Promise Assisted Living, Llc.

Give PRN medication by physician order

Based on observation, interview, and record review), the licensee did not comply with the section cited above in four (4) out of five (5) residents medication for R1-R3, and R5 are not documented as either missed or destroyed medication for residents and Medication review was not able to determine the status of medication which poses an immediate health, safety or personal rights risk to persons in care.

Provide resident hot water for personal care

Based on observation, the licensee did not comply with the section cited above in five bathrooms did not have the required temperature for bathroom 1-151.5F, bathroom 2-153.5 F, bathroom 3: 192.2F, bathroom 4: 151.6F and bathroom 5:129.3F which poses an immediate health, safety or personal rights risk to persons in care.

Keep window screens clean and in repair

87303 Maintenance and Operation (c) All window screens shall be clean and maintained in good repair. This requirement was not met as evidence by: During tour LPA observed multiple window screens missing throughout the facility, specifially in dining room and the following resident bedrooms: room #’s 8, 9/10, and 17/18.

Provide resident hot water for personal care

Based on observation, the licensee did not comply with the section cited above in three bathrooms did not have the required temperature upstairs bathroom 68.1,downstairs bathroom #1 140, and bathroom #2 127.2 which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in facilty did not have working carbon moxide detectors at time of visit which poses an immediate health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

Based on observation, the licensee did not comply with the section cited above kitchen floor was dirty which poses/posed a potential health, safety or personal rights risk to persons in care.

Ensure hazardous items are locked and not unattended

Based on observation, the licensee did not comply with the section cited above cleaning solutions were left unlocked in laudry room which poses an immediate health, safety or personal rights risk to persons in care.

Keep bath, laundry and kitchen floors clean

Based on observation, the licensee did not comply with the section cited above auditory devices on two doors did not work which poses/posed a potential health, safety or personal rights risk to persons in care.

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not being met as evidenced by : LPA observed that facility did not submit a special incident report for resident #1's fall on 6/21/22.

Arrange appropriate medical and dental care

a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging, for medical and dental car This requirement is not being met as evidenced by: LPA learned that resident #1 was not sent out to be medically assessed after falling on 6/21/22.

Dignity in personal relationships

a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not being met as evidenced by: LPA learned that resident #1 was assisted by resident #2 in the bathroom while resident #1 was not dressed.

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not being met as evidenced by : LPA observed that facility did not submit a special incident report for resident #1's fall on 6/21/22.

Dignity in personal relationships

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not being met as evidenced by: LPA learned that resident #1 was assisted by resident #2 in the bathroom while resident #1 was not dressed.

Arrange appropriate medical and dental care

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement is not being met as evidenced by: LPA learned that resident #1 was not sent out to be medically assessed after falling on 6/21/22.

(a) In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all the following:This requirement is not met as evidenced by: Based on record review and interviews, the licensee did not comply with the section cited above in LIC 610D and emergency disaster plan reviewed was not the currently updated to include S6 who is the sole staff during the overnight shift 10PM -6PM which poses/posed a potential health, safety or personal rights risk to persons in care

Facility personnel sufficiency and competence

87411.Personnel Requirements-General. (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...This was not met as evidenced by: Facility staff was not aware of R1 walking out of the facility. R1 was not supervised by staff. According to files, R1 is not able to leave the facility unassisted. This poses an immediate Health and Safety risk for residents in care and supervision.

Based on record review, the licensee did not comply with the section cited above in LIC 610D and emergency disaster plan reviewed was not the current version which poses/posed a potential health, safety or personal rights risk to persons in care.

Keep prescriptions in original containers

Based on observation, the licensee did not comply with the section cited above in 1 out of 5 medicaitons reviewed, R1's medication was stored in plastic bag not in original container which poses an immediate health, safety or personal rights risk to persons in care.

Provide resident hot water for personal care

Based on observation, the licensee did not comply with the section cited above in B1 tested at 157.9 degrees F., B2 tested at 136.0 degrees F., B3 tested at 141.4 degrees F., B4 tested at 89.4 degrees F., and B5 tested at 155.1 degrees F. which poses an immediate health, safety or personal rights risk to persons in care.

Kitchen sanitation against contamination sources

Based on observation, the licensee did not comply with the section cited above in kitchen and pantry's floor were observed dirty which poses/posed a potential health, safety or personal rights risk to persons in care.

Facility maintenance and healthful environment

87303 Personal Accomodations and Services: (d) The following space and safety provisions shall apply to all facilities: (2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.This requirement is not met as evidence by: Based on observatiosn licensee failed to ensure facility's flooring, BR1, and RR5 wardrobe and door lock is in good repair which poses a potential risk to the health, safety, or personal rights of persons in care.

Provide resident hot water for personal care

87303 Maintenance and Operation: (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care...shall be maintained... not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).This requirement is not met as evidence by: Based on observation licensee failed to ensure water temperature in BR2,BR3,B#4,And BR5 is maintained within the required 105-120 degrees which is an immediated health, safety, or personal rights risk to the persons in care.*Civil Penalites have been asses for a repeated violation*

Keep bath, laundry and kitchen floors clean

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance ...(1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition.This requirement is not met as evidence by: Based on observation licensee failed to ensure facility is free of mildew and smells which poses a potential health, safety, or personal rights risk to the persons in care.

Maintain facility in clean, safe, sanitary condition

87303 Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.This requirement is not met as evidence by: Based on observation licensee failed to ensure RR2 and RR9 and RR10, common hallway, and medicaiton room were free of holes and/or water damage which poses a potential health, safety, or personal rights risk to the persons in care.

Clean linen quantity and hygiene supplies

87307(a)(3)(C) Personal Accommodations and Services. Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths.....This requirement was not met by evidence of: Based on physical plant observations none of the resident beds had mattress pads; they only had plastic bed protectors; which poses poses a potential health and safety risk.

Safe, healthful, comfortable accommodations

87468.1(a)(2) Personal Rights. Each resident shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This requirement was not met by evidence of: Based on observation, LPA observed that the majority of resident rooms with windows had sheer curtains that were see through; not providing resident's privacy during day and night hours; which poses a potential health and safety risk to clients in care.

(a) Each licensee shall furnish to the licensing agency such reports...:(1) A written report shall be submitted to the licensing agency... within seven days of the occurrence of any of the events specified in (A) through (D) below...(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by:Facility did not submit Special Incident Report to CCLD regarding incident involving R1 on 06/16/22. This poses a potential health, safety, and/or personal rights risk to the residents in care.

Give PRN medication by physician order

Based on observation and record review, the Administrator did not comply with the section cited above in 4 out of 5 residents' medications reviewed and observed Resident #1 was not given the Respiridone 2MG and for Residents #3 - 5, all the medications observed were not indicated on the MAR log 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 record review, the Administrator did not comply with the section cited above in 4 out of 5 residents' medications where Staff could not indicate if the medication observed in their boxes were discontinued by the physician which poses an immediate health, safety or personal rights risk to persons in care.

Maintenance and operation requirements for facilities

Based on observation, the Administrator did not comply with regulation cited above where the hot water temperature measured at 143 degree F for the bathroom upstairs between rooms #18 and room #19, which poses an immediate health, safety or personal rights risk to persons in care.

87101 Definitions(3)"Care and Supervision" means those activities which if provided shall require the facility to be licensed. It involves assistance as needed with activities of daily living and the assumption of varying degrees of responsibility for the safety and well-being of residents.... "Care and Supervision" shall include, but not be limited to...:(F) Supervision of resident schedules and activities;This was not met as evidenced by R1 leaving the facility and going missing without the knowledge of staff. This poses a potential health and safety risk to residents in care and supervision.