Advent Residence Home

Fire approval and staff access to unlock systems

Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. There is a lock added to the front exterior door which does not have fire clearance approval.

Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. When LPA arrived the 2 caregivers on duty did not have a current CPR/first aid training.

Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPA asked for a drill log or verification of drills conducted quarterly, and Administrator was not able to provide.

Maintain facility in clean, safe, sanitary condition

Based on observation & interview, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPA observed dish washer to have debris build up, kitchen appliances having grease/food build up on the outside & inside, and microwave to have buildup on the inside. Kitchen sink has a leak that needs to be fixed. LPA observed refrigerator and kitchen cabinets to be unclean.

Ensure hazardous items are locked and not unattended

Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed tools in unlocked kitchen cabinet, knives in cabinet not properly locked, lighters in unlocked kitchen drawer.

Document required staff training and orientation

Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Administrator was not able to provide verification of current training.

Maintain records of centrally stored medication dosages

Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. R3 Centrally Stored Medication Log incomplete Raloxifene HCL 60 MG TAB not logged. R3'sMed count off Raloxifene HCL 60 MG TAB started 11/29/2025- 2/24/2026 (87days), 90 count, 90-87= 3 pills should be left, 5 pills were left in the bottle

Based on observation, interview, & record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. R3's PRN Lorazepam was not be documented as list above.

Freedom to leave and not be locked in

Based on observation, Licensee did not comply with the section cited above, when LPA observed a long stick on the track of the sliding door in the kitchen preventing the door from being opened, which is an immediate health and safety risks to persons in care.

Based on interview and record review, the licensee did not comply with the section cited above when the facility did not conduct a fire drill, which poses a potential health, safety or personal rights risk to persons in care.

Maintain required personnel records for staff

Based on record review, the licensee did not comply with the section cited above in when 3 out of 3 staff did not have a complete personnel record, which poses a potential health, safety or personal rights risk to persons in care.

Store centrally held medications in locked secure place

Based on observation, the licensee did not comply with the section cited above when medication and nutrional supplements were observed accessible to 6 out of 6 residents in care, which poses an immediate health, safety or personal rights risk to persons in care.

Dispose of unused medications with required witness

Based on observation and interviews, the licensee did not comply with the section cited above when LPA observed multiple medications that had been discontinued stored in the facility, which poses a potential health, safety or personal rights risk to persons in care.

Each terminal resident needs a written hospice care plan

Based on record review, the licensee did not comply with the section cited above when 3 out of 4 residents receiving hospice services did not have a written care plan on file, which poses a potential health, safety or personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above when 3 out of 3 staff did not have training specific to the needs of the individual resident which poses a potential health, safety or personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above when 1 out of 6 residents did not have an updated medical assessment which poses a potential health, safety or personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above when 2 out of 3 staff did not have an additional 20 hours of training in 2022 and 2023 which poses a potential health, safety or personal rights risk to persons in care.

Maintain facilities for fire and panic safety

Based on observation, the licensee did not comply with the section cited above when LPA observed multiple objects blocking the emergency exit in the dining room and the path to the exit gate which poses an immediate health, safety or personal rights risk to persons in care.