Sunrise Care Homes-hayden

Based on documentation review, record review, and interview, the manager failed to ensure an caregiver or assistant caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services on behalf of the facility, for two of three sampled caregiver and assistant caregivers. The deficient practice posed a risk if employees did not have the skills and knowledge necessary to ensure the health and safety of residents. Findings include: 1. A review of facility documentation revealed a current staffing schedule for October 2024 showing E3 and E4 were scheduled to work at the facility as caregivers or assistant caregivers on multiple shifts throughout October 2024. 2. A review of E3's and E4's personnel records revealed no documented verification of E3's and E4's skills and knowledge. 3. In an interview, E2 acknowledged E3's and E4's personnel records did not contain documented verification of skills and knowledge.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance of an individual, the individual submitted documentation dated within 90 calendar days before the individual was accepted by an assisted living facility to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, 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 R1's medical record revealed a document titled "DETERMINATION FORM" that was not dated before R1 was accepted. Intermittent nursing services are required for home health services; however, the box indicating the need for intermittent nursing services was not checked. 2. A review of R3's medical record revealed a document titled "DETERMINATION FORM" that was not dated before R3 was accepted. 3. In an interview, E1 acknowledged that the documents for R1 and R3 were not dated before the individuals were accepted by the assisted living facility and the proper indicator to show that R1 required intermittent nursing services was not properly marked.

Based on observation and interview, the manager failed to ensure a calendar of planned activities was prepared at least one week in advance, posted in a location easily seen by the residents, and updated as necessary to reflect substitutions in the activities provided. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer did not observe a calendar of planned activities posted in any location easily seen by the residents. 2. During the environmental inspection of the facility, the Compliance Officer observed E1 to eventually obtain a pin code to place a calendar of planned activities on a television screen in the dining room area to be seen by residents. 3. During the environmental inspection of the facility, the Compliance Officer observed a calendar of planned activities to state no activities for today, October 10, 2024. There were no substitutions posted; however, a vendor for music came to the facility. 2. In an interview, E1 acknowledged a calendar of planned activities was not posted in a location easily seen by the residents, and updated as necessary to reflect substitutions in the activities provided.

Based on observation and interview, the manager failed to ensure a means of exiting the facility controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a potential risk to the health and safety of residents. Findings include: 1. The Compliance Officer observed a large ground level window, similar to an arcadia door that could be easily stepped out of in R3's bedroom. The window was cracked open, had no screen, or alert on it at the time of inspection. This window exits to the front side of the facility in which the main, busy road is accessible. 2. In an interview, E1 confirmed that the ability to walk out of this window which was not locked or alerted may cause a resident to suffer physical injury.

Based on record review, observation, and interview, for three of three residents reviewed, the manager failed to ensure medications were administered to a resident in compliance with a medication order. The deficient practice posed a health and safety risk to residents, if the facility did not administer medications in compliance with a medication order, and a resident did not receive medication as ordered. Findings include: 1. In record review, R1's medical record included medication orders dated October 4, 2024, for Systane Balance 0.2% and Trazadone 100 MG which matched R1's medication administration record (MAR). 2. R1's physical medications administered indicated the following: - Systane Balance 0.6% - Trazadone 150 MG 3. In record review, R2's medical record included medication orders dated September 19, 2024, for Lorazepam 0.5 MG which matched R2's medication administration record (MAR). 4. R2's physical medications administered indicated the following: - Lorazepam 1 MG 5. In record review, R3's medical record included medication orders dated September 19, 2024, for Senna 8.6 MG and Aspirin 81 MG to be administered on Monday, Wednesday, and Friday only or three times a week. 6. 4. R3's medication administration record (MAR) for October 2024 revealed that R3 was administered Senna 8.6 MG and Aspirin 81 MG daily except for on October 6, 2024. 5. During an interview, E1 denied having updated medication orders. 6. During an Interview, E1 acknowledged that medications were not administered to R1, R2, or R3 in compliance with medication orders.

Based on documentation review, observation, and interview, the manager failed to ensure policies and procedures were implemented for storing medication. The deficient practice posed a health risk to a resident. Findings include: 1. A review of the facility's policies and procedures revealed a policy titled, "Discontinued Medications". This document stated "Responsible person: Assisted Living Facility Manager/Administrator... a.) remove discontinued/expired medications from the medication cabinet, b) put it on the top shelf of the resident record cabinet, c) write DC on the label, d) Cross it out on the MAR record and write the date the new medication started." 2. The Compliance Officer observed Aspercreme Lidocaine 4% Creme and Nystatin 100,000U in R2's medication storage bin. No medication order was available at the time of inspection for this medication. 4. During an interview, E1 acknowledged the facility did not discard the medications per the facility's policy and procedure on discarding medications.

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 and includes any food substitutions no later than the morning of the day of meal service with a food substitution. The deficient practice posed a risk if the source of a potential food borne illness could not be identified. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed no posted food menus; however, after logging into a pin locked system, E1 was able to get the menus on a television screen in the dining room area for residents to see. 2. During the environmental inspection of the facility, the Compliance Officer observed a posted menu dated October 10, 2024 in which Ranch chicken, glazed sweet potatoes, zucchini corn saute, baked roll, and chocolate cream pie were to be served for lunch; however, burgers and salad were served. There was no food substitution posted. 3. In an interview, E1 acknowledged a food menu was not conspicuously posted at least one calendar day before the first meal on the food menu was served and there was no substitution listed on the menu.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials stored by the facility were stored in a locked area and inaccessible to residents. The deficient practice posed a health and safety risk to residents with access to the poisonous or toxic materials. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed a bottle of "Windex", two bottles of "Clorox Cleaner with Bleach", a bottle of "Shout Stain Remover", and other poisonous and toxic cleaning products stored in an unlocked cabinet under the sink in R1's private bathroom. The unlocked cabinet had a locking device installed, but the door was left unlocked at the time of the observation. 2. In an interview, El acknowledged the aforementioned poisonous or toxic materials were stored by the facility, not stored in a locked location, and were accessible to residents at the time of the inspection.