Markesh Care Home

Based on documentation review, record review, and interview, the health care institution failed to ensure the health care institution developed and administered a training program for all staff regarding fall prevention and fall recovery that included initial training and continued competency training. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. A review of E1’s personnel record revealed E1’s hire date of July 25, 2022. In addition, there was no documentation of completed fall prevention and fall recovery training. 2. In an exit interview, the findings were reviewed with E3, and no additional information was provided. 3. This is a repeat deficiency from the compliance inspection conducted on May 3, 2024.

Based on documentation review and interview, the health care institution failed to implement tuberculosis (TB) infection control activities, including annually assessing the health care institution's risk of exposure to infectious tuberculosis. Findings include: 1. A review of the facility’s documentation revealed no annual assessment of the facility's TB risk assessment. 2. In an interview, E3 acknowledged that the annual assessment of the facility's TB risk assessment was not completed. 3. In an exit interview, the findings were reviewed with E3, and no additional information was provided.

Based on documentation review and interview, the healthcare institution failed to include in the plan for the healthcare institution's quality management program a process for review of incidents of opioid-related adverse reactions and other negative outcomes a patient experiences, or opioid related deaths. The deficient practice posed a risk as a quality management program documents the necessary information required to effectively manage services provided. Findings include: 1. A review of the facility’s documentation revealed that there was no Quality Management Program in place related to the use of opioids, as no documentation of a Quality Management Program was provided. 2. In an exit interview, the findings were reviewed with E3, and no additional information was provided.

Based on record review, documentation review, and interview, the manager failed to ensure an assisted living facility had caregivers and assistant caregivers with the qualifications, experience, skills, and knowledge necessary to meet the needs of a resident and ensure the health and safety of a resident. The deficient practice posed a risk if the employees were unable to ensure the health and safety of a resident. Findings include: 1. During an environmental inspection, the Compliance Officers observed that R1 had a Hoyer lift in R1’s room. 2. A review of R1’s medical record revealed a current service plan dated November 13, 2025. The service plan indicated that R1 was bedbound and used a Hoyer lift. 3. A review of E2’s personnel records revealed a completed “Caregiver Skills Documentation.” The documentation did not include Hoyer Lift training. 4. A review of E3’s personnel records revealed a completed “Caregiver Skills Documentation.” The documentation did not include Hoyer lift training. 5. In an interview, E3 acknowledged that the Hoyer lift is used to transfer R1. 6. In an exit interview, the findings were reviewed with E3, and no additional information was provided.

Based on documentation review and interview, the manager failed to ensure documentation was maintained of the caregivers and assistant caregivers working each day, including the hours worked by each. The deficient practice posed a risk as there was no documentation to identify the staff that was present each day to ensure the health and safety of residents. Findings include: 1. A review of the facility’s November 2025 personnel schedule revealed a calendar with no dates, times per shift, or a guide indicating the different shifts. 2. A review of the facility’s December 2025 personnel schedule revealed a calendar with no dates, times per shift, or a guide indicating the different shifts. 3. In an interview, E3 reported that the schedule has not changed. However, E3 reported that E4 had quit, but the schedule was not updated to reflect the change. 4. In an exit interview, the findings were reviewed with E3, and no additional information was provided.

Based on record review, documentation, and interview, the manager failed to ensure that, before providing assisted living services to a resident, a caregiver provided current documentation of first aid training and cardiopulmonary resuscitation (CPR) training specific to adults, for one of three personnel sampled. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency. Findings include: 1. A review of E2's personnel record revealed an expired CPR and First Aid card with an expiration date of July 27, 2025. However, there was no current CPR and First Aid Card. 2. In an interview, E3 reported E2 was a current employee and provided physical health services at the facility. 3. A review of the facility’s November and December 2025 personnel schedule revealed that E2 worked Saturday to Monday morning. 4. In an exit interview, the findings were reviewed with E3, and no additional information was provided.

