Oakbridge Terrace at Spring House Estates

Multiple incidents involving allegations of inappropriate sexual behaviors or abuse were not reported to the Local Area Agency on Aging.

The residence failed to report several incidents involving allegations of abuse and a police response to the Department's office within 24 hours.

Resident medications and a medication cabinet containing personal medical information were left unlocked, unattended, and accessible to residents.

Resident's face sheet and discharge transfer sheet containing medication and health information were left unlocked and unattended in a shared office.

A direct care staff person received only 14.89 hours of required annual training for the 2024 training year.

The bathroom in resident living unit 212 had a strong odor, a brown stain on the floor, and feces on the outside of the toilet bowl.

The bathroom in resident living unit 212 lacked an operable window and the ventilation fan was inoperable.

A cardboard box containing trash was found outside the covered dumpster.

The temperature in the ice cream freezer was recorded at 12 degrees Fahrenheit, which is above the required 0°F.

Monthly fire drills were held on Thursday for three consecutive months.

An expired vial of Humalog, with a discard-after date of 08/03/2024, was found in a medication cart.

Medical evaluations for Resident #1 and Resident #2 did not indicate a diagnosis of Alzheimer's or dementia or the need for a special care unit.

Written cognitive preadmission screenings for Resident #1 and Resident #2 did not reflect the resident's need for special care unit services.

Resident #1, who lacks a primary diagnosis of dementia or brain injury, was admitted to the special care unit without a required medical evaluation for a spouse, friend, or family member.

The contract for Resident #1 was not signed by the resident.

Resident #1's record lacked a signed statement acknowledging receipt of resident rights and complaint procedures.

Privacy was not provided to Resident #2 during medication administration in the dining room.

Resident #3 did not have access to an operable bedside lamp or light source.

Resident #1 had not been educated on their right to question or refuse medication in the event of a suspected error.

The initial support plan for Resident #4 was not completed within the required 72 hours of admission.