Marie Silver Assisted Living Facility LLC

Based on record review and interview, the manager failed to ensure a resident's written service plan was reviewed and updated no later than 14 calendar days after a significant change in the resident's physical, cognitive, or functional condition, for one of two residents sampled. Findings include: 1. A review of R2's medical record revealed a service plan, dated October 14, 2024, for personal care services. 2. A review of R2's medical record revealed R1 enrolled with hospice services on November 4, 2024, for health decline and cognitive decline. 3. A review of R2's medical record revealed that an updated service plan was not available for review. 4. In an interview, E1 acknowledged R2's service plan had not been updated within 14 calendar days after R2 had a significant change in condition.

Based on documentation review, observation, and interview, the manager failed to ensure there was a means of exiting the facility for a resident who did not have a key, special knowledge for egress, or the ability to expend increased physical effort, that provided access to an outside area, and controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a risk if the facility was unaware of the general or specific whereabouts of a resident. Findings include: 1. Review of the license issued by the Department revealed the facility was authorized to provide directed care services. 2. During an environmental inspection of the facility with E1, the Compliance Officer observed the door exiting to the backyard had a device that was intended to alert employees to the egress of a resident to the outside area. However, the device did not work. 3. In an interview, E1 acknowledged there was a means of exiting the facility to an outside area which did not control or alert employees of the egress of a resident from the facility.

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 R2's medical record revealed a current written service plan dated December 26, 2023. This service plan indicated R2 received medication administration. 2. Review of R2's medical record revealed a signed medication order dated December 26, 2023. This medication order stated "Trazodone 50mg PO 8pm". 3. Review of R2's medical record revealed a January 2024 medication administration record (MAR). This MAR stated "Trazodone 100mg 1 tab PO QD QHS" and indicated one tab was administered at 8pm January 1st - present. 4. During an observation of R2's medications, Trazodone 100mg was observed and one tab was observed prefilled in the "Evening" slot of R2's medication organizer. 5. In an interview, E1 reported the medication was administered per the medication organizer and acknowledged R2's medication was not administered in compliance with the available medication order.

Based on documentation review and interview, the health care institution failed to implement tuberculosis (TB) infection control activities that included an annual assessment of the health care institution's risk of exposure to infectious TB. The deficient practice posed a TB exposure risk to residents and staff. Findings include: 1. Review of facility documentation revealed a policy titled "Tuberculosis (TB) Testing" that stated "A...the health care institution establishes, documents, and implements tuberculosis infection control activities that: 1. Include:...d...Annually assessing the health care institution's risk of exposure to infectious tuberculosis." 2. Review of facility documentation revealed no documentation of an annual assessment of the health care institution's risk of exposure to infectious TB. 3. In an interview, E1 acknowledged an assessment of the health care institution's risk of exposure to infectious TB was not conducted. 4. Technical assistance was provided on this Rule during the compliance inspection conducted January 26, 2023.