Based on observation, record review, and interview, the manager failed to ensure that a resident was not subjected to restraints for one of five residents sampled. The deficient practice posed a risk of injury and violated a resident’s rights. Findings include: 1. R9-10-101.202 defines “Restraint” as any physical or chemical method of restricting a patient’s freedom of movement, physical activity, or access to the patient’s own body. 2. During an environmental inspection of the facility, the Compliance Officers observed R2 lying in bed asleep with half bedrails in the upright position on the side opposite the wall, positioned at both the head and foot of the bed. The bed was placed close against the wall. 3. A review of R2’s medical record revealed a current service plan dated December 10, 2025. The service plan indicated that R2 received directed care services, was bedbound, and non-ambulatory. 4. In an interview, E3 reported that the bedrails were to prevent R2 from getting out of bed. 5. In an exit interview, the findings were reviewed with E3, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that a resident's medical record contained a medication order from a medical practitioner for each medication that was administered to the resident, for one of two residents sampled. The deficient practice posed a risk as the medication administered could not be verified against a medication order. Findings Include: 1. A review of R2's medical record revealed the following: A current written service plan dated December 10, 2025. This service plan indicated R2 received medication administration. A medication list dated October 1, 2025; however, it was not signed by a medical practitioner. The medication list included “Bisacodyl 10 mg Rectal Suppository - Rectal - Daily - Take only as needed.” A Medication Administration Record (MAR) for December 2025 revealed that “Bisacodyl 10 mg” was signed as administered on December 1, 2025, December 4, 2025, December 10, 2025, December 16, 2025, December 17, 2025, December 23, 2025, and December 25, 2025. 2. In an interview, E3 reported that “Bisacodyl 10 mg Rectal Suppository” was administered without a signed medication order. 3. In an exit interview, the findings were reviewed with E3, and no additional information was provided.

Based on record review, documentation review and interview, the manager retained a resident confined to a bed or chair without meeting the requirements in R9-10-814.B.2.a.b.i-iii., including documentation of the resident's or the resident's representative's request the resident remain in the facility; documentation to demonstrate the resident's primary care provider or other medical practitioner examined the resident at least once every six months throughout the duration of the resident's condition; reviewed the facility's scope of services; and signed and dated a determination stating the resident's needs were being met at the facility. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings Included: 1. A review of R2’s medical record revealed the following: A current service plan dated December 10, 2025. The service plan indicated that R2 received directed care services, was bedbound, and non-ambulatory. A document titled “Approval of Continued Residency” dated February 28, 2025. No further documentation for “Approval of Continued Residency” was available. Based on R2's admission date, this information was required. 2. A review of the facility’s policies and procedures revealed a policy titled “Pre-admission Determination Form.” The policy stated, “Licensee shall ensure that before or at the time of acceptance of an individual, the individual submits documentation that is dated within 30 days before the individual is accepted by this facility and at least once every 6 months throughout the duration of the resident’s condition.” 3. In an exit interview, the findings were reviewed with E3, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that a resident received orientation to the exits from the assisted living facility and the route to be used when evacuating the assisted living facility, for one of two residents sampled. The deficient practice posed a risk if a resident was unaware of the evacuation path to be used in an emergency. Findings include: 1. A review of R2's medical record revealed no documentation of orientation to the exits of the facility. 2. In an exit interview, the findings were reviewed with E3, and no additional information was provided.

Based on documentation review, record review, and interview, the manager failed to ensure the health care institution developed and administered a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. Review of facility documentation revealed a policy and procedure titled "Fall Prevention and Fall Recovery Training". However, this policy did not include initial training or continued competency training in fall prevention and fall recovery. 2. Review of E1's, E2's and E3's personnel records revealed no documentation showing that personnel had completed Fall Prevention and Fall Recovery training. 4. In an interview, E1 acknowledged the health care institution did not develop and administer a training program for all staff regarding fall prevention and fall recovery including initial training and continued competency training.

Based on record review and interview, the manager failed to ensure a personnel record for each employee included the individual's ending date of employment, for one of one former employee sampled. Findings include: 1. A review of E4's personnel record revealed the record did not include the ending date of employment. 2. In an interview, E1 acknowledged E4's personnel record did not include the ending date of employment.

Based on record review and interview, the manager failed to ensure a written service plan was updated at least once every six months, for one of two residents reviewed receiving personal care services. The deficient practice posed a health and safety risk to the resident if the employees did not know what services the resident needed. Findings include: 1. Review of R1's record revealed a current written service plan for personal care services dated September 11, 2023. However, a service plan after September 11, 2023 was not available for review. 2. During an interview, E1 acknowledged R1 received personal care services and the service plan was not updated at least once every six months.

