Brookdale Sylvan Ranch

(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:(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by:Based on medication audit the facility did not ensure that residents were given their medications as prescribed. This poses an immediate health and safety risk to residents in care.

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not ensure that residents R1, R2, R3, R4, R5, and R6 were properly supervised, resulting in the AWOL of all 6 residents, which poses an immediate health, safety, and personal rights risk to residents in care.

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (...) by compliance with the following: (5) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Through review of records and interview, LPA learned that R1 received the wrong medication on 5/12/21; and on 5/19/21 it was found that medication for R2 was entered into the electronic MAR in the wrong dose, causing R2 to receive the incorrect dosage of medication.

Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility...(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidence by records and statements that arrangements were not made for R1’ medical condition. This posed an immediate risk to the resident.

Additional Personal Rights of Residents in Privately Operated Facilities(a)... residents ... shall have all of the following personal rights: (8) To be free from neglect, financial exploitation,...This requirement was not net as evidenced by records and statements that S1 committed the crime when at the facility without supervision as outlined in Provider Information Notice (PIN) 20-37-ASC. This posed immediate risk to resident’s personal rights.

Admission Agreements (g) Admission agreements shall specify the following: (3) Payment provisions, including the following: (B) Rate for additional items and services, including: 2. A separate charge for an item or service may be assessed only if that charge is included in and authorized by the admission agreement. This requirement was not met as evidenced by records and statements which found charges in excess of those agreed to. This posed a potential risk to resident and their finances.

87219 Planned Activities (e) In facilities licensed for sixteen (16) to forty-nine (49) persons, one staff member,...who has the primary responsibility for... planned activities. This requirement was not met as evidenced by records and statements an activities director was not present at the facility Sept 2020- March 2021. This posed a potential risk to residents.

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 requirement was not met as evidenced by records and statements that found insufficient staff to meet resident needs. This posed an immediate risk to residents.

Basic Services (f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living... This requirement was not met as evidenced by facility records and staff statements that as staff shortages delayed residents dressing, eating, bathing and assistance with taking prescribed medications. This posed an immediate risk to residents

Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility…by compliance with the following: (5) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evident from records and statements that R12 was not provided medication. This poses an immediate risk to residents in care.This is a repeat violation in 12 months.

Care of Persons with Dementia (e) (5) Each resident with dementia shall have an annual medical assessment..., and a reappraisal done at least annually...This requirement was not met as evidenced by records review with found of five of eight records reviewed has expired annual medical assessments. This posed a potential risk to residents.

Reporting Requirements (c) Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within twenty-four (24) hours... This requirement was not met as evidenced by late submission of SOC 341 reports and statement. This posed a potential risk to residents.

87405(d) (2) Administrator- Qualifications and Duties (d)(2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met by Administrator Jennifer Scarberry as evidenced by failure to provide the necessary support and resources for proper medication management, insure adequate staffing for resident needs, maintain resident records, provide proper reporting of incidents, provide for appropriate staff screening and supervision. This posed an immediate risk to residents.

Managed Incontinence (b)…the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met as evidenced by statements, resident records and staff schedules that a hospice resident will pressure injuries was not kept clean. This posed an immediate risk to this resident. This is a repeat of citation issued on 11/10/20. Civil penalties to be issued.

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (...) by compliance with the following: (5) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not ensure residents are receiving medications as perscribed, which poses an immediate health, safety, and personal rights risk to the residents in care.