Paradise Assisted Living Home LLC

Based on documentation review, record review, observation, and interview, the manager failed to ensure an individual authorized by policies and procedures to administer an opioid, documented in the resident's medical record the identification of the resident's need for the opioid and the effect of the opioid administered, for one of one resident reviewed. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1 . A review of the facility's policies and procedures revealed a policy titled Opioid Prescribing and Treatment. This policy stated, "Except for a resident (patient) with a terminal condition as documented by a physician, an individual authorized to administer an opioid shall do the following: 1. Identify the resident's pain before the opioid is administered by using a pain scale table. Ask resident to rate pain level (0 = no pain to 10 = worst pain possible). If resident is unable to communicate, caregiver will document signs and symptoms that lead them to believe that the resident was in need of the opioid medication". 2 . A review of R2's medical record revealed a signed order dated August 11, 2025 for "Tramadol, 50 MG 1 TAB PO Q 6 HRS PRN". 3 . A review of R2's medical record revealed a July 2025 medication administration record (MAR). This MAR revealed no documentation that Tramadol was administered. However, a "controlled drug sign out log" revealed Tramadol was administered on the following dates and times: July 1, 2025, at 8 PM July 6, 2025, at 3 PM July 8, 2025, at 11 PM July 11, 2025, at 2 PM July 13, 2025, at 4 PM July 15, 2025, at 8 PM July 16, 2025, at 9 PM Documentation was not available that showed the identification of R2's need for the opioid and the effect of the opioid administered. 4 . A review of R2's medical record revealed no documentation R2 had an end-of-life condition or active malignancy. 5 . In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that a medication administered to a resident was administered in compliance with a medication order for one of two residents sampled. The deficient practice posed a risk as medication could not be verified as administered as prescribed against a medication order . Findings include: 1 . A review of R1's medical record revealed a signed medication order dated June 3, 2025. This order stated, "Midodrine 5 MG 1 TAB PO TID for BP, hold if BP>130 SYS". 2 . Review of R1's medical record revealed an August 2025 medication administration record (MAR). This MAR revealed administered of Midodrine 5 MG 1 TAB PO TID on the following days at 8AM, 12 PM and 5PM: August 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 25, 16, 17, 18 3 . Review of R1's medical record revealed blood pressure vital statistics flowchart was not properly documented based on the order for Midodrine, 5MG, 1 TAB PO TID for blood pressure, hold if blood pressure is above 130 systolic. There was no recording of blood pressure statistics for the 12PM or 5PM medication administration for the following months: January 2025 February 2025 March 2025 April 2025 May 2025 June 2025 July 2025 August 2025 4 . In an exit interview, findings were discussed with E1 and no additional information was provided.

Based on observation, documentative review, and interview, the manager failed to ensure an assisted living home had a smoke detector installed in all required areas. The deficient practice posed a risk if safety measures were not in place to protect residents and employees in the event of a fire. Findings include: 1. During the environmental inspection, the Compliance Officers observed that there was no smoke detector in the facility's office that was used to store medical records and medication, and there was no smoke detector installed in an employee's bedroom. 2. The facility's documentation review revealed policies and procedures that stated, "Smoke detectors systems in the Facility that will be kept in working order; hard wire system that is connected into the electrical system of the Facility; and will be installed at a minimum in the following areas: bedrooms, hallways that adjoin bedrooms, attached garages or storage areas, if applicable, rooms, hallways adjacent to kitchen and other locations as required by local authorities." 3 . In an exit interview, the findings were reviewed with E1, and no additional information was provided.