Precious Moments Assisted Living LLC

Based on record review, document review, and interview, for one of two caregivers sampled, the manager failed to ensure a caregiver provided current documentation of first aid and cardiopulmonary resuscitation (CPR) training before providing assisted living services. The deficient practice posed a risk if a caregiver was unable to meet a resident's needs during an emergency. Findings include: 1. A review of E4's personnel record revealed E4 was hired as a caregiver on January 28, 2025. However, evidence within E4’s personnel record to indicate E4 was trained and certified in first aid and CPR was unavailable for review. 2. A review of available staff schedules revealed documentation indicating E4 worked numerous shifts in October 2025. 3. In an interview, E1 confirmed E4 had worked numerous shifts as a caregiver since E4's date of hire. E1 acknowledged E4's personnel record did not include evidence of documentation to indicate E4 had received training in first aid or CPR. 4. 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 an assistant caregiver's orientation was documented before the assistant caregiver began providing assisted living services to a resident. Findings include: 1. A review of E2's personnel record revealed E2 was hired as an assistant caregiver on January 25, 2023. E2's personnel record included an orientation checklist, however, the checklist had not been filled out and was only signed by E2. 2. In an interview, the findings were reviewed with E1 and no additional information was provided.

Based on record review and interview, before or within seven calendar days after a resident's date of occupancy, the manager failed to ensure a resident provided evidence of freedom from infectious tuberculosis, for one of two sampled residents. Findings include: 1. A review of R2's medical record revealed documentation of the administration of tuberculin serum to R2 two days prior to R2's acceptance date. However, documentation of a baseline screening per R9-10-113(A)(2)(a) to include a risk assessment, symptom screen, and the skin test result, were not available for review. However, based on R2's date of acceptance, this documentation was required. 2. In an exit interview with E1, the findings were reviewed and no additional information was provided.

Based on record review and interview, the manager failed to ensure a service plan was signed and dated by the resident or resident's representative when the service plan was initially developed or when updated, for one of two sampled residents. Findings include: 1. A review of R1's medical record revealed a service plan, dated March 3, 2025, for personal care services. However, the service plan had not been signed and dated by the resident or resident's representative. 2. A review of R1's medical record revealed a service plan, dated September 3, 2025, for personal care services. However, the service plan had not been signed and dated by the resident or resident's representative. 3. In an exit interview with E1, the findings were reviewed and no additional information was provided.

Based on record review and interview, the manager failed to ensure medication administered to a resident was documented in the resident's medical record, for one of two sampled residents. The deficient practice posed a risk as medication could not be verified as administered against a medication order. Findings include: 1. A review of R1's medical record revealed signed orders for, "Levetiracetam 250 MG Oral Tablet, 1 tablet BID - Twice Daily by mouth," and "Doxycycline Hyclate 100 MG Oral Capsule, 1 capsule BID - Twice Daily Po." 2. A review of R1's medical record revealed a Medication Administration Record (MAR) dated August 4, 2025 through September 4, 2025. The MAR documented the medications administered to R1 on each day. However, the MAR documented Levetiracetam and Doxycycline had each been administered one time per day. 3. In an exit interview with E1, the findings were reviewed and no additional information was provided. This is a repeat deficiency from the on-site compliance inspection conducted on September 4, 2025.

Based on documentation review, and interview, the manager failed to ensure documentation was maintained for at least 12 months after the last date on the documentation of the caregivers and assistant caregivers working each day, including the hours worked by each. Findings include: 1. During the on-site inspection on September 4, 2024, The Compliance Officer requested to review the facility work schedule for August 2024, however, this documentation was not provided for review. 2. In an interview, E1 acknowledged documentation of the caregivers and assistant caregivers who worked during August, 2024, including the hours worked by each, had not been provided for review.

Based on record review, documentation review, and interview, the manager failed to ensure, for two of two caregivers sampled, before providing assisted living services to a resident, a manager or caregiver provided current documentation of first aid training and cardiopulmonary resuscitation (CPR) training certification. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency. Findings include: 1. A review of E2's personnel records revealed CPR and First Aid training certifications dated July 30, 2022 with a marked expiration of July 30, 2024. However, current documentation of CPR and First Aid training for E2 was not available for review. 2. A review of E3's personnel records revealed a First Aid training certification dated April 7, 2022 with a marked expiration of April 7, 2024. However, current documentation of First Aid training for E3 was not available for review. 3. In an interview, E1 acknowledged E2's and E3's personnel records did not include documentation of current CPR and First Aid training certification.

