Renata's Home for the Elderly

Based on observation and interview, the manager failed to ensure that there was a means of exiting the facility that controlled or alerted employees of the egress of a resident from the facility. Findings include: 1. A review of the Department's documentation revealed the facility was licensed at the directed care level. 2. During an environmental tour of the facility, the Compliance Officer observed that the front door, door to the garage, and sliding back door to the backyard were equipped with an alarm to alert employees of egress. However, the alarms were not turned on at the time of the inspection. 3. In an interview, E1 acknowledged that the facility provided directed care services and did not contain a way to control or alert employees of the egress of a resident from the facility on all exits. This is a repeat deficiency from the compliance inspection and complaint investigation conducted on May 12, 2023.

Based on observation and interview, the manager failed to ensure that food was protected from potential contamination. Findings include: 1. During an inspection of the facility, the Compliance Officer observed an open box on the floor with bags of potatoes. 2. In an interview, E1 acknowledged that food was not protected from potential contamination.

Based on observation and interview, the manager failed to ensure a refrigerator used by an assisted living facility to store food or medication contains a thermometer, accurate to plus or minus 3° F, placed at the warmest part of the refrigerator. Findings include: 1 . During an environmental inspection of the facility, the Compliance Officers observed that the refrigerator did not contain a thermometer. 2 . In an interview, E1 acknowledged that a thermometer had not been placed inside the refrigerator.

Based on observation and interview, the manager failed to ensure food was free from spoilage, filth, or other contamination and was safe for human consumption. 1. During an environmental inspection of the kitchen, the compliance officer observed moldy cheese in the fridge. 2. In an interview, E1 acknowledged that food was not free from spoilage, filth, or other contamination and safe for human consumption.

Based on observation and interview, the manager failed to ensure the premises were free from a condition or situation that may cause a resident or other individual to suffer physical injury. Findings include: 1. A review of Department documentation revealed the facility was licensed to provide directed care services. 2. While on-site, the Compliance Officers observed ambulatory residents. 3. During an environmental inspection of the backyard, the Compliance Officer observed a hose lying on the walkway that presented a tripping hazard. 4. In an interview, E2 acknowledged this area was not free from a condition or situation that may cause a resident or other individual to suffer physical injury.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance of an individual, the individual submitted documentation dated within 90 calendar days before the individual was accepted, to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse or physician assistant, for one of three sampled residents. Findings include: 1. A review of R2's medical record revealed no documentation dated within 90 calendar days before R2 was accepted by the assisted living facility to include whether R2 required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse or physician assistant. 2. In an interview, E1 acknowledged the manager failed to ensure before or at the time of acceptance of an individual, the individual submitted documentation dated within 90 calendar days before the individual was accepted, to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse or physician assistant.

Based on record review and interview, the manager failed to ensure a written service plan was available, for one of three residents sampled. The deficient practice posed a risk as there was no service plan to direct services to be provided to a resident. Findings include: 1. A review of R2's medical record revealed no documentation of a written service plan. Based on R2's date of acceptance, a service plan was required. 2. In an interview, E1 reported R2 received directed care services. E1 acknowledged R2's record did not include a written service plan.

Based on record review and interview, the manager failed to ensure a resident's written service plan was signed and dated by the resident or resident's representative when initially developed and when updated, for one of three residents sampled. Findings include: 1. A review of R1's medical record revealed a service plan dated February 17, 2022, for directed care services. However, the service plan was not signed and dated by R1's representative. 2. In an interview, E1 acknowledged the service plan provided for R1 was not signed and dated by R1 or R1's representative. This is a repeat citation from the previous on-site compliance inspection conducted on April 11, 2022.