Based on record review and interview, the manager failed to ensure a caregiver provided a resident with the assisted living services in the resident's service plan, for two of two residents reviewed. The deficient practice posed a risk as the service plan to direct services was not followed. Findings include: 1. Review of R1's medical record revealed a current written service plan for personal care services dated September 11, 2023. This service plan stated "Conditions Requiring Caregiver to Call Physician [...] -Weight loss greater than 5 pounds in 1 month -Weight gain greater than 2 pounds in 24 hours or 5 pounds per week." 2. Review of R2's medical record revealed a current written service plan for personal care services dated April 4, 2024. This service plan stated "Conditions Requiring Caregiver to Call Physician [...] -Weight loss greater than 5 pounds in 1 month -Weight gain greater than 2 pounds in 24 hours or 5 pounds per week." 3. Review of R1's and R2's medical records revealed documents titled "Weight Record". However, the resident's weights were not being documented. The documents stated "no scale". 4. In an interview, E1 reported that the facility did not have a scale because E1 did not want to purchase one. E1 acknowledged R1 and R2 were not provided with the assisted living services in the residents' service plans.

Based on observation and interview, the manager failed to ensure a current drug reference guide was available for use by personnel members. Findings include: 1. The Compliance Officer observed the facility's drug reference guide was the "Nursing 2023 Drug Handbook". 2. A review of the publisher's website revealed the "Nursing 2024 Drug Handbook" was the most recent edition. 3. In an interview, E1 acknowledged that a current drug reference guide was not available for use by personnel members.

Based on observation and interview, the manager failed to ensure that a current toxicology reference guide was available for use by personnel members. Findings include: 1. The toxicology guide available for use by personnel members was the "EMRA and ACMT Medical Toxicology Guide", published in 2018. 2. A review of the publisher's website revealed the "EMRA and ACMT Medical Toxicology Guide, 2nd edition", published in 2022, was the most recent edition. 3. During an interview, E1 acknowledged that a current toxicology reference guide was not available for use by personnel members.

Based on observation and interview, the manager failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed a risk to residents who could access the medication. Findings include: 1. During the facility tour, the Compliance Officers observed a plastic box in an unlocked refrigerator containing R2's medications. The box included a combination lock, however, the lock was not locked. 2. During the facility tour, the Compliance Officers observed an unlocked cabinet in an unlocked room that held three resident's medications. 3. In an interview, E1 acknowledged the medication was not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage.

Based on observation and interview, the manager failed to ensure foods requiring refrigeration were maintained at 41\'b0 F or below. The deficient practice posed a health risk to the residents. Findings include: 1. During the facility tour, the Compliance Officer observed an open container of "Kroger Original pancake syrup" in a pantry closet. The container stated "Refrigerate after opening." 2. During an interview, E1 acknowledged foods were stored at room temperature and required refrigeration.

Based on documentation review and interview, the manager failed to ensure an evacuation drill for employees and residents was conducted at least once every six months. The deficient practice posed a risk if employees were unable to implement the evacuation plan. Findings include: 1. Review of the facility's employee and resident evacuation drills revealed the most current drill conducted September 4, 2023. No other employee and resident evacuation drills were available after September 4, 2023. 2. During an interview, E1 acknowledged the employee and resident evacuation drills were not conducted at least once every six months.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were maintained 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 the facility tour, the Compliance Officer observed an unlocked kitchen cabinet containing the following: -"Pledge expert care wood oil" which stated "Caution: Keep out of reach of children and pets"; -"Home Store glass cleaner" which stated "Danger: Keep out of reach of children"; -"Comet foam bath cleaner" which stated "Keep out of reach of children". This cabinet had a magnetic locking device, however the device was not locked. 2. In an interview, E1 acknowledged poisonous or toxic materials stored by the assisted living facility were not maintained in a locked area inaccessible to residents.

Based on observation and interview, the manager failed to ensure the bathroom accessible from the common area contained paper towels in a dispenser or a mechanical air hand dryer. Findings include: 1. During the facility tour, the Compliance Officer observed a roll of paper towels on a shelf above the toilet. However, the paper towels were not in a dispenser. 2. In an interview, E1 acknowledged the bathroom accessible from the common area did not contain paper towels in a dispenser or a mechanical air hand dryer.