Simply Together Alh LLC

Based on observation, interview, documentation review, and record review, the governing authority failed to administer a training program for all staff regarding fall prevention and fall recovery, for one of five personnel members sampled. The deficient practice posed a risk if a personnel member was unable to meet a resident's needs during an emergency. Findings include: 1. During a tour of the facility, the Compliance Officer observed E5 working at the facility. 2. In an interview, E1 reported E5 was a caregiver. 3. A documentation review revealed a policy and procedure titled "Fall Prevention" dated January 1, 2023. The policy and procedure stated: "Fall Prevention and Recovery Training is required upon hire and at least every 12 months thereafter. . . . Documentation of Fall Prevention and Recovery training completion will be maintained in personnel records." The review further revealed a personnel schedule dated between September 1, 2022, and June 26, 2023. The schedule revealed E5 worked on the following dates: - September 1-3, 5-10, 12-17, 19-24, and 26-31, 2022, [September indicated 31 days rather than 30 days]; - October 1-3, 5-10, 12-17, 19-24, and 26-31, 2022; - November 1-3, 5-10, 12-17, 19-24, and 26-31, 2022, [November indicated 31 days rather than 30 days]; - December 1-3, 5-10, 12-17, 19-24, and 26-31, 2022; - January 1-5, 7-12, 14-19, 21-26, and 28-31, 2023; - February 1-5, 7-12, 14-19, 21-26, and 28-31, 2023, [February indicated 31 days rather than 28 days]; - March 1-5, 7-12, 14-19, 21-26, and 28-31, 2023; - April 1-5, 7-12, 14-19, 21-26, and 28-31, 2023, [April indicated 31 days rather than 30 days]; - May 1-5, 7-12, 14-19, 21-26, and 28-31, 2023; and - June 1-5, 7-12, 14-19, and 21-26, 2023. 4. A review of E5's personnel record revealed E5 was hired as a caregiver. However, the review revealed no documentation of fall prevention and fall recovery training. 5. In an interview, E5 reported E5 had not yet completed fall prevention and fall recovery training.

Based on record review, interview, and observation, the manager failed to ensure a resident had a written service plan that was signed and dated by the resident or resident's representative when initially developed and when updated, for two of two sampled residents. The deficient practice posed a risk if a resident was unable to exercise the right to participate or have the resident's representative participate in the development of, or decisions concerning, the resident's service plan; and as the Department was provided false or misleading information. Findings include: 1. A review of R1's medical record revealed a service plan dated February 6, 2023. However, the service plan was not signed and dated by R1 or R1's representative. The review revealed a second service plan, dated June 21, 2023. However, the service plan was not signed and dated by the resident or resident's representative. 2. A review of R2's medical record revealed a service plan dated June 9, 2023. However, the service plan was not signed and dated by R2 or R2's representative. 3. In an interview, E1 acknowledged the manager failed to ensure a resident had a written service plan that was signed and dated by the resident or resident's representative when initially developed and when updated. E1 reported R1's representative was at the facility during the inspection and could sign the service plan. E1 reported R2 was at the facility during the inspection and could sign R2's own service plan. 4. The Compliance Officer observed E1 leave the room with the service plans for R1 and R2 and return moments later with the service plans. 5. A review of R1's medical record revealed the service plan dated February 6, 2023, was now signed by R1's representative with the signature dated June 26, 2023. The review revealed the service plan dated June 21, 2023, was now signed by R1's representative with the signature dated June 21, 2023, even though the service plan was signed during the inspection conducted on June 26, 2023. 6. A review of R2's medical record revealed the service plan dated June 9, 2023, was now signed by R2 with the signature dated June 9, 2023, even though the service plan was signed during the inspection conducted on June 26, 2023. Technical assistance was provided on this rule during the complaint/compliance inspection conducted on October 13, 2021.

