North Star Care Home

Based on record review and interview, the manager failed to maintain a standardized form for each resident that included the information prescribed in subsection A of this section, except for the information prescribed in subsection A, paragraph 1 of this section, which shall be provided at the time the emergency responder is contacted, for one of three residents sampled. Findings include: 1 . A review of R1's medical record revealed documentation of a maintained standardized emergency responder form was not available for review at the time of inspection. 2 . In an exit interview, the findings were discussed with E4 and no additional information was provided.

Based on observation, documentation review, and interview, the manager failed to designate, in writing, a caregiver who was present on the assisted living facility’s premises and accountable for the assisted living facility when the manager is not present on the assisted living facility premises. Findings include: 1 . The Compliance Officer observed E2 and E3 working at the facility by themselves when the Compliance Officer arrived at the facility at approximately 9:30 AM. 2 . A review of facility documentation revealed E2 was a caregiver and E3 was an assistant caregiver. A designation in writing for E2 to act as the manager designee was not available for review at the time of inspection. 3 . In an exit interview, the findings were discussed with E4 and no additional information was provided.

Based on observation and interview, the manager failed to ensure medication stored by the assisted living facility was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. Findings include: 1 . During an environmental inspection of the facility, the Compliance Officer observed a bottle of "Gentamicin" sitting on a shelf inside the kitchen refrigerator. 2 . In an exit interview, the findings were discussed with E4 and no additional information was provided.

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 two residents sampled. Findings include: 1. A review of R2's medical record revealed documentation titled "Initial Physician Recommendation Form" which indicated whether R2 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. However documentation was dated December 29th, 2023 which was not within 90 calendar days before the resident's acceptance. 2. In an interview, E1 acknowledged R2 did not submit documentation signed by a medical practitioner or a registered nurse that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints dated within 90 days before R2 was accepted by the facitliy.

Based on record review and interview, the manager failed to ensure a resident received orientation to the exits from the assisted living facility and the route to be used when evacuating the assisted living facility within 24 hours after acceptance, for one of two residents sampled. Findings include: 1. A review of R2's medical record revealed an orientation documentation dated December 29, 2024. However, this date was not within 24 hours after R2's acceptance. 2. In an interview, E1 acknowledged R2 did not receive orientation to the exits from the assisted living facility and the route to be used when evacuating the assisted living within 24 hours after acceptance.