Silvergate Assisted Living Home

Based on documentation review and interview, the manager failed to ensure that policies and procedures were reviewed at least once every three years and updated as needed. The deficient practice posed a risk as policies and procedures reinforce and clarify standards expected of employees. Findings include: 1. A review of the facility's policy and procedure manual revealed no documentation indicating the policies and procedures were reviewed by the manager. 2. In an interview, E2 acknowledged that the policies and procedures were not reviewed at least once every three years and updated as needed.

Based on documentation review, record review, and interview, the manager failed to ensure that a caregiver's skills and knowledge were verified and documented before the caregiver provided health services for three of three personnel sampled. The deficient practice posed a risk if a personnel member was unable to meet a resident's needs. Findings include: 1. A review of the facility's policies and procedures revealed a policy titled, "Verifying Caregiver's Skills and Knowledge." The policy stated, "The manager or manager's designee should ensure that before the caregiver provides physical health services or behavioral health services, his or her skills and knowledge are verified and documented." 2. A review of the facility's employee schedule for August 2024 revealed E2 and E3 were scheduled to work, and provide services in the month of August 2024. 3. A review of E1's, E2's, and E3's personnel records revealed no documentation of verification of E1's, E2's, and E3's skills and knowledge prior to providing health services. 4. In an interview, E2 reported E1 was on-site and interacted with residents on average every two days. E2 acknowledged verification of skills and knowledge was not documented in E1's, E2's, and E3's personnel records before E1, E2, and E3 provided health services. This is a repeat citation from the compliance inspection conducted on June 13, 2022.

Based on documentation review, record review, and interview, the manager failed to ensure documentation was maintained of the caregivers and assistant caregivers working each day, including the hours worked by each. The deficient practice posed a risk as there was no documentation to identify the staff that was present each day to ensure the health and safety of residents. Findings include: 1. A review of R1's and R2's medication administration record (MAR) for the month of July 2024 revealed E2 administered all medications for R1 and R2 July 1 - July 31, 2024. 2. A review of the facility's employee schedule revealed E2 was not scheduled to work July 28 - July 31, 2024. However, R1 and R2's MAR indicated E2 administered medications. 3. In an interview, E2 reported E2 was the only personnel to administer medication, despite not being on the schedule July 28 - July 31, 2024. E2 acknowledged the employee work schedule did not include documentation of the caregivers who worked each day, and the hours worked by each. 4. A review of the facility's employee work schedule revealed a schedule for August 2024, that included the names of employees working each day, with no record of hours worked by each. Additionally, the employee work schedule did not contain documentation of a caregiver scheduled to work the night shift August 1 - August 31, 2024. No further documentation of the caregivers scheduled to work, and hours worked by each was available for Compliance Officer review. This is a repeat citation from the compliance inspection conducted on June 13, 2022.

Based on record review and interview, the manager failed to ensure that before or at the time of acceptance of an individual, the individual submitted documentation that was dated 90 calendar days before the individual was accepted by the assisted living facility and included whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints and was dated and signed by a medical practitioner for one of two residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R2's medical record revealed a document titled "Preliminary Admission Data." This document did not contain whether or not R2 required continuous medical services, continuous or intermittent nursing services, or restraints and was not signed a dated by a registered nurse or medical practitioner. 2. In an interview, E2 acknowledged R2's medical record did not contain the required documentation that was dated 90 days before R2 was accepted by the facility. This is a repeat deficiency from the compliance inspection conducted on June, 13, 2022.

Based on documentation review and interview, the manager failed to ensure that a calendar of planned activity was prepared at least once week in advance. The deficient practice posed a risk if residents were unable to participate in planned activities. Findings include: 1. During the on-site inspection, the Compliance Officer requested the facility's calendar of planned activities, but none was provided for review. 2. In an interview, E2 acknowledged that a calendar of planned activity was not prepared at least one week in advance.

Based on record review and interview, the manager failed to ensure that the service plan for a resident receiving directed care services included coordination of communications with the resident's representative, family members, and other individuals identified in the resident's service plan for two of two residents sampled. The deficient practice posed a risk if the resident's representative and other individuals identified were unable to participate in decisions concerning the assisted living services the resident was to receive. Findings include: 1. A review of R1's medical record revealed a service plan dated May 8, 2024. The service plan revealed R1 received directed care services, however the service plan failed to include coordination of communications with R1's representative, family members, and other individuals identified in R1's service plan. 2. A review of R2's medical record revealed a service plan dated July 6, 2024. The service plan revealed R2 received directed care services, however the service plan failed to include coordination of communications with R2's representative, family members, and other individuals identified in R2's service plan. 3. In an interview, E2 acknowledged R1's and R2's service plans did not include coordination of communications with R1's and R2's representatives, family members, and other individuals identified in R1's and R2's service plans. This is a repeat deficiency from the compliance inspection conducted on June 13, 2022.