Based on documentation review, observation, and interview, for a facility authorized to provide directed care services, the manager failed to ensure there was a means of exiting the facility that provided access to an outside area which allowed a resident to be at least 30 feet away from the facility and controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a risk if the facility was unaware of the general or specific whereabouts of a resident. Findings include: 1. A review of Department records revealed the facility was licensed to provide directed care services. 2. During an environmental inspection of the facility, the Compliance Officer observed an exit door in the living room leading to the back yard had a door alarm. However, the door alarm was turned off. 3. In an interview, E1 acknowledged the door alarm was observed to be turned off during the on-site inspection. Technical assistance for this rule was provided during the on-site compliance inspection conducted on July 17, 2023.

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 one of two residents sampled who received medication administration. The deficient practice posed a risk if a resident experienced a change in condition due to improper administration of medication. Findings include: 1. A review of R1's medical record revealed a service plan, updated August 2024, for directed care services including medication administration. 2. A review of R1's medical record revealed an order, dated August 19, 2024 for, "Mirtazapine 7.5 MG Oral Tablet, 7.5 mg QHS, Start 8/19/2024, Give one tablet at bedtime daily." 3. A review of R1's medical record revealed an electronic Medication Administration Record (eMAR) dated August 2024. The eMAR documented the following: - "Mirtazapine, 7.5 mg, 7:00 PM, Dose 7.5 MG," had been marked as administered at 7 PM on August 31, 2024, but had been marked as omitted on August 17, 2024 through August 30, 2024. 4. The Compliance Officer observed a multi-dose medication organizer for R1 included Mirtazapine in each daily section as ordered. 5. In an interview, E1 reported the Mirtazapine had been administered as ordered and there was an issue with the eMAR. E1 acknowledged the provided documentation of medication administration for R1 was not accurate. This is a repeat deficiency from the on-site compliance inspection conducted on July 17, 2023.

Based on observation and interview, the manager failed to ensure a refrigerator used by an assisted living facility to store food contained a thermometer, accurate to plus or minus 3\'b0 F, placed at the warmest part of the refrigerator. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed a refrigerator in the kitchen. The refrigerator contained foods requiring refrigeration. However, refrigerator did not contain a thermometer. 2. During an environmental tour of the facility, the Compliance Officer observed a refrigerator in the laundry room. The refrigerator contained foods requiring refrigeration. However, refrigerator did not contain a thermometer. 3. In an interview, E1 acknowledged the refrigerators did not contain a thermometer placed at the warmest part of each refrigerator.

Based on observation and interview, the manager failed to ensure garbage and refuse were stored in covered containers lined with plastic bags. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed a shared bathroom located in the east hallway. Inside the bathroom, the Compliance Officer observed a trash can next to the toilet. The trash can contained garbage and was lined with a plastic bag, however, the lid had been removed and was stored behind the toilet. 2. During an environmental tour of the facility, the Compliance Officer observed a small trash can next to the bed in room three. The trash can was lined with a plastic bag but did not have lid. The trash can was overflowing due to containing a soiled disposable incontinence pad which did not fit into the trashcan. 3. In an interview, E1 acknowledged the manager failed to ensure garbage and refuse were stored in covered containers lined with plastic bags.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials stored by the facility were stored in a locked area and were inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed a shared bathroom located in the east hallway. The Compliance Officer observed a cabinet below the bathroom sink did not have a lock and was accessible to residents. Inside the cabinet, the Compliance Officer observed a bottle of nail polish remover. 2. During an environmental inspection of the facility, the Compliance Officer observed a closet located in the east hallway. The Compliance Officer observed the closet had a curtain instead of a door and was accessible to resident.. Inside the closet, the Compliance Officer observed a container of joint compound. 3. In an interview, E1 acknowledged poisonous or toxic materials stored by the facility were not stored in a locked area inaccessible to residents. This is a repeat deficiency from the onsite compliance inspection conducted on July 17, 2023.

Based on record review, observation, and interview, the manager failed to ensure a medication was administered in compliance with a medication order, for one of two residents sampled. Findings include: 1. A review of R2's medical record revealed a service plan, updated February 8, 2023, for directed care services including medication administration. 2. A review of R2's medical record revealed a signed list of medication orders dated May 2, 2023. The list included: - "Lisinopril 10mg 1 PO QD;" 3. A review of R2's medical record revealed a Medication Administration Record (MAR) dated July 2023. The MAR documented the following medication administration had been provided to R2 in July 2023: - For, "Lisinopril 20 MG, 1 PO QD," the MAR indicated R1 had received the medication at 7 am on July 3, July 4, July 5, July 6, July 7, July 10, July 11, July 12, July 13, July 14, and July 16, 2023. However, the administered dosage of 20 milligrams was not in compliance with the order for 10 milligrams. 4. The Compliance Officer observed a box containing R2's medications included a multi-dose package of, "Lisinopril 5MG tablets, take 1 tablet by mouth daily." The package indicated it had been filled on June 22, 2023, and had 18 of 30 doses remaining at the time of the inspection. However, the actual dosage of 5 milligrams was not in compliance with the order for 10 milligrams. 5. In an interview, E1 acknowledged R2's medical record and available medication indicated medications had not been administered to R2 in compliance with an order.

