Serenity Care Kingston

Approximately 8 inches of snow accumulation was blocking the exit doors of the 300 hallway, Secured Dementia Dining Room, and 400 hallway.

Staff failed to notify the doctor as required by the resident's sliding scale insulin order following a high blood glucose reading.

A medication administration record incorrectly documented a resident receiving 35 units of insulin instead of the prescribed sliding scale dose.

A resident's initial support plan was not completed within the required 72-hour window following admission to the Secure Dementia Care Unit.

A resident's bedside mobility device was not attached to the bed frame, posing a risk of injury or entrapment.

A grey wheeled utility cart was blocking the egress from the dining room exit door to the parking lot.

An employee handled a resident roughly and struck them in the back with a closed fist during a shower.

A written cognitive preadmission screening was not completed for a resident admitted to the Secure Dementia Care Unit on 5/9/25.

During a fire drill on 5/31/25, residents refused to evacuate the building to the designated meeting place.

Residents did not receive prescribed daily blood glucose checks at 4:00 P.M., and a resident received an incorrect dosage of medication at 9:00 P.M.

Resident #1 was not evacuated during fire drills from October 2024 through March 2025 without a written physician certification that the resident is actively dying.

The designated staff member failed to notify the resident and staff that the resident was not to be evacuated during fire drills conducted between October 2024 and March 2025.

There was no written informed consent from Resident #1 or their power of attorney regarding the decision not to evacuate during fire drills.