Rosecrest Assisted Living Residence

A resident requiring a two-person assist for transfers was transferred by a single staff member, violating the resident's support plan.

Staff involved in an allegation of verbal abuse continued to work unsupervised or without suspension during the investigation.

An allegation of abuse was not reported to the Department within 24 hours and the report was incomplete regarding involved staff.

An allegation of verbal abuse against staff was not reported to the Area Agency on Aging immediately.

A resident was subjected to physical mistreatment involving being grabbed by the wrist and arm, resulting in bruising.

Staff could not provide requested staff files and a complete staff contact list to the Department agent upon request.

An allegation of resident abuse was not orally reported to the local Area Agency on Aging until 01/10/24.

The residence failed to report an incident to the Department's office or complaint hotline within the required 24-hour timeframe.

The facility failed to immediately implement a plan of supervision or suspend a staff person involved in an alleged abuse incident.

The residence failed to immediately report suspected resident abuse to the local Area Agency on Aging.

The facility failed to complete annual additional written assessments for a resident.

Resident #1 experienced numerous unwitnessed falls resulting in injuries, including skin tears, abrasions, and a broken elbow, indicating potential neglect.

Contracts for resident #1 and resident #2 were not signed by the residents.

The residence failed to provide required ADL assistance, including ambulation with a walker and healthcare management, for resident #1 between January and May 2023.

The final support plan for resident #1 lacked descriptions of service needs, plans to meet needs, frequency, and responsible parties for several behavioral and cognitive needs.

The written initial assessment for resident #1 was blank in the sections for medication administration, dental needs, dietary needs, and sensory needs.

The initial support plan for Resident #2 was not dated when completed.

Resident #1's medical evaluation for the special care unit was missing the evaluation date, completion date, and type of evaluation.

Cognitive preadmission screenings for Residents #1 and #2 were missing the date of determination and, in one case, the name of the screener.