Buck Serenity Homes

Based on [LPA and admin observation licensee did not comply with the section cited above in 5 out of 5 resident room did not have door signal system on which poses a potential health, safety or personal rights risk to persons in care.

Based on [LPA and admin record review and observation, the licensee did not comply with the section cited above in that Centrally Stored Medication Log was not complete for S2 requiring medication administration which poses a potential health, safety or personal rights risk to persons in care.

Based on LPA and admin observation, the licensee did not comply with the section cited above in Toxins found in two resident bathrooms unlocked under bathroom sink including chemicals found unsecured in bathrooms accessible for residents which poses an immediate health, safety or personal rights risk to persons in care.

Basic Services 87464(f)(4) Personal assistance and care...as indicated in the pre admission appraisal, with those activities of daily living such as...bathing... This requirement is not met as evidenced by: Based on record review and interviews Staff refused to give R1 showers due to R1’s large size and facility was not able to provide documentation of shower logs.

§1569.269Enumerated rights(a) Residents of residential care facilities for the elderly shall have all of the following rights: (6) To care, supervision, and services that meet their individual needs...delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement has not been met as evidence by: Based on records review, observations and interviews conducted Licensee did not ensure to services needs were provided necessary to meet individual care needs which poses an immediate risk to the health and safety of residents in care.

Based on LPA and Admin record review and observation , the licensee did not comply with the section cited above in three out of three: S1,S2, S3 did not have current First AId Certification which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPA and Admin observation the licensee did not comply with the section cited above in Medications found to be prepoured in small plastic containers and not in its originally received container which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPA and admin observation, the licensee did not comply with the section cited above in that Tiles on vanity in bathroom next to room #4 and around left hand side of kitchen sink observed to have dark black substance present in grout as well as broken tile. Deck ramp on wrap around deck has two sections of plywood. Section of plywood in the middle of ramp bows heavily under pressure, cracking sound when stepped on which poses a potential health, safety or personal rights risk to persons in care.

Based on LPA and Admin observation , the licensee did not comply with the section cited above in thatThickener stored under stairs made accessible to residents. Medication fridge unlocked, making medication accessible to residents. Fridge had suppositories(bisacodyl 10mg),and Insulin pen without a label inside ziplock bag in also in fridge.which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interviews and record review, the licensee did not comply with the section cited above. Facility retained R1 who had an unstaged wound. Although the injury is not yet staged, it appears to be more than stage 2. Which poses/posed an immediate health, safety or personal rights risk to persons in care.

HSC 1569.695 Emergency Plans 1569.695(a)(1)...a residential care facility for the elderly shall have an emergency plan that shall include..(1) Evacuation procedures. This requirement was not met as evidenced by: based on interviews & record reviews, licensee failed to ensure the facility’s emergency plan sent to CCL was implemented 8/19/20 during mandatory evacuation. This posed an immediate health & safety risk to the residents in care.

HSC 1569.269(a)(6) Enumerated Rights: 1569.269(a)(6) Residents of residential care facilities for the elderly shall have all of the following rights: To care, supervision, and services that meet their individual needs and are delivered by staff..This requirement was not met as evidenced by: based on interviews and record review, the licensee failed to ensure adequate supervision was provided to 1 of 4 residents on 8/19/20, which posed an immediate health & safety risk to the residents in care.