Post of Orchards Assisted Living

Based on record review and interview, the manager failed to ensure any care instructions for a resident provided to the assisted living facility by the home health agency was documented in the resident's service plan, for one of two residents receiving services from home health. The deficient practice posed a risk as the service plan intended to direct R2's care did not reflect R2's current needs. Findings include: 1. A review of R2's medical record revealed a signed order dated April 28, 2023 for wound care instructions. The order identified wound care and stated "Wound care R foot 2nd and 3rd toe. Hospice will change Monday and Thursday. ALF will change all other days....soak foot in mild soapy water for 10-15 min; dry; clean with wound cleanser. Pat dry; apply triple antibiotic. xeroform gauze strip to cover toes. Wrap with gauze and secure with tape". However, R2's service plan dated April 28, 2023, did not include instructions for care for R2's wound care. 2. In an interview, E1 acknowledged R2's service plan did not include instructions for R2's wound care.

Based on documentation review, and interview, the manager failed to ensure a resident was not subjected to misappropriation of personal and private property by the assisted living facility's caregiver for one of two residents sampled. The deficient practice posed a risk as R3's personal benefits were used for the facility rather than exclusively for R3 as allowed by United Healthcare. Findings: 1. Based on review of R3's medical record, R3 received personal care services. 2. R3 received ALTCS services and was issued a United Healthcare benefit card. E1 reported the United healthcare benefit card could be used for food, over the counter medications or adult depends. E1 reported the card contained the following monthly amounts: September 2022 - $175 October 2022 - $175 November 2022 - $175 December 2022 - $175 January 2023- $265 3. During an interview, the Compliance Officer asked E1 if E1 used the card. E1 reported to have used the United Healthcare card that was issued in R3's name. E1 reported to have used the card for facility food from September 2022 - January 2023. E1 reported R3 gave permission to use the card. When asked to review receipts of the purchases made on the card, E1 stated "I don't have them at this time".

Based on record review and interview, the manager failed to ensure medication administered to residents were administered by an individual under direction of a medical practitioner, for two of two residents sampled. The deficient practice posed a risk as medication administration was being completed by individuals who had not been approved by a qualified individual to provide medication administration services. Findings include: 1. Review of R1's medical record showed R1 recently moved into the facility and a service plan was still be completed. E1 reported R1 received medication administration services. 2. Review of R1's medical record revealed medication was being administered by E1, E2, and E4 However, there was no signed medical practitioner's order for facility staff to provide medication administration services to the resident. There was no additional documentation provided. 3. Review of R2's service plan dated April 2023 revealed R2 received medication administration services. 4. Review of R2's medical record revealed medication was being administered by E1, E2, and E4 However, there was no signed medical practitioner's order for facility staff to provide medication administration services to the resident. There was no additional documentation provided. 5. In an interview, E1 acknowledged that facility caregivers provided medication administration services to R1 and R2 without designation and authorization by a medical practitioner to administer medications to the resident.

Based on record review, observation, and interview, the manager failed to ensure a medication administered to a resident was documented in the resident's medical record, for two of two residents reviewed. The deficient practice posed a risk as medication could not be verified as administered against a medication order. Findings include: 1. Review of R1's medical record revealed a signed medication order dated May 10, 2023. This medication order stated "Levothyroxine take one daily". 2. Review of R1's medical record revealed May 2023 medication administration record (MAR). The MAR did not include documentation of administration of the medication for the 8:00 AM administration on May 14, 2023. 3. During an observation of R1's medications, Levothyroxine was observed. 4. Review of R2's medical record revealed a signed medication order dated April 6, 2023. This medication order stated "Mirtazapine 15 mg take one daily". 5. Review of R2's medical record revealed May 2023 medication administration record (MAR). The MAR did not include documentation of administration of the medication for the 8:00 AM administration on May 14, 2023. 6.. During an observation of R2's medications, Mirtazapine was observed. 7. During an interview, E1 acknowledged the aforementioned medications were administered per the medication orders and acknowledged R1 and R2's medical record did not include documentation the medication was administered.

Based on documentation review and interview, the manager failed to ensure an employee disaster drill was conducted on each shift at least once every three months and documented. The deficient practice posed a risk if employees were unable to implement the disaster plan. Findings include: 1. Review of the May 2023 personnel schedule revealed two shifts; 6am-6pm (day shift) and 6pm-6am (night shift). 2. Review of the facility's employee disaster drills revealed a drill conducted as follows: September 24, 2022 on the day shift, December 10, 2022 on the day shift, and March 8, 2023 on the day shift. No other employee disaster drills were available for review. 3. During an interview, E1 acknowledged the employee disaster drills were not conducted on each shift at least once every three months.