Brightwater Senior Living of Highland (dba)

Based on observation the licensee did not comply with the section cited above by not ensuring that the bath mat in the memory care unit was non-slip, which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and interview, Licensee/Administrator did not ensure that medications were not centrally stored which poses/posed a potential health, safety or personal rights risk to persons in care. Several bottles of medications were found in the bathroom cabinet of resident in room 224.

Based on observation the licensee did not comply with the section cited above by not ensuring that the four bottles of cleaning solution were locked and inaccessible to memory care residents, which poses an immediate health, safety or personal rights risk to persons in care.

Incidental Medical and Dental Care: The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including...an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met, as evidenced by: Based on interviews and records, facility staff did not immediately contact 9-1-1, rather staff contacted R1's hospice and began cooling measures for the resident. This posed an immediate threat to the health and safety of the resident in care.

Personnel Requirements – General Facility personnel shall at all times be … and competent to provide the services necessary to meet resident needs. This requirement was not met, as evidenced by: Based on interviews and records the Licensee did not ensure facility personnel was competent to provide the services necessary to meet R1's needs. S1 did not demonstrate competency when they did not follow facility policy of observing R1 every 30 minutes, resulting in R1 sustaining 2nd degree burns. This posed an immediate threat to the health and safety of the resident in care.

...Assistance with self administered medications shall be limited to the following: Medications usually prescribed for self-administration which have been authorized by the person's physician. The facility did not meet this requirement as evidenced by providing R1 with the wrong dose of the medication Norco 09/11/2023 through 09/19/2023. This poses a potential health and safety risk for residents in care.

87465 Incidental 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... (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 met as evidenced by: The Licensee failed to ensure that R1 received treatment for the wound in a timely manner. This posed a potential health, safety and personal rights risk to persons in care.

(b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication. This requirement was not met evidenced by:LPA reviewed R1 medication administration records that are not the same as the medical order. Records further reveal that R1 was administered allergy medication for itching once on 08/11/23

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by:Staff interviews that one scheduled medication is pre-poured. LPA observed pills for days 20 and 21 were not inside the medicine bubble pack.

If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms...Facility staff shall contact the resident's physician prior to each dose, describe the resident's symptoms, and receive direction to assist the resident in self-administration of that dose of medication This requirement was not met as evidenced by:Records reviewed and staff interviews confirmed that Resident 1 (R1) scheduled medication ran out on 9/15/22 and the facility did not communicate with R1's family that the medication has not been filled until 10/5/22.This poses and immediate health and safety risk to residents in care.

(i)(1)(B): Facilities shall have signal systems...All facilities licensed for 16 or more..Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal...This requirement is not met as evidenced by: Based on observation and interview, the licensee did not ensure that R1's call system was operable.

PERSONNEL REQUIREMENTS - GENERAL: Facility personnel shall at all times be...competent to provide the services necessary to meet resident needs. This requirement was not met, as evidenced by: Based on records review and interviews the Licensee did not ensure staff were competent to provide the services necessary to R1. Records revealed R1 was observed in pain on 2 occasions & staff were re-educated on medication administration on 5 occasions in December 2020. Interviews revealed staff weren't administering the prescribed dosage of medication to R1.

MAINTENANCE AND OPERATION: The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by: Based on Observation, the Licensee did not ensure R1's bedroom was maintained clean at all times. Photographs of R1's bedroom were obtained; report was received indicating R1's bedroom was observed to be dirty.