posed a risk as an assisted living facility cannot provide continuous medical or continuous nursing services. Findings include: 1. A review of R3's medical record revealed a document titled "DETERMINATION FOR ADMISSION". The document stated "… Please answer the following questions: Questions #1, 2, 4, & 5 must be checked NO for appropriate placement in ALF. 1. Does the person require continuous medical services?... 2. Does the person require continuous nursing services?”. Questions two was marked to indicate R3 required continuous nursing services. The document was signed by a medical practitioner seven days after admission. 2. In an interview, E1 reported R3 does not receive continuous nursing services; however, R3 is on hospice and receives intermittent nursing services. E1 reported the box indicating R1 required continuous medical services should not have been marked.

Based on the record review and interview, the manager failed to ensure a written service plan included the signature and date from the resident or resident’s representative for one of three resident records reviewed. The deficient practice posed a health and safety risk if the resident or representative did not acknowledge the services to be provided. Findings include: 1. A review of R3's medical record revealed an initial written service plan for directed care services. However, this service plan did not include a signature and date from the resident or the resident’s representative. The document included one note that the document was emailed to the representative for signature on the same date the service plan was signed by the manager and nurse. There was no documentation that additional attempts had been made to acquire R3's representative's signature. 2. In an interview, E1 acknowledged R3’s service plan did not include a signature and date from the resident or the resident’s representative. 3. This is a repeat deficiency from the compliance inspection conducted on February 8, 2024.

Based on observation and interview, the manager failed to ensure medications stored by the facility were stored in a locked area. Findings include: 1. During a tour of the facility, the Compliance Officer observed a one-pint bottle of Lactulose Solution 10g/15mL, and a 17.9 oz bottle of Clearlax Powder, unlocked on kitchen counters. 2. During a tour of the facility, the Compliance Officer observed an unlocked medication box in the refrigerator, which contained four prefilled pens of Lantus Solostar (insulin glargine). 3. The Compliance Officer observed an unlocked cabinet in the dining area, which contained a bottle of Equate Allergy Relief tablets, a box of Vicks DayQuil, a box of Vicks NyQuil, a bottle of Equate sore throat spray, a box of Claritin tablets, and a box of Fleet Laxative Liquid Glycerin. 4. During a tour of the facility, the Compliance Officer observed two tablets of Bisacodyl 5mg in an unlocked drawer in the kitchen. 5. The Compliance Officer observed E1 and E2 secure the medications. 6. During an interview, E1 acknowledged the Compliance Officer found medications stored in unlocked areas.

Based on record review and interview, the manager failed to ensure a resident's written service plan was signed and dated by the resident or resident's representative, for one of two medical records reviewed. Findings include: 1. A review of R1's medical record revealed a service plan dated November 1, 2023, for directed care services. However, the service plan was not signed and dated by R1's representative. 2. In an interview, E1 acknowledged the service plan provided for R1 had not been signed and dated by R1's representative when the plan was developed or updated. E1 reported the document was reviewed with R1's representative over the phone, though not signed and returned to the facility.

Based on record review and interview, the manager failed to ensure a resident, receiving directed care services, had a written service plan that was reviewed and updated at least once every three months, for one of two resident records reviewed. Findings include: 1. A review of R2's medical record revealed a service plan for directed care services dated Novermber 1, 2023. Based on the date of R2's service plan, a reviewed and updated service plan was required on or before February 1, 2024. No updated service plan was available for review. 2. In an interview, E1 acknowledged the medical record provided for R2 did not include the required service plan update at least once every three months.

Based on document review, observation, and interview, the manager failed to ensure a facility authorized to provide directed care services had a means of exiting the facility for a resident who does not have a key, special knowledge for egress, or the ability to expend increased physical effort and provided access to an outside area which controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a potential egress danger to residents. Findings include: 1. A review of the Department's documentation revealed the facility was authorized to provide directed care services. 2. The Compliance Officer observed the alert posted on a back door, leading from a living room to the secured backyard, did not alert when the door was opened. 3. In an interview E1 reported the door was recently replaced and the alarm company needed to come out and reinstall a part of the mechanism. 4. In an interview, E1 acknowledged the door alert was not functioning and would be unable to alert employees of the egress of a resident from the facility. E1 reported the alert would be replaced immediately.