Based on record review, 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. The deficient practice posed a risk if the facility was unaware of the general or specific whereabouts of a resident. Findings include: 1. A review of R1's and R2's medical records revealed R1 and R2 received directed care services. 2. During an environmental tour of the facility, the Compliance Officer observed the front door, sliding back door to the patio, and the door to garage were equipped with an alarm to alert employees of egress; however the alarms were not turned on at the time of inspection. 3. In an interview, E2 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 conducted on June 13, 2022.

Based on record review and interview, the manager failed to ensure that a medication administered to a resident was accurately documented in the resident's medical record for one of two residents sampled. The deficient practice posed a risk as false or misleading information was provided to the Department. Findings include: 1. A review of R1's medical record revealed R1 received medication administration. 2. A review of R1's medication administration record (MAR) for August 2024 revealed documentation that Docusate Sodium 100 mg three tablets by mouth was administered on August 17, 2024, however the inspection was conducted on August 16, 2024. 3. In an interview, E2 acknowledged R1's medical record did not contain accurate documentation of a medication administered to the resident.

Based on observation and interview, the manager failed to ensure 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 unable to self-administer medications. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed a cabinet in the kitchen labeled "Medicine Cabinet." The cabinet had a lock installed, however the lock was not in working order at the time of inspection. Resident medications were observed in the cabinet. 2. In an interview, E2 acknowledged medication was not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. This is a repeat deficiency from the compliance inspection conducted on June 13, 2022.

Based on observation and interview, the manager failed to ensure that foods requiring refrigeration were maintained at 41\'b0 F or below. The deficient practice posed a risk for potential food borne illnesses. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed the following potentially hazardous foods open and stored in a non-refrigerated cabinet next to the sink: - Torani Dark Chocolate Sauce; - Kikkoman Less Sodium Soy Sauce; and - Lady's Choice Sandwich Spread. The labels of the aforementioned products stated, "refrigerate after opening." 2. In an interview, E2 acknowledged the potentially hazardous foods were not maintained at 41\'b0 F or below.

Based on documentation review and interview, the manager failed to ensure the facility's disaster plan was reviewed at least once every 12 months. The deficient practice posed a risk as a disaster plan reinforces and clarifies standards expected of employees. Findings include: 1. A review of the facility's policies and procedures revealed the facility's disaster plan, however no documentation of a review was available. 2. In an interview, E2 acknowledged that the facility's disaster plan was not reviewed at least once every 12 months. This is a repeat deficiency from the compliance inspection conducted on June 13, 2022.

Based on documentation review and interview, the manager failed to ensure that a disaster drill for employees was conducted on each shift at least once every three months and documented. The deficient practice posed a risk if employees were unable to implement a disaster plan. Findings include: 1. A review of the facility's disaster drills revealed no documentation of disaster drills conduced on each shift at least once every three months for the past 12 months. 2. In an interview, E2 acknowledged a disaster drill for employees was not conducted on each shift at least once every three months and documented. This is a repeat deficiency from the compliance inspection conducted on June 13, 2022.

Based on documentation review, record review, and interview, the manager failed to ensure that an evacuation drill for employees and residents included all individuals on the premises except for a resident whose medical record contained documentation that evacuation from the assisted living facility would cause harm to the resident. The deficient practice posed a risk if employees were unable to implement a disaster plan. Findings include: 1. A review of the facility's evacuation drill documentation from April 5, 2024 identified all residents who currently resided at the facility and stated, "All residents refused to participate." 2. A review of R1's and R2's medical records did not include documentation that indicated R1 and R2 were exempt from participation in an evacuation drill. 3. In an interview, E2 acknowledged that an evacuation drill for employees and residents did not include all individuals on the premises except for a resident whose medical record contains documentation that evacuation from the assisted living facility would cause harm to the resident.

Based on observation and interview, the manager failed to ensure that toxic materials stored by the assisted living facility were maintained in a locked area and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed a bottle of Instant Power Heavy Duty Drain Opener and Drano X-gel stored by the facility in an unlocked garage, accessible to residents. 2. The Compliance Officer observed a container of Clorox Disinfecting Wipes stored by the facility and placed on the back of a toilet in a shared resident bathroom. 3. In an interview, E2 acknowledged the toxic materials stored by the facility were not maintained in a locked area and inaccessible to residents. This is a repeat deficiency from the compliance inspection conducted on June 13, 2022.