Five Star Senior Living

Based on (record review)], the licensee did not comply with the section cited above. During a review of residents files 4 (R1, R2, R5, R6) Out of 6 residents are under the age of 60. The facility has a census of 6 and the facility did not request an exception request for the residents who are under the age of 60 years. This 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. While reviewing R2's and R6's medications, LPA observe both medication containers had several loose medications not inside their original container. which poses an immediate health, safety or personal rights risk to persons in care.

Record centrally stored prescriptions and refill data

Based on record review, the licensee did not comply with the section cited above. Resident R2 and R3 had medications that were not listed on the centrally stored medicatoin record. S1 stated R2 does not have his/her medications listed on the centrally stored medication record. This poses/posed a potential health, safety or personal rights risk to persons in care.

Track resident cash safeguard records

Based on record review, the licensee did not comply with the section cited above. LPA also noted R3 did not have a personal property log. R5 had a personal property log that was blank. R6 has a personal property log from his/her previous form, but does not have one for this facility, dated from his/her move in. which poses/posed a potential health, safety or personal rights risk to persons in care.

Require physician order and label for PRN medication

Based on interview and records reviewed, the licensee did not comply with the section cited above. while reviewing R2's medications, S1 informed LPA that the facility has Tums and Tylenol medications that they use for all the residents in the home. LPA asked S1 if all the residents have a prescription for the Tums and tylenol. S1 stated the facility does not have a prescription. which poses an immediate health, safety or personal rights risk to persons in care.

Based on interview and record review, the licensee did not comply with the section cited above. LPA requested to review the facility emergency drill log. LPA was not provided documentation showing drills have taken place. This poses/posed a potential 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. LPA noted cigarettes scattered on the floor in the backyard. LPA also noted tree foileage on the ground. LPA also noted stains in the hallway bathroom. 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. During the course of the inspection, LPA noted multiple instances where cleaning products, were acessilbe to residents in care. LPA also noted insect killer and lighter fluid acessible in the garage. which poses an immediate health, safety or personal rights risk to persons in care.

Health screening and fitness requirements

Based on record review and interview, the licensee did not comply with the section cited above. LPA requested to review staff S1's health screening. S1 stated he/she did not have it and was going to get one. which poses/posed a potential health, safety or personal rights risk to persons in care.

Document required staff training and orientation

Based on interview, the licensee did not comply with the section cited above. LPA requested to review staff S1-S3's training records. LPA was provided a sheet with 1 training, for April 1, regarding medication training, for staff S1 and S2. This which poses/posed a potential health, safety or personal rights risk to persons in care.

Dignity in personal relationships

**This LIC9099-D page is amended to remove the deficiency issued on 08/22/2025. The allegation finding was amended to be changed from Substantiated to Unsubstantiated.**

Include required health screening documents

Based on record review, the licensee did not comply with the section cited above in that 2 out of 3 staff without health screen forms which poses/posed a potential health, safety.

Health screening and fitness requirements

Based on record review, the licensee did not comply with the section cited above in that staff S1 works for the facility more than one month and staff S2 works for the facility more than 6 months, both wiout health screen forms. which poses/posed a potential health, safety risk to persons in care.

Obtain baseline medical assessment before resident admission

Based on record review, the licensee did not comply with the section cited above in that 2 out of 3 residents physician reports are more than 1 year which poses/posed a potential health, safety or personal rights risk to persons in care.

Hold reappraisal meeting on changes

Based on record review, the licensee did not comply with the section cited above in that 2 out of 3 residents' appraisal needs and service plan are over than one year which poses/posed 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 in that 3 out of 3 residents' central stored medication forms without started date which poses/posed a potential health, safety or personal rights risk to persons in care.

Modified diets for medical necessity

87555 General Food Service Requirements (b) The following food service requirements shall apply:(7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided.This requirements was not met as evidenced by: Based on the interviews and record reviews, the facility did not provide the special diet prescribed by resident R1's physician, this poses a potential health, safety or personal rights risk to a person in care.

Signed rights acknowledgement in resident record

Based on records review, the licensee did not comply with the section cited above in that 1 out of 3 resident files did not have personal rights policy which poses a personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in that the personal rights posters were not observed in the main entrance which poses an personal rights risk to persons in care.

Maintain records of centrally stored medication dosages

Based on record review, the licensee did not comply with the section cited above in that 1 out 3 resident centrally stored medication record was observed inaccurate and not up to date, which poses a potential health, safety or personal rights risk to persons in care.