Spring Creek Retirement & Assisted Living Community

Hazardous items (medications, cleaning supplies, ointments, flammable products) were left unsecured in unlocked rooms/cabinets in the Memory Care Unit.

The facility failed to have a current exam and vaccinations for one of three sampled pets residing in the ALF.

Facility failed to assess resident's ability to safely self-administer medications within 14 days of admission.

Facility failed to conduct an assessment regarding the use of bedrails for a resident, posing a risk for strangulation/entanglement.

Facility failed to complete Negotiated Service Agreements (NSA) for newly admitted residents within 30 days of admission.

Electrical outlet without a faceplate in the ALD office.

Portable electric heater in the ALD office plugged into a power strip.

Facility unable to provide documentation for the 12 months of semi-annual hood cleanings.

Missing annual fire door inspection documentation; resident room doors (321, 121) blocked; cross corridor fire rated door near activities room blocked open.

Multiple fire rated doors (4th floor sitting room, near rooms 345, 232, 235, 134, 140, and 1st floor breezeway) would not close and latch from full open.

Facility unable to provide documentation for semi-annual kitchen suppression system servicing.

Extinguishers did not receive monthly maintenance for August.

Fire extinguisher in 2nd floor activities room mounted with top over five feet above floor.

Facility unable to provide documentation for annual fire alarm system testing.

Facility unable to provide documentation for annual servicing of the emergency generator.

Facility failed to ensure 2 of 3 staff completed 70-hour basic training within 120 days of hire. This was a recurring deficiency.

Facility failed to ensure administrators and caregivers met long-term care worker training requirements.

The licensee failed to ensure two staff completed 70-hour basic training within 120 days from their date of hire; resulted in one staff member lacking a training certificate and the other lacking training related to job duties.

The licensee failed to ensure two staff completed 70-hour basic training within 120 days from their date of hire; resulted in one staff member lacking a training certificate and the other lacking training related to job duties.

Department completed a follow-up inspection and found no deficiencies; previous deficiency corrected.

Resident 3 did not receive multiple scheduled medications (Apixaban, Aspirin, Atorvastatin, Losartan, Memantine, Metoprolol, Olanzapine, Senna) between 11/13/2024 and 11/16/2024 due to the facility staff's failure to update the electronic medication administration record (EMAR) following a readmission, despite staff claims that family provided assistance (contradicted by a collateral contact). This is a recurring deficiency.

The facility failed to evaluate and take appropriate action for Resident 1's wounds; specifically, nursing staff did not assess or document a pressure sore reported by staff, placing the resident at risk for complications.

The facility failed to cooperate with the Local Health Jurisdiction (LHJ) during an influenza A outbreak, specifically failing to provide updated line lists of confirmed cases and deaths in a timely manner.

The licensee failed to ensure three residents received medications as prescribed by their physicians, resulting in distress and risk for medical complications. This is an uncorrected deficiency previously cited on December 19, 2024.