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Inspection visit

Incident investigation

BLESSED HOMECARE 3License 345920062
Clean visit · 0 citations

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to open a complaint the Department received. LPA met with Licensee and explained the purpose of the visit. When conducting the exit interview at approximately 1:15 PM, LPA and Licensee were interrupted by residents in care. R1 was sitting on the couch near the dining room, when became agitated. Licensee then gave R1 an apple to eat which R1 then mumbled words to Licensee and threw the apple onto the floor towards Licensee. Caregiver attempted to redirect R1 and gave R1 the apple again. LPA observed R1 throwing the apple again, breaking apart onto the floor. R1 then walked into the kitchen forcing cabinets and drawers to open. When Licensee attempted to redirect R1, R1 then punched the wall and informed Licensee to stay away. In midst of R1's behavior, R2 was in the common area watching television. LPA observed R2 yelling at staff to change the channel. When dismissed, R2 became upset and walked towards the front door attempting to escape. LPA observed R2 shouting profanity and refusing to stay at the facility. Once R2 saw R1 was having behavioral issues, R2 walked to the dinning room to observe. At this time when LPA, Licensee, S1, R1 and R2 were all present in the dining room, R1 walked around the table and hit Licensee with a closed fist. Due to safety precaution, LPA gathered her belongings and informed Licensee LPA will be in the car until the situation is handled. LPA advised Licensee to contact 911 as R1 is not on baseline. Licensee stated R1 is on hospice and she did not know if R1 can go to the hospital. LPA again informed Licensee that 911 should be contacted immediately for the health and safety of other residents in care as R1 should be evaluated. LPA then vacated the facility to notify Licensing Program Manager of the following. Please continue on LIC 809-C LIC 809-C Upon LPA's return to the facility, Licensee was no longer at the facility. LPA observed R1 to still be at the facility with hospice nurse. LPA and Hospice Nurse discussed R1's change of condition. Hospice nurse stated at this time, it is strongly recommended for direct 1:1 care supervision as R1 can be erratic until R1 is further assessed. The following incident will be under reviewed and further discussed by the Department. Exit interview conducted and a copy of the report was provided. Due to Licensee no longer being at the facility, S1 has signed the following report, signature on this form acknowledges receipt.

Citations

5 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 87405(d)(3)Type B

    87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (3) Ability to maintain or supervise the maintenance of financial and other records. This requirement is not met as evidenced by: Based on file review and interview, Licensee did not comply as R1's skilled nursing facility discharge paperwork was mistaken for LIC 602 which R1 has no current LIC 602 on file, which poses a potential risk for residents in care.

  • 87458(a)Type B

    87458 Medical Assessment(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Based on file review, Licensee did not comply as R1 did not have a LIC 602 / Medical Assessment present on file which poses a potential risk for residents in care.

  • 1569.312(e)Type A

    §1569.312 Basic services requirements Every facility required to be licensed under this chapter shall provide at least the following basic services: (e) Monitoring the activities of the residents while they are under the supervision of the facility to ensure their general health, safety, and well-being. This requirement is not met as evidenced by: Based on file review of the incident report and interview, Licensee did not comply as R1 left the facility through the front door without staff seeing which poses an immediate health and saftey risk.

  • 87555aType B

    87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner.This requirement is not met as evidenced by: Based on LPA and S1's food inspection, Licensee did not comply as there was a jar of instant coffee in the pantry with expiration date of August 31, 2024, which poses a potential risk for residents in care.

  • 87355(c)Type A

    87355 Criminal Record Clearance(c) A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another, or from Trust Line to a state licensed facility by providing the following documents to the Department:This requirement is not met as evidenced by: Based on observation, file review and interview, the licensee did not comply with the section cited above as S1 was observed to be working but are not associated to the facility roster which poses an immediate health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the November 5, 2024 inspection of BLESSED HOMECARE 3?

This was a other inspection of BLESSED HOMECARE 3 on November 5, 2024. The inspection found no deficiencies and no citations were issued.

Were any citations issued to BLESSED HOMECARE 3 on November 5, 2024?

No citations were issued during this inspection. The facility was found to be in compliance with all applicable regulations.

What type of inspection was this?

This was a other inspection. other inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.