Welcome Home Residential Adult Care

Based on documentation review, record review, and interview, the health care institution failed to administer a training program for all staff regarding fall prevention and fall recovery. Findings include: 1. A review of facility documentation revealed a fall prevention and recovery training program. That states, "We will also go over this training program materials with a new employee during orientation". 2. A review of E3's personnel record revealed no documentation of fall prevention and recovery training. 3. In an interview, E1 acknowledged that E3 did not receive fall prevention and fall recovery during new employee orientation. This is a repeat deficiency from the compliance inspection conducted on May 6, 2024.

Based on observation, record review, and interview, the manager failed to ensure a caregiver was designated to be present on the assisted living facility's premises and accountable for the assisted living facility when the manager was not present on the assisted living facility's premises. Findings include: 1. A review of the Manager Delegation revealed that E3 was not listed on the current delegation. When the compliance Officers arrived at the facility, E3 was the only staff member present. E3 confirmed they were a caregiver. 2. In an interview, E1 and E2 acknowledged that there was no manager designee present at the assisted living facility's premises and accountable for the assisted living facility when the manager was not present on the assisted living facility's premises.

Based on record review and interview, the manager failed to ensure that a caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services or behavioral health services, and according to policies and procedures. Findings include: 1. A review of E3's personnel record revealed there was no documentation of verification of E3's skills and knowledge. 2. In an interview, E1 and E2 acknowledged there was no documentation of verification of E3's skills and knowledge before E3 provided physical health services or behavioral health services, and according to policies and procedures.

Based on record review and interview, the manager failed to ensure that before a caregiver provided assisted living services to a resident, the caregiver received orientation that was specific to the duties to be performed. Findings Include: 1. A review of E3 personnel record revealed a form titled "Employee General Orientation Record and In-Service Tracking Log", and the orientation form needed to be completed within 3 days of hire. The form had E3's signature but no documentation that orientation was completed. 2. In an interview, E1 and E2 acknowledged that E3 did not receive the orientation that was specific to the duties to be performed by the caregiver before providing assisted living services to a resident.

Based on observation and interview, the manager failed to ensure that a refrigerator used by an assisted living facility to store food or medication contained a thermometer, accurate to plus or minus 3° F, placed at the warmest part of the refrigerator. Findings Include: 1. During an environmental inspection of the kitchen, the Compliance Officers were unable to locate a thermometer in the fridge. 2. In an interview, E1 acknowledged that the refrigerator did not have a thermometer in the warmest part of the refrigerator.

Based on observation and interview, the manager failed to ensure that poisonous or toxic materials stored by the assisted living facility were maintained in a locked area and were inaccessible to residents. Findings include: 1. A review of Department records revealed the facility was licensed to provide directed care services. 2. During an environmental inspection of a resident's bathroom, the Compliance Officers opened a cabinet that contained a bottle of Fantastik Disinfected Multi-Purpose Cleaner with a warning label to keep out of the reach of children. The cabinet had a broken lock mechanism. 3. During an environmental inspection of a resident's bathroom, the Compliance Officers opened a cabinet that contained a bottle of Lysol All Purpose Cleaner with a warning label to keep out of the reach of children. The cabinet had a lock mechanism that was not engaged. 4. In an interview, E2 acknowledged that poisonous or toxic materials stored by the assisted living facility were not maintained in a locked area and inaccessible to residents.

Based on documentation review, record review, and interview, the manager failed to ensure the health care institution developed and 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. Review of facility documentation revealed no documentation related to developing and administering a training program for all staff regarding fall prevention and fall recovery. 2. Review of E1's, E2's and E3's personnel records revealed no documentation showing that personnel had completed fall prevention and fall recovery training. 3. In an interview, E1 acknowledged the health care institution had not developed and administered a training program for all staff regarding fall prevention and fall recovery.

Based on record review, observation and interview, the manager failed to ensure the caregiver documented the services provided in the resident's medical record, for two of two residents reviewed. The deficient practice posed a health and safety risk. Findings include: 1. Review of R1's record revealed a current written service plan for directed care services dated March 27, 2024. This service plan stated the following service was needed: "Nail Care: -Check fingernails daily and as needed -Trim fingernails as needed -Trim toenails as needed." However, documentation was not available indicating this service was provided. 2. Review of R2's record revealed a current written service plan for personal care services dated November 24, 2023. This service plan stated the following service was needed: "Nail Care: -Check fingernails daily and as needed -Trim fingernails as needed -Trim toenails as needed." However, documentation was not available indicating this service was provided. 3. The Compliance Officer observed that R1's and R2's fingernails looked as if the nail care was being provided. 4. During an interview, E2 acknowledged R1's and R2's medical records did not include documentation of nail care.

Based on observation and interview, the manager failed to ensure a current drug reference guide was available for use by personnel members. Findings include: 1. The Compliance Officer observed the facility's drug reference guide was the "2021 Lippincott Pocket Drug Guide for Nurses". 2. A review of the publisher's website revealed the "2024 Lippincott Pocket Drug Guide for Nurses" was the most recent edition. 3. In an interview, E1 and E2 acknowledged that a current drug reference guide was not available for use by personnel members.

Based on observation and interview, the manager failed to ensure that a current toxicology reference guide was available for use by personnel members. Findings include: 1. The Compliance Officer observed the facility's toxicology guide available for use by personnel members was the "Elsevier Toxicology Handbook 3rd Edition". 2. A review of the publisher's website revealed the "Elsevier Toxicology Handbook 4th Edition" was the most recent edition. 3. In an interview, E1 and E2 acknowledged that a current toxicology reference guide was not available for use by personnel members.

Based on observation and interview, the manager failed to ensure hot water temperatures were maintained between 95\'b0 F and 120\'b0 F in the areas of a facility used by residents, which posed a health and safety risk to the residents. Findings include: 1. During the facility tour with E1, the Compliance Officer observed the hot water temperature at 126.5\'b0 F in the hall bathroom near resident bedrooms. 2. In an interview, E1 reported that it looked like a caregiver had changed the setting on the water heater. E1 and E2 acknowledged the hot water temperatures were not maintained between 95\'b0 F and 120\'b0 F in the areas of a facility used by residents.