Based on record review and interview, the manager failed to ensure a caregiver provided a resident with the assisted living services in the resident's service plan and documented the services provided in the resident's medical record, for three of three sampled residents. Findings include: 1. A review of R1's medical record revealed a service plan dated February 17, 2022 for directed level of care. R1's service plan revealed R1 required assistance with activities of daily living (ADLs), including the following: -"Eating...three times daily and as needed for snacks"; -"Oral care...twice daily and as needed"; -"Hair care/ shaving...daily and as needed"; -"Dressing...twice daily and as needed"; -"Bathing...twice weekly and as needed"; and -"Transferring...daily as needed". However, no documentation of any ADL assistance provided to R1 was available for review. 2. A review of R3's medical record revealed a service plan dated February 6, 2023 for personal level of care. R3's service plan revealed R3 required assistance with ADLs, including the following: -"Eating...Three times daily and as needed with snacks"; -"Oral care...twice daily and as needed"; -"Nail Care...Nails checked daily and trimmed as needed"; -"Hair care...daily and as needed"; -"Dressing...twice daily and as needed"; -"Bathing.. twice weekly and as needed"; and -"Transferring...daily as needed". However, no documentation of any ADL assistance provided to R3 was available for review. 3. In an interview, E1 reported the ADL documentation was contained in electronic medical records and stated E1 would email the documentation for R1 and R3 to the Compliance Officer. However, the Compliance Officer did not receive any email containing the ADL documentation to review.

Based on observation and interview, the manager failed to ensure a calendar of planned activities was prepared at least one week in advance of the date the activity was provided. Findings include: 1. During the environmental inspection of the facility, the Compliance Officers observed an activity calendar posted in the front entry way of the facility. However, the activity calendar was dated September 2022. 2. In an interview, E1 and E3 acknowledged the posted activities calendar was not current.

Based on observation and interview, the manager failed to ensure a resident was not subjected to restraint. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed R4 laying in bed. One side of R4's bed was placed against a wall and bedrails, half the length of the bed, were placed on both sides of the bed. The Compliance Officer observed R4 was awake, but was unable to communicate for an interview. 2. During the environmental inspection of the facility, the Compliance Officer observed R5 laying in bed. One side of R5's bed was placed against a wall and bedrails, half the length of the bed, were placed on both sides of the bed. 3. In an interview, R5 stated R5 was not able to put the bedrails down, and the facility had purchased the bedrails in order for R5 to not fall out of bed. 4. In an interview, E3 acknowledged R4 and R5 were not able to put the bedrails down, and R4 was not vocal to express R4's needs. E3 stated the bedrails were used to prevent R4 and R5 from falling out of bed.

Based on observation and interview, the manager failed to ensure a bell, intercom, or other mechanical means to alert employees to a resident's needs or emergencies was available in a bedroom being used by a resident receiving directed care services or had implemented another means to alert a caregiver or assistant caregiver to a resident's needs or emergencies. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed R4's bedroom did not contain a bell, intercom, or other means to alert employees to R4's needs or emergencies. 2. In an interview, E3 stated R4 was non-verbal and was not able to call for assistance. E3 also acknowledged R4's bedroom did not contain a bell, intercom, or other means to alert employees to needs or emergencies.

Based on documentation review, observation, and interview, the manager failed to ensure for a facility authorized to provide directed care services, the means of exiting the facility for a resident who did not have a key, special knowledge for egress, or the ability to expend increased physical effort, controlled or alerted employees of the egress of a resident from the facility to the outside area allowing the resident to be at least 30 feet away from the facility. Findings include: 1. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. During the environmental inspection of the facility, the Compliance Officer observed a door leading from the living room area out to the back yard. The outside area in the back yard allowed residents to be at least 30 feet away from the facility. However, the door did not have a device to alert employees of the egress of a resident from the facility. 3. In an interview, E1 acknowledged the manager failed to ensure for a facility authorized to provide directed care services, the means of exiting the facility for a resident who did not have a key, special knowledge for egress, or the ability to expend increased physical effort, controlled or alerted employees of the egress of a resident from the facility to the outside area allowing the resident to be at least 30 feet away from the facility.

Based on documentation review and interview, the manager failed to ensure policies and procedures for medication administration were reviewed and approved by a medical practitioner, registered nurse, or pharmacist. Findings include: 1. A review of facility documentation revealed a policy and procedure manual, dated September 28, 2021. The manual included several policies and procedures for medication administration, including "Medication Administration Authorization," and "Medication Statement." However, there was no documentation to indicate the policies and procedures were reviewed and approved by a medical practitioner, registered nurse, or pharmacist. 2. In an interview, E1 acknowledged the policies and procedures for medication administration were not reviewed and approved by a medical practitioner, registered nurse, or pharmacist.

Based on observation and interview, the manager failed to ensure a food menu was conspicuously posted at least one calendar day before the first meal on the food menu was served. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed a food menu conspicuously posted for residents on the kitchen refrigerator. However, the menu was dated for April 2023. 2. In an interview, E1 acknowledged the facility's posted food menu was out of date.