Pine Meadows Ranch

Based on record review, documentation review, and interview, the manager failed to ensure a caregiver's skills and knowledge were verified and documented before providing physical health services and according to policies and procedures, for three of four caregivers reviewed. The deficient practice posed a health and safety risk. Findings include: 1. A review of E2's, E3's, and E4's personnel records revealed no documentation of verification of the employees' skills and knowledge. 2. A documentation review of the Policy and Procedures revealed a policy titled "Skills and Knowledge Policy and Procedures." The document states: "VERIFICATION PROCESS: Skills and knowledge will be verified by Manager/Designee on date of hire through practical assessment and demonstrate their understanding by checking, sign and dated the caregiver skills and knowledge documentation before they are permitted to provide services to the residents. The signed document will be included in the employee's file. REGULAR AUDITS: Caregiver skills and knowledge documentation is completed accurately and thoroughly before the employee provides services to residents. Any lapses on verification process must be address promptly and perform a regular performance review to implement continuous education as part of the in service or refresher course training." 3. In an interview, E1 acknowledged that E2, E3, and E4 did not have documentation of the skills and knowledge in their personnel record. 4. In an exit interview, the information was reviewed with E1; no other documentation was provided.

Based on record review and interview, the manager failed to ensure a resident's written service plan included the frequency of assisted living services being provided to the resident for three of the three residents reviewed. The deficient practice posed a risk as the service plans did not reinforce and clarify the services to be provided to a resident. Findings include: 1. A review of R1's medical record revealed a current service plan dated October 9, 2025. This service plan did not include the frequency of assistance with dressing, bathing, or showering, grooming, incontinence care, and medication administration. 2. A review of R2's medical record revealed a current service plan dated June 4, 2025. This service plan did not include the frequency of assistance with dressing, bathing or showering, grooming, and medication administration. 3. A review of R3's medical record revealed a current service plan dated December 12, 2024. This service plan did not include the frequency of assistance with dressing, bathing or showering, grooming, and medication administration. 4. In an interview, E1 acknowledged that the service plans did not include the frequency of services for R1, R2, and R3. 5. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review and interview the health care institution failed to develop and administer a training program for all staff regarding fall prevention and fall recovery. Findings include: 1. Review of the record for E1 (hired May 1, 2022), failed to reveal documentation of fall prevention and fall recovery training. 2. Review of the record for E3 (hired June 13, 2019), failed to reveal documentation of fall prevention and fall recovery training. 3. During an interview, E1 indicated that training for fall prevention and fall recovery had not been developed and administered to all staff. 4. This is a repeat deficiency from the compliance inspection conducted on August 4, 2022.

Based on 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 was not present. Findings include: 1. During an interview, E2 indicated that on September 14, 2023 E3 had worked alone at the facility from 1pm to 5pm. 2. The delegation of authority statement failed to indicate that the manager designated E3 to be accountable for the facility in the manger's absence. 3. Review of the record for E3 (hired June 13, 2019) revealed documentation of caregiver certification. 4. During an interview, E1 acknowledged that documentation failed to indicate that the manager had designated in writing that E3 act as manager designee when the manager was not present on the assisted living facility premises.

Based on documentation review and interview, the manager failed to ensure that documentation was maintained that included the hours worked by each caregiver. Findings Include: 1. Review of the record of employee work schedule dated September 14, 2023 indicated that E2 worked a 24-hour shift. 2. During an interview, E2 stated, "I was gone from 1pm to 5pm that day. E3 worked for me during that time. I forgot to put that on the schedule." 3. During an interview, E1 acknowledged the required documentation was not available for review.

Based on record review and interview, the manager failed to ensure for one of three personnel records that before providing services to a resident, a manager or caregiver provides documentation of first aid training and cardiopulmonary resuscitation (CPR) training certification specific to adults. Findings include: 1. The record for E2 (hired August 21, 2023), failed to reveal documentation of CPR and First aid certifications. 2. During an interview, E1 acknowledged that the caregiver provided services to residents without documentation of first aid and CPR training certification. 3. This is a repeat deficiency from the compliance inspections conducted on April 25, 2019, July 24, 2020, August 6, 2021, and August 4, 2022.

Based on documentation review and interview, the manager failed to ensure that the disaster plan was reviewed at least once every 12 months. Findings include: 1. Review of facility disaster plan review documentation indicated that the last review was conducted on January 5, 2022. 2. During an interview, E1 acknowledged that the documentation failed to reflect that a review had been conducted at least once every 12 months.