Rocky Mountain Assisted Living - Saulsbury

A revisit survey was completed on 4/16/25 for all previous deficiencies cited on 8/15/24. The facility is in compliance with all deficiencies that were cited. Citation coded "0000" or "9999" are initial and final comments of an inspection for informational purposes, this field may also have been left blank intentionally

A relicensure survey with complaints #CO36871 and #CO36929 was completed on 8/15/24. Deficiencies were cited. Based on interview and record review, the residence failed to notify a resident' s representative when a resident experienced a change in baseline status, affecting one of three sample residents (#1).Findings include:1. Record ReviewResident #1 was admitted to the residence on 11/1/22.A fall report, dated 7/4/24, read in part: "(Staff) went to administer medications and found [Resident #1] on the floor. RCC (resident care coordinator) witnessed and caregiver (witnessed). Pain (was) mentioned (with) no visible injuries." However, staff did not document in the fall report that they notified the resident' s representative.A progress note, dated 7/16/24, read in part: "Fall (unwitness.. Based on interview and record review, the residence failed to, on a quarterly basis, audit the accuracy and completeness of medication administration records (MARs), affecting 12 current residents.Findings include:On 8/15/24 at approximately 9:30 a.m., the last two quarterly medication audits were requested from the administrator. However, no documentation was provided.On 8/15/24 at 12:46 p.m., the administrator stated she was aware of the requirement to complete quarterly audits of the MARs. The administrator confirmed she had not completed the medication audits for the last two quarters. Based on observation and interview, the residence failed to ensure a storage area with items that could pose a risk to residents was inaccessible to residents, affecting 12 current residents.Findings include:1. ObservationsOn 8/15/24 from approximately 7:30 a.m. to 8:50 a.m., the door to the storage and laundry room containing chemicals and toxic materials was open and accessible to residents. A delivery stack of boxes full of hand sanitizer was stacked in the hallway next to the laundry and storage area and was accessible to residents.On 8/15/24 from 9:11 a.m. to 9:46 a.m., the door to the storage and laundry room containing chemicals and toxic materials was open and accessible to reside.. Based on record review and interview, the residence failed to comply with practitioners orders, affecting two of three current sample residents (#1 and #3).Findings include:1. Record ReviewResident #1 was admitted to the residence on 11/1/22.A written practioner' s order, dated 7/13/23, directed the residence to administer tramadol HCL 50 mg twice daily for pain. However, the August 2024 medication administration record (MAR) read the the residence failed to administer the medication on 8/11 and 8/12/24 because they did not have the medication in stock, for a total of four missed doses.2. InterviewOn 8/15/24 at 3:00 p.m., the administrator stated she expected staff to order medications .. THIS PORTION OF THE REPORT IS FOR INFORMATIONAL PURPOSES ONLY.No response is necessary.The residence was advised it must review and maintain the following processes in accordance with existing program regulations found at 6 CCR 1011-1, Chapter 7.10.1 The assisted living residence shall have readily available a roster of current residents, their room assignments and emergency contact information, along with a facility diagram showing room locations.14.29 All prescribed and PRN medications shall be listed and recorded on a medication administration record (MAR) which contains the name and date of birth of the resident, the resident ' s room location, any known allergies,..

A licensure complaint, prompted by #CO31596 and #CO34448, was completed on 1/4/24. Deficiencies were cited. Based on record review and interview, the residence failed to ensure that it had trained staff available to evaluate residents who have fallen and provide lift assistance when determined appropriate instead of relying on emergency medical responders affecting nine current residents. Findings include 1. Residence policy The residence' s lift assist procedures, dated 11/27/23, read in part: In the event a resident had fallen, staff placed a chair without wheels next to the resident so they may use it for stability and encouraged the resident to remain in a sitting position until they are ready and able to stand. When the resident was standing, staff assisted them to a comfortable position so they may rest.2. Record ReviewA staff orientation checklist for Staff #1, dated 10/18/22, did not include documentation of lift assistance training.A December 2023 staff schedule revealed that Staff #1 provided care and services to residents on 12/7/23.3. InterviewOn 1/4/24 at 7:30 a.m., Staff #3 stated the resident care coordinator trained staff to transfer residents, however, had not trained staff to provide lift assistance for the residents that fell. On 1/4/24 at 7:37 a.m., Staff # 3 stated they did not recall receiving lift assist training from the residence. On 1/4/24 at 9:04 a.m., the assistant executive director stated the residence provided a book for contracted staff that included all information n.. Based on record review and interview, the residence failed to provide lift assistance to residents who had fallen and were unable to independently get up off the floor, affecting one of two sample residents (#1). Findings include 1. Residence policyThe residence' s lift assist procedures, dated 11/27/23, read in part: In the event a resident had fallen, staff placed a chair without wheels next to the resident so they may use it for stability and encouraged the resident to remain in a sitting position until they are ready and able to stand. When the resident was standing, staff assisted them to a comfortable position so they may rest. 2. Record ReviewResident #1 was admitted to the residence on 12/7/21 with diagnoses including Alzheimer' s disease and epilepsy.A progress note, dated 12/7/23, for Resident #1 read Staff #1 telephoned for lift assistance after the resident was found on the floor, there was no evidence Staff #1 attempted to lift the resident.3. InterviewOn 1/4/23 at 7:30 a.m., Staff #3 stated if a resident fell and staff could not lift the resident, staff would telephone for lift assist. She also stated the resident care coordinator trained staff to transfer residents; however, she had not trained staff to provide lift assistance for the residents that fell. She confirmed that staff were required to telephone for lift assistance whenever a resident fell and was unable ..