Mom's Place Assisted Living Home LLC

Based on observation, documentation review, and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were maintained in a locked area and were inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental tour, the Compliance Officers observed glass cleaner, Cascade dishwasher pods, and Purell surface sanitizer in an unlocked cabinet in the kitchen. 2. A review of the facility’s policies and procedures revealed a policy titled "Emergency, Safety, and Environmental Standards”. The policy stated, “Poisonous and toxic materials will be in labeled containers and stored in a locked area separate from food preparation and food storage areas.” 3. In an interview, E1 reported all cabinets were usually locked. 4. In an exit interview, the findings were discussed with E1 and no additional information was provided. 5. This is a repeat deficiency from the inspection dated May 30, 2023.

Based on record review and interview, the manager failed to ensure a medication administered to a resident was documented in the resident's medical record, for one of two residents reviewed. The deficient practice posed a risk as medication could not be verified as administered against a medication order. Findings include: 1. A review of R1's medical record revealed a current written service plan dated August 9, 2024. This service plan indicated R1 received medication administration. 2. A review of R1's medical record revealed a signed medication order dated September 20, 2024. This medication order stated "Amlodipine 1 tablet oral 1 times a day (10 MG tablet)". 3. A review of R1's medical record revealed a September 2024 medication administration record (MAR). However, Amlodipine 10 mg was not documented on the September 2024 MAR. 4. In an interview, E1 acknowledged Amlodipine 10 mg was not documented on the MAR for September 20th to present.

Based on observation and interview, the manager failed to ensure food stored by the facility was free from spoilage and was safe for human consumption. The deficient practice posed a risk for potential food borne illnesses. Findings include: 1. The Compliance Officer observed bread stored in the pantry with fuzzy green spots that appeared to be mold. 2. In an interview, E1 acknowledged food stored by the facility was not free from spoilage.

Based on observation and interview, the manager failed to ensure a resident bathroom contained a window that opened or another means of ventilation. The deficient practice posed a risk to the health and safety of the residents. Findings include: 1. The Compliance Officer observed a private bathroom shared by two residents, did not contain a window or other means of ventilation. 2. In an interview, E1 reported the exhaust fan broken. E1 acknowledged the bathroom did not have a window or other means of ventilation.

Based on record review and interview, the manager failed to ensure a caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services, for one of three caregivers sampled. The deficient practice posed a risk if E3 was unable to meet a resident's needs and, the Department was unable to determine substantial compliance as the documentation was not provided during the inspection. Findings include: 1. A review of E3's (hired in 2023) personnel record revealed documentation of the verification of E3's skills and knowledge was not available for review. 2. In an interview, E1 acknowledged E3's skills and knowledge were not verified prior to E3 providing services to residents.

Based on record review and interview, the manager failed to ensure a caregiver provided current documentation of first aid training and cardiopulmonary resuscitation (CPR) training, for two of three employees sampled. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency or an accident, and the Department was unable to determine substantial compliance during the inspection. Findings include: 1. A review of E1's (hired in 2006) personnel record revealed a training card for first aid and CPR. However, the training card expired on October 18, 2022. 2. A review of E2's (hired in 2018) personnel record revealed a training card for first aid and CPR. However, the training card expired on October 21, 2022. 3. A review of documention, per R9-10-806.A.8, dated May 23, 2023, revealed E1 provided assisted living services and worked on the following days: -May 22 - June 1, 2023 - 6 AM - 6 PM 4. A documentation review of a daily staffing schedule, dated May 23, 2023, revealed E2 provided assisted living services and worked on the following days: -May 22 - 24, 2023 - 6 PM - 6 AM -May 25 - June 1, 2023 - 6 AM - 6 PM 5. In an interview, E1 acknowledged E1's and E2's first aid and CPR training cards had expired. E1 reported E1 believed both E1 and E2 had taken recent first aid and CPR trainings but was unable to provide new documentation of current training.