Based on documentation review, record review, interview, and observation, the manager failed to ensure medication administered to a resident was documented in the resident's medical record, for one of two residents sampled. The deficient practice posed a risk to the health and safety of a resident as emergency personnel would not have correct health data to make decisions regarding a resident's treatment in an emergency and as the Department was provided false or misleading information. Findings include: 1. A documentation review revealed a policy and procedure titled "Medications Including Opioids and Narcotics: Medication Administration, Records and Monitoring" dated January 1, 2023. The policy and procedure stated: "Medication administration provided to a resident is in compliance with an order, and is documented in the resident's medical record. Medication administration is not documented until the resident is seen taking them." 2. A review of R1's medical record revealed a service plan dated June 21, 2023. The service plan stated the facility "Provides Medication Administration [to R1]." The review revealed a medication order for "cefdinir 300 mg capsule Take 1 capsule (300 mg total) by mouth 2 (two) times daily for 5 days" dated June 13, 2023. The order stated the "Next dose" was to be taken at 9:00 PM on June 13, 2023. The review further revealed a medication administration record dated June 2023. The review revealed R1's cefdinir was documented as administered at 8:00 PM on June 14-17, 2023, and at 8:00 AM on June 15-23, 2023. The review revealed R1's cefdinir was documented as administered four times more than stated on the order, namely at 8:00 AM on 20-23, 2023. 3. In an interview, E3 reported E3 erroneously documented R1's cefdinir as administered at 8:00 AM on June 20-23, 2023. E3 stated, "It was a mistake." E3 reported R1's cefdinir was documented as administered at 8:00 AM on June 20-23, 2023, but was not administered. 4. The Compliance Officer observed R1's pharmacy bottle of cefdinir to be empty.

Based on observation and interview, the manager failed to ensure a food menu was conspicuously posted at least one calendar day before the first meal on the food menu was served. The deficient practice posed a risk if the source of a potential food borne illness could not be identified. Findings include: 1. During a tour of the facility, the Compliance Officer observed a food menu posted in the dining room. The menu was dated. However, the dates were crossed out. Upon closer inspection, the menu was dated Sunday, August 1, 2021, through Saturday, August 7, 2021. Behind the menu, the Compliance Officer observed other menus. However, the dates of each of these menus were also crossed out. 2. In an interview, E1 reported the posted menu was the menu for the current week. However, E1 acknowledged E1 could not prove the posted menu was conspicuously posted at least one calendar day before the first meal on the food menu was served because the menu was not dated for the date of the inspection. When the Compliance Officer asked if the facility dated the menus, E1 stated, "No." Technical assistance was provided on this rule during the complaint/compliance inspection conducted on October 13, 2021.

Based on documentation review, observation, and interview, the manager failed to ensure 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. A documentation review revealed a policy and procedure titled "Food Services" dated January 1, 2023. The policy and procedure stated, "Food is kept refrigerated or frozen except when being handled and following the label instructions for storage [and] The facility refrigerator's temperature is kept at 41 degrees or below." 2. During a tour of the facility conducted at approximately 9:05 AM, the Compliance Officer observed a refrigerator in the dining room. The Compliance Officer measured the temperature of various spots in the refrigerator and observed temperatures between 34.9\'ba F and 49.6\'ba F. The Compliance Officer observed perishable food in the refrigerator. At approximately 9:10 AM, the Compliance Officer observed a refrigerator in the kitchen. The Compliance Officer measured the temperature of various spots in the refrigerator and observed temperatures between 37.6\'ba F and 47.3\'ba F. The Compliance Officer observed perishable food in the refrigerator. At approximately 9:20 AM, the Compliance Officer observed a plastic bag of meat sitting in a plastic container on the counter in the kitchen. The Compliance Officer measured the temperature of various spots on the bag and observed temperatures between 39.7\'ba F and 43.7\'ba F. 3. In an interview, E3 reported E3 was thawing the meat. 4. At approximately 12:25 PM, the Compliance Officer re-measured the refrigerator in the dining room and observed temperatures between 42.3\'ba F and 43.5\'ba F. At approximately 12:25 PM, the Compliance Officer re-measured the refrigerator in the kitchen and observed temperatures between 42.3\'ba F and 55.6\'ba F. 5. In an interview, E1 acknowledged the manager failed to ensure foods requiring refrigeration were maintained at 41\'b0 F or below. Technical assistance was provided on this rule during the complaint/compliance inspection conducted on October 13, 2021.

Based on documentation review, observation, and interview, the manager failed to ensure hot water temperatures were maintained between 95\'ba F and 120\'ba F in areas of an assisted living facility used by residents. The deficient practice posed a potential burn risk to the residents. 1. A documentation review revealed a policy and procedure titled "Environmental and Physical Plant Safety" dated January 1, 2023. The policy and procedure stated, "Hot water temperature will be maintained between 95\'ba F and 120\'ba F at all times." 2. During a tour of the facility, the Compliance Officer observed a sink in a bathroom accessible from both a hallway and an occupied bedroom. The Compliance Officer measured the water temperature and observed a temperature of 128.6\'ba F. The Compliance Officer observed a sink in a bathroom accessible from an occupied bedroom. The Compliance Officer measured the water temperature and observed a temperature of 127.4\'ba F. 3. In an interview, E1 reported the hot water heater was new. E1 reported the installers must not have set it to the right temperature. Technical assistance was provided on this rule during the complaint/compliance inspection conducted on October 13, 2021.