Sierra Adult Care, LLC

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. Findings include: 1. A review of R2's medical record revealed a service plan, updated October 16, 2024, for directed care services including medication administration. 2. A review of R2's medical record revealed an order, dated August 1, 2024, for, "Furosemide 20 MG Tablet, Take 1 tablet by mouth daily." 3. A review of R2's medical record revealed a Medication Administration Record (MAR), dated October 2024. The MAR documented the medications administered to R2 during the month of October, 2024. However, the MAR did not document the administration of Furosemide 20 milligram capsules to R2. 4. A review of R2's medical record revealed a Medication Administration Record (MAR), dated September 2024. The MAR documented the medications administered to R2 during the month of September, 2024. However, the MAR did not document the administration of Furosemide 20 milligram capsules to R2. 5. A review of R2's medical record revealed a Medication Administration Record (MAR), dated November 2024. The MAR documented the medications administered to R2 during the month of November, 2024, and did document the administration of Furosemide to R2 as ordered. 6. The Compliance Officer observed a box containing R2's medications included a multi-dose package of "Furosemide 20 MG Tablet," filled on October 4, 2024. The number of remaining tablets indicated the medication was likely administered in October 2024. 7. In an interview, E1 and E2 acknowledged the MAR provided for R2 did not accurately document the medications administered to R2.

Based on record review and interview, the manager failed to ensure, for two of two sampled residents, a documented residency agreement included the date of occupancy or expected date of occupancy. Findings include: 1. A review of R1's and R2's medical records revealed residency agreements for both residents. However, the residency agreements did not include the date of occupancy or expected date of occupancy. 2. In an interview, E1 and E2 acknowledged the provided residency agreements had not included the date of occupancy for each resident.

Based on record review, documentation review, and interview, the manager failed to ensure an individual submitted documentation dated within 90 calendar days before the individual was accepted by the facility including whether the individual required continuous medical services, continuous nursing services, or intermittent nursing services, for one of two residents sampled. Findings include: 1. A review of R1's medical record revealed a document titled "Determination for Admission." This document was signed by a medical practitioner within 90 calendar days before admission and stated whether R1 would require Restraints. However, the section of the document for the medical practitioner to indicate whether R1 would require continuous medical services, continuous nursing services, or intermittent nursing services had been left blank. 2. In an interview, E1 and E2 acknowledged the admission form provided by the facility for R1 had not been completely filled out to indicate whether R1 would require continuous medical services, continuous nursing services, or intermittent nursing services.

Based on record review, documentation review, and interview, the manager failed to ensure before or at the time of an individual's acceptance by the assisted living facility, there was a documented residency agreement with the assisted living facility which included the requirements in R9-10-807(D)(1-10), for one of three residents sampled. The deficient practice posed a risk if the resident was not informed of the terms of residency. Findings include: 1. A review of R2's residency agreement revealed a document that was not completed. The following was missing: - Terms of occupancy, including: - Date of occupancy or expected date of occupancy; - For an assisted living home, whether the manager or a caregiver is awake during nighttime hours; and - The manager's signature and date signed. 2. In an interview, E1, and E2 acknowledged R2's residency agreement did not include all the requirements in R9-10-807(D)(1-10).

Based on observation and interview, the manager failed to ensure the premises was free from a condition or situation which could cause a resident or other individual to suffer physical injury. Findings include: 1. The Compliance Officer observed two residents sitting on a sofa with a broken leg on the right front side. The Compliance officer walked around the sofa and noticed it was propped up with two bricks and a rock. 2. The Compliance Officer asked E1 about the sofa, E1 reported the sofa broke last night and I haven't had time to call the store where I bought it because it's only a few months old. The Compliance Officer told E1 it needed to be removed immediately and keep the residents off the sofa. 3. In an interview, E1 acknowledged the sofa had a broken leg and could be a situation which could cause a resident or other individual to suffer physical injury.

Based on record review and interview, the manager failed to ensure the health care institution administered a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. A review of E2 and E4's personnel record revealed no documentation of fall prevention and fall recovery training. 2. A review of policies and procedures revealed a document titled "Administering CPR, First Aid And Fall Recovery To Residents". 3. In an interview, E1, and E4 acknowledged having a fall prevention and fall recovery program however, did not administer a training program for new hires E2 and E4 regarding fall prevention and fall recovery. This is a repeat citation from the compliance survey conducted on September 19, 2022.

Based on record review and interview, the manager failed to ensure the service plan for a resident receiving directed care services included the requirements in R9-10-815(C)(1-5), for two of two directed care residents sampled. Findings include: 1. A review of R2's medical record revealed documentation of service plans indicating R2 was receiving directed care services. However, the service plans did not contain the following: - Incontinence care that ensures that a resident maintains the highest practicable level of independence when toileting; - Cognitive stimulation and activities to maximize functioning; - Strategies to ensure a resident's personal safety; - Encouragement to eat meals and snacks; and - Documentation of the resident's weight, or from a medical practitioner stating that weighing the resident is contraindicated. 2. A review of R3's medical record revealed documentation of service plans indicating R3 was receiving directed care services. However, the service plans did not contain the following: - Incontinence care that ensures that a resident maintains the highest practicable level of independence when toileting; - Cognitive stimulation and activities to maximize functioning; - Strategies to ensure a resident's personal safety; - Encouragement to eat meals and snacks; and - Documentation of the resident's weight, or from a medical practitioner stating that weighing the resident is contraindicated. 3. In an interview, E1, and E2 acknowledged the service plans did not contain all of the requirements for directed care residents.

Based on observation, record review, 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. The deficient practice posed a risk to residents who were not prescribed the accessible medications. Findings include: 1. During a tour of the facility, E1 showed the Compliance Officer a cabinet in a shared resident room that had a plastic child-proof lock. E1 asked the Compliance Officer if this kind of lock was okay? The Compliance Officer watches E1 turn the plastic knob and open the cabinet without a key. The Compliance Officer closed the plastic lock and reopened it without any difficulty. Inside the unlocked cabinet were the following medications accessible to residents: - "Robitussin" Strong Soothing Action for cough relief; - "Secura" Protective Ointment skin Protectant; - "Medline Remedy" Phytoplex for sensitive skin; - "Medline Remedy" Intensive skin therapy "Calazime"; - "Biofreeze" cool the pain; - "Salonpas" and "Lidocaine" pain relief gel patches; - "Pacific Pharma" Polymyxin B sulfate and Trimethoprim ophthalmic solution, USP; - 2 "Loperamide Hydrochloride" Tablets, 2 mg; - "Systane" Ultra High Performing Dry Eye Relief; - "Lidocaine" Topical Anesthetic 4% Cream; - "Terramicina" Oxitertaciclina/Polimixina B; and - "Nystatin" Cream USP,100,00 units. 2. In an interview, E1 reported being told this kind of lock was okay. E1 acknowledged the medication was not stored in a locked cabinet, or self-contained unit used only for medication storage and not accessible to residents.