Based on record review and interview, the manager failed to ensure a personnel record for each employee included documentation of the individual's skills and knowledge applicable to the caregiver's or manager's job duties, for one of three personnel members sampled. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the required documentation was not provided during the inspection. Findings include: 1. A review of E2's (hired in 2018) personnel record revealed documentation of the verification of E2's skills and knowledge was not available for review. 2. In an interview, E1 acknowledged E2's personnel record did not contain verification of skills and knowledge.

Based on record review and interview, the manager failed to ensure a resident provided evidence of freedom from infectious tuberculosis (TB) as specified in R9-10-113., for two of three residents sampled. The deficient practice posed a TB exposure risk to residents and the Department was unable to determine substantial compliance as the documentation was not provided during the inspection. Findings include: 1. A review of R1's (admitted in 2022) medical record revealed a Mantoux skin test, read on September 5, 2022. However, a baseline symptom screening signed by a registered nurse, medical practitioner or local health department was not provided for review. 2. A review of R2's (admitted in 2022) medical record revealed a Mantoux skin test, read on October 3, 2022. However, a baseline symptom screening signed by a registered nurse, medical practitioner or local health department was not provided for review. 3. In an interview, E1 acknowledged R1's and R2's medical records did not include a baseline symptom screening signed by a registered nurse, medical practitioner or local health department. E1 reportyed R1 and R2 had not had a baseline symptom screening completed.

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. Findings include: 1. The Compliance Officers observed the following medications in the bedroom shared by R2 and R3: -Albuterol inhaler (belonging to R3, on R3's bedside) -Orajel medicated tooth gel (belonging to R3, on R3's bedside) -A medication measuring cup with a Tums tablet (on R2's bedside) 2. The Compliance Officers observed numerous ambulatory residents on the premises. 3. In an interview, E1 acknowledged the unlocked medications in R2's and R3's bedroom were not stored in a separate locked room, closet, cabinet or self-contained unit and were accessible to residents.

Based on documentation review and interview, the manager failed to ensure a disaster plan review required in (A)(2) was documented. The deficient practice posed a risk to the health and safety of residents if the disaster plan was not current to meet the needs in a disaster. Findings include: 1. A review of facility documentation revealed an undated disaster plan. A review of the disaster plan was completed and documented on January 3, 2022. However, a disaster plan review completed within the last 12 months was not provided for review. 2. In an interview, E1 acknowledged a review of the disaster plan had not been completed at least once every 12 months.

Based on observation and interview, the manager failed to ensure the premises and equipment used at the assisted living facility were free from a condition or situation that may cause a resident or other individual to suffer physical injury. The deficient practice posed a risk of seclusion, a potential for psychological distress, and a risk to the resident's health and safety if personnel members were unable to access or help a resident during an accident or an emergency. Findings include: 1. The Compliance Officers observed R1's bedroom contained a knob lock placed on the door handle. The knob lock was place on the hallway side of the bedroom door and allowed for an individual to lock another individual inside the bedroom. 2. In an interview, E1 acknowledged the lock on the hallway side of the doors were a condition or situation that may cause a resident or other individual to suffer physical injury. The Compliance Officer closed R1's door while another Compliance Officer and E1 were inside R1's bedroom. The Compliance Officer, in the hallway, locked R1's door and asked if E1 was able to open R1's door. E1 attempted to open R1's door but reported to be locked inside of R1's bedroom.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials were maintained in a locked area and were inaccessible to residents. The deficient practice posed a health and safety risk to residents. Findings include: 1. The Compliance Officers observed a can of air freshener on a shelf in R1's bedroom. The air freshener was accessible to residents and included a warning label. 2. The Compliance Officers observed a can of air freshener on the counter in a hallway bathroom. The air freshener was accessible to residents and included a warning label. 3. The Compliance Officers observed numerous ambulatory residents on premises. 4. In an interview, E1 acknowledged the unlocked toxic materials, in various places around the assisted living facility, were accessible to residents. This is a repeat deficiency from the compliance inspection conducted on June 21, 2022.