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 sampled who received medication administration. Findings include: 1. A review of R1's medical record revealed a service plan, updated February 1, 2023, for personal care services including medication administration. 2. A review of R1's medical record revealed a signed list of medication orders dated May 2, 2023. The list included: - "Aspirin 81 mg 1 po QD;" - "Docusate sodium 100MG, 2 PO QHS;" - "Latanoprost 0.005% 1 drop QPM;" - "Trazodone 50 mg, 1 PO QHS;" and - "Tamsulosin 0.4 mg, 1 PO A.C. PM." 3. A review of R1's medical record revealed a Medication Administration Record (MAR) dated July, 2023. The MAR indicated the following: - For the medications, "Aspirin 81 MG", "Tamsulosin 0.4 MG," "Trazodone 50 mg," "Docusate 100 mg," and, "Latanoprost 0.5%," the MAR indicated the medications had not been administered on July 1, July 2, July 4, July 6, July 9, July 11, July 13 or July 15, 2023. 4. A review of R2's medical record revealed a service plan, updated February 8, 2023, for directed care services including medication administration. 5. A review of R2's medical record revealed a signed list of medication orders dated May 2, 2023. The list included: - "Amantadine 100 mg 1 po BID;" - "Divalproex 250mg 2 po AM;" - "Divalproex 250mg 4 po QHS;" - "Lisinopril 10mg 1 PO QD;" - "Simvastatin 20mg 1 PO QHS;" - "HCTZ 12.5mg 1 PO QD;" - "Docusate 100mg 1 PO BID;" and - "Trazodone 100mg 2 PO QHS." 6. A review of R2's medical record revealed a Medication Administration Record (MAR) dated July, 2023. The MAR indicated the following: - For the medications, "Amantadine," "Divalproex 250 mg 2 PO AM," "Lisinopril 20 mg," "HCTZ 12.5 mg," and, "Colace 100 mg," the MAR indicated the medications had not been administered at 6 AM or at 7 AM on July 1, July 2, July 8, July 9, or July 15, 2023; and - For the medications, "Amantadine," "Divalproex 250 mg 4 PO PM," "Simvastatin 20mg," "Colace 100 mg," and, "Trazodone 100 mg," the MAR indicated the medications had not been administered at 6 PM on July 1, July 2, July 4, July 6, July 9, July 11, July 13, or July 15, 2023. 7. In an interview, E1 acknowledged the medications administered to R1 and R2 had not been accurately documented in each resident's medical record.

Based on observation and interview, the manager failed to ensure that medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed a refrigerator located in the kitchen was not locked and was accessible to residents. Inside the refrigerator, the Compliance Officer observed a container of "Lorazepam Oral 2 mg/ mL," a container of, "Morphine Sulfate 20mg/mL," and a container of, "Latanoprost Opthalmic 2.5ML," in an unlocked metal box stored inside the refrigerator. 2. During an environmental inspection of the facility, the Compliance Officer observed an unlocked drawer in a cabinet in a hallway adjacent to the front door. Inside the drawer, the Compliance Officer observed a box of, "Gentle Lax 10MG Suppositories," 3. In an interview, E1 acknowledged medication was not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials were maintained in a locked area separate from food preparation and storage areas and were inaccessible to residents. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed an unlocked cabinet below the kitchen sink. Inside the cabinet, the Compliance Officer observed three bottles of, "Great Value All Purpose Cleaner with Bleach" 2. During an environmental inspection of the facility, the Compliance Officer observed an unlocked cabinet in a hallway between the kitchen and laundry room. Inside the cabinet, the Compliance Officer observed a bottle of bleach. 3. During an environmental inspection of the facility, the Compliance Officer observed an unlocked cabinet below the sink in a shared bathroom located on the east side of the facility. Inside the cabinet, the Compliance Officer observed a bottle of glass cleaner. 4. In an interview, E1 acknowledged poisonous or toxic materials were not maintained in a locked area inaccessible to residents.