Routine inspection (multi-day)·July 11, 2021

Citations

15 citations recorded^*CCLD

• 87307(a)(3)(C)Type A

  87307 Personal Accommodations and Services (a)(3)(C) The use of common wash cloths and towels shall be prohibited. This requirement was not met as evidenced by: Based on observation, Licensee did not prevent the use of a shared common hand towel for 2 of 2 clients which poses an immediate health and safety risk for 2 of 2 residents in care.

• 87411(c)(1)Type B

  87411 Personnel Requirements - General (c)(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement was not met as evidenced by: Based on staff records review, Licensee did not ensure that 1 of 1 resident (S1) maintain an active first aid/CPR certificate which poses a potential health and safety risk to all residents in care.

• 87465(a)(5)Type A

  87465 Inciental Medical and Dental (a) The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (5) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on medication review, Licensee did not provide medication assistance for R4 (missing 11 pills) which poses an immediate health and safety risk to 1 of 1 resident in care.

• 87465(i)Type B

  87465 Incidental Medical and Dental (i) Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician and documented in the resident’s record nor disposed of according to the hospice’s established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. This requirement was not met as evidenced by: Based on resident medication reveiw, Licensee did not destroy left over medication and equipment for 1 of 1 resident (R2) which poses a potential health and safety risk to all residents in care.

• 87506(a)Type B

  87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility...this requirement was not met as evidenced by: Based on resident records review, License did not maintain a complete and current records for 6 of 6 residents which poses a potential health and safety risk for 6 of 6 residents in care.

• 87555(b)(21)Type B

  87555 General Food Service Requirements (b)(21) Freezers of adequate size shall be maintained at a temperature of 0 degrees F (-17.7 degrees C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degrees F (4 degrees C). This requirement was not met as evidenced by: Based on observation, Licensee did not ensure that facility refrigerator and freezer have a thermometer which poses a potential health and safety risk to all residents in care.

• 87555(b)(25)Type A

  87555 General Food Service Requirements (b)(25) Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies. This requirement was not met as evidenced by: Based on observation, Licensee did not store cleaning materials separate from food supplies (found in ice chest) which poses an immediate health and safety risk to all residents in care.

• 87555(b)(8)Type A

  87555 General Food Service Requirements (b)(8) All food shall be of good quality. This requirement was not met as evidenced by: Based on observation, Licensee did not to maintain food of good quality, rotten food found, which poses an immediate health and safety risk to all residents in care.

• 87618(b)(3)(B)Type B

  87618 Oxygen Administrator - Gas and Liquid (b)(3)(B) "No Smoking-Oxygen in Use" signs shall be posted in the appropriate areas. This requirement was not met as evidenced by: Based on observation, Licensee did not ensure that there were proper precaution signs for oxygen use in resident room #18 and #22 which poses a potential health and safety risks for all residents in care.

• 87705(f)(2)Type A

  87705 Care of Person of Dementia (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, ...cleaning supplies and disinfectants. This requirement was not met as evidenced by: Based on observation, Licensee did not keep cleaning and disinfectants inaccessible to dementia residents in care which poses an immediate health and safety risk to residents in care.

• 87411(f)Type B

  87411 Personnel Requirements - General (f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. This requirement was not met as evidenced by: Based on staff records review, Licensee did not ensure that 1 of 1 staff (S3) obtain a complete TB test which poses a potential health and safety risk to all residents in care.

• 87412(c)Type B

  87412 Personnel Records (c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement was not met as evidenced: Based on records review, Licensee did not maintain Continuing Education Units (4 of 4 staff) and Orientation completion verification (3 of 4 staff) which poses a potential health and safety risk for all residents in care.

• 87465(h)(6)(A)Type B

  87465 Incidental Medical and Dental (h)(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes:(A) The name of the resident for whom prescribed.(B) The name of the prescribing physician.(C) The drug name, strength and quantity.(D) The date filled.(E) The prescription number and the name of the issuing pharmacy.(F) Instructions, if any, regarding control and custody of the medication.this requirement was not met as evidenced by: Based on resident medication review, Licensee did not completely fill out 1 of 1 resident's (R1) medication centrally stored medication log which poses a potential health and safety risk for 1 of 1 resident in care.

• 87212(a)Type B

  87212 Emergency Disaster Plan (a) Each facility shall have a disaster and mass casualty plan of action. This requirement was not met as evidenced by: Based on facility records review, Licensee did not maintain a complete and up-to-date Emergency Disaster Plan (LIC 610E) which poses a potential health and safety risk to all residents in care.

• 87555(b)(27)Type B

  87555 General Food Service Requirements (b)(27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement was not met as evidenced by: Based on observation, Licensee did not ensure that kitchen area was free of flies (observed fly strip trap hanging from ceiling) which poses a potential health and safety risk to all residents in care.

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