Metropolitan Assisted Living LLC

Based on record review, and interview, the governing authority failed to administer a training program for five of five staff members regarding fall prevention and fall recovery. The deficient practice posed a risk if a staff member was not properly trained to assist a resident who had fallen and was unable to recover independently. Findings include: 1. A review of E1's, E2's, E3's, E4's, and E5's personnel records revealed no documentation of training in fall prevention and fall recovery was available for review at the time of inspection. 2. In an interview, E1 acknowledged documentation of a training program for E1, E2, E3, E4, and E5 regarding fall prevention and fall recovery was not available for review at the time of inspection.

Based on documentation review, record review, and interview, the manager failed to ensure a caregiver or assistant caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services on behalf of the facility, for one of five sampled caregiver and assistant caregivers. The deficient practice posed a risk if employees did not have the skills and knowledge necessary to ensure the health and safety of residents. Findings include: 1. A review of E3's personnel record (hired in July 2020) revealed no documented verification of E3's skills and knowledge. 2. In an interview, E1 acknowledged E3's personnel record did not contain documented verification of skills and knowledge.

Based on documentation review, record review, and interview, the manager failed to ensure, before providing assisted living services to a resident, a caregiver provided current documentation of first aid training and cardiopulmonary resuscitation (CPR) training certification specific to adults, for one of two sampled personnel members. The deficient practice posed a risk if the caregivers were unable to meet a resident's needs during an emergency. Findings include: 1. A review of facility documentation revealed a staff schedule for January 2024. The schedule revealed E5 worked at the facility from August of 2023 to January 2024 as a live-in caregiver. 2. A review of E5's personnel record revealed no documentation of first aid training and CPR training. 3. In an interview, E1 acknowledged E5 worked at the facility from August of 2023 to January 2024 as a live-in caregiver as reflected on the schedule. E1 acknowledged E5's had no documentation of CPR and first aid training.

Based on documentation review and interview, the manager failed to maintain a personnel record for each employee which included the items required by this rule, for one of five employees sampled. The deficient practice posed a risk as required information could not be verified for an employee. Finding include: 1. During the environmental inspection of the facility, the Compliance Officer observed R4 arrive at the facility and provide two residents nail care which is activities of daily living services. 2. A review of documentation revealed no personnel record for E4. 3. In an interview, E4 reported they come to the facility once a week to provide nail care services to the residents of the facility. 4. In an interview, E1 acknowledged E4 provided nail care services This is a repeat deficiency from the compliance inspection conducted on July 28, 2022.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance 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 three of three residents. The deficient practice posed a risk if the facility was unable to meet a resident's needs and the Department was unable to determine substantial compliance as the required documentation was not in the medical records at the time of the inspection. Findings include: 1. A review of R1's (accepted in May 2024) medical record revealed documentation 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 was not available for review. 2. A review of R2's (accepted in March 2024) medical record revealed documentation 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 was not available for review. 3. A review of R3's (accepted in October 2023) medical record revealed documentation 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 was not available for review. 4. In an interview, E1 acknowledged documentation to include whether R1, R2, and R3 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 was not available for review.

Based on observation and interview, the manager failed to ensure a means of exiting the facility 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. During the environmental inspection of the facility, the Compliance Officer observed the front door, a door leading from the common area to the back yard leading to the back yard, and a kitchen door leading to the back yard. The Compliance Officer observed the doors had no mechanism to alert employees of the egress of a resident from the facility. 2. In an interview, E1 acknowledged the doors had no mechanism to alert the staff of a resident leaving the facility.

Based on documentation review and interview, the manager failed to ensure a disaster drill for employees was conducted on each shift at least once every three months and documented. The deficient practice posed a risk if employees were unable to implement a disaster plan. Findings include: 1. A review of facility documentation revealed a staff schedule. The schedule indicated the facility operates on a 24-hour shift, However, E1 reported there are at least two shifts for the facility. 2. A review of facility documentation revealed the most recent documented disaster drill was conducted on June 30, 2022, for one shift. No other documentation of disaster drills conducted at the facility was provided for review. 3. In an interview, E1 acknowledged the disaster drills were not up to date at the time of the inspection. This is a repeat deficiency from the compliance inspection conducted on July 28, 2022.

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 personnel members were unable to safely evacuate residents in an emergency situation. Findings include: 1. A review of facility documentation revealed an evacuation drills sheet dated July 3, 2023. No other documentation was available for review to show evacuation drills were conducted after July 3, 2023. 2. In an interview, E1 acknowledged there was no other documentation available for review at the time of the inspection to indicate evacuation drills for employees and residents were conducted at least once every six months after July 3, 2023.

Based on observation and interview, the manager failed to ensure the premises used at the assisted living facility were clean according to policies and procedures designed to prevent, minimize, and control illness or infection which posed a health and safety risk. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed R3's room was filled with a large amount of expired food in containers and miscellaneous trash which covered the floor of R3's room and dressers. 2. In an interview, E3 acknowledged R3's room was filled with large amounts of expired food in containers and miscellaneous trash which covered the floor of R3's room and dressers and the room was not clean.