White Oak Village Memory Care Community

Failure to provide carbon monoxide detector testing records.

Missing required annual trip test of dry system, quarterly inspections, and annual forward flow of backflow.

Fire damper report identifies failed fire dampers; report should be deficiency free.

Facility failed to provide a system (keypad/code) for exits and failed to post exit instructions within six feet of doors.

Failure to provide required fire alarm inspection reports.

Failure to provide annual generator inspection reports.

Facility failed to provide a system, such as a keypad and code, in place that allows visitors, staff persons and appropriate residents to exit. Instructions for exiting shall be posted within six feet of the door

Facility failed to provide annual trip test of dry sprinkler system, quarterly fire sprinkler inspection, and annual forward flow of backflow

Facility failed to provide fire damper inspection report 1 year after installation of fire dampers

Facility failed to provide carbon monoxide detector testing

Interview with Staff B deleted.

The facility failed to take appropriate actions to protect the safety and well-being of 2 of 4 sampled residents regarding a resident-to-resident incident. Resident R1 exhibited known unmanageable physical and verbal aggressive behaviors, eventually forcefully shoving Resident R2, who was frail and wheelchair-bound, causing a fall and injury that led to R2's decline and death.

The facility failed to protect the safety and well-being of 2 residents involved in a resident-to-resident incident. Specifically, Resident 1 (with known aggressive behaviors) pushed Resident 2, causing a fall and subsequent injury/death.

Facility failed to ensure Negotiated Service Agreements (NSA) were signed by the resident or their representative for 5 of 5 sampled residents.

Facility failed to ensure a written plan was submitted including minimum required information for 4 of 5 residents who had family assisting with medications.

Facility failed to complete background checks within the required timeline for 3 of 4 sampled staff (Staff B, C, and D).

Facility failed to ensure staff were screened for TB within three days of employment for 3 of 4 sampled staff (Staff A, B, and D).