Olive Grove Assisted Living

Based on document review and interview, the manager failed ensure policies and procedures were established and documented to protect the health and safety of a resident that covered methods by which the assisted living facility was aware of the general or specific whereabouts of a resident, based on the level of assisted living services provided to the resident and the assisted living services the assisted living facility was authorized to provide. Findings include: 1. A review of the facility’s documentation revealed there was no established and documented policy and procedure that covered methods by which the assisted living facility was aware of the general or specific whereabouts of a resident, based on the level of assisted living services provided to the resident and the assisted living services the assisted living facility was authorized to provide. 2. In an interview, E1 acknowledged there was no policy and procedure established and documented to protect the health and safety of a resident that covered methods by which the assisted living facility was aware of the general or specific whereabouts of a resident, based on the level of assisted living services provided to the resident and the assisted living services the assisted living facility was authorized to provide.

Based on record review and interview, the manager failed to ensure a written notice of termination of residency included the policy for refunding fees, charges or deposits, the deposition of a resident’s fees, charges, and deposit, for one of one sampled resident who was terminated. Findings include: 1. A review of R3’s resident records revealed a “Final Eviction Notice due to behaviors” dated August 15, 2025, which did not include the policy for refunding fees, charges, or deposits, nor the deposition of R3’s fees, charges, and deposits. 2. In an interview, E1 reviewed R3’s “Final Eviction Notice due to behaviors” and acknowledged that there was no other documentation available for review to reflect that the above documentation was given to R3 upon termination.

Based on record review and interview, the manager failed to ensure the following was provided to a resident when the manager provided the written notice of termination of residency in subsection (G): a copy of the resident’s current service plan and documentation of the resident’s freedom from infectious tuberculosis, for one of one sampled resident who was terminated. Findings include: 1. A review of R3’s resident records revealed a “Final Eviction Notice due to behaviors” dated August 15, 2025, which did not reflect R3’s service plan, and documentation of freedom from infectious tuberculosis was included in the termination of residency. 2. In an interview, E1 reviewed R3’s termination of residency and acknowledged that there was no documentation available for review during the survey to reflect that the above requirement was met.

Based record review and interview, the manager failed to ensure that a written notice of termination included the contact information for the State Long-Term Care Ombudsman. Findings include: 1. A review of R1’s medical record revealed a document titled “Formal Notice of Termination” dated April 7, 2025 due to nonpayment of rent. R1’s termination letter reflected “Should you have any questions or need further assistance, you may contact the state long-term care ombudsman at [Ombudsman Phone Number] or [Ombudsman Phone Number]”. R1’s notice of termination did not include the contact information for the State Long-Term Care Ombudsman. 2. In an interview, E1 acknowledged that the notice of termination provided to R1 did not include the contact information for the State Long-Term Care Ombudsman.

Based on documentation review and interview, the manager failed to ensure that the facility conducted an investigation and created an incident report for an allegation of sexual assault. The deficient practice posed a potential danger to the health and safety of residents. Findings include: 1. Documentation review established that the facility had not conducted an investigation and did not have an incident report for the incident involving R1. 2. In an interview, E1 confirmed that the facility had not conducted an investigation and did not have an incident report for the incident involving R1. 3. In an interview, R1 confirmed to the Compliance Officer that R1 was reportedly raped by an employee about nine to ten months ago and R1 also did not want this employee’s identity to be known. R1 reported the rape to E2 who then reported it to E3. 4. In an interview, E2 reported that R1 told E2 about the sexual assault in February. E1 confirmed that the alleged perpetrator had been put on administrative leave pending a full investigation.

Based on documentation review and interview, the manager failed to ensure that the facility was treating residents with dignity, respect, and consideration. The deficient practice posed a potential risk to the health and safety of residents. Findings include: 1. Documentation review established that the facility had not conducted an investigation and did not have an incident report for the incident involving R1. 2. In an interview, E1 confirmed that the facility had not conducted an investigation and did not have an incident report for the incident involving R1. E1 confirmed that this was not in accordance with treating R1 with dignity, respect, and consideration.