Inspection Reports for
Brookdale Boise Parkcenter

.009.01 Criminal History and Background Check: one of fifteen employees did not have a Department Criminal History and Background Check completed.

.009.06.c Use of Previous Criminal History and Background Check: four of twelve employees did not have Idaho State Police background checks completed prior to working alone with residents.

.161.01 Combustible Supplies and Flammable Items: the designated smoking area contained multiple combustible materials including two gas cans and a five-gallon propane tank.

.161.04 Designated Smoking Areas: the facility did not have clearly marked designated smoking areas and no smoking signs were posted in the staff smoking area.

.310.04.e Psychotropic or Behavior Modifying Medication: psychotropic medication reviews for five residents were not reviewed and signed by the physician.

.320 Negotiated Service Agreement (NSA) Requirements: housekeeping was not provided according to residents' NSAs, some NSAs were unsigned, and NSAs were not updated to reflect significant changes in residents' care needs.

.330.04.c.vi Resident Care Records: the facility did not maintain complete and accurate records documenting staff notifications to the nurse of changes in residents' conditions.

.330.04.c.vii Resident Care Records: nurses did not document when changes of condition were conducted for several residents, including hospitalizations and injuries.

.330.13.i Personnel Records: one of eight medication-passing staff did not have documented delegation in personnel files to pass medications by the current facility nurse.

.330.15.c.v Fire and Life Safety Records: the facility failed to document monthly visual inspections of all portable fire extinguishers on the first floor.

.405.04 Prohibited Applications: the facility failed to inspect, service, and clean fuel-fired heating systems on an annual basis.

.645.01.a Training Requirements: one of eight medication technicians did not have documentation of an Idaho Board of Nursing approved medication assistance course in their employee record.

39-3308 Assessment (4)a Assessments: the facility nurse did not conduct 90-day assessments in a timely manner for several residents.

39-3321.2.e Qualifications and Requirements of Administrator: the administrator did not complete investigations and written reports within 30 days of accidents and incidents involving multiple resident falls.

39-3321.4 Qualifications and Requirements of Administrator: the administrator did not immediately implement corrective actions to prevent recurrence of incidents and accidents involving resident falls.

.305.02.b. Current Medication Orders and Treatment Orders: the facility failed to ensure residents' medications were given as ordered, including missed doses of cyanocobalamin, magnesium carbonate, Mounjaro, diclofenac sodium, trospium chloride, and lispro for multiple residents.

.155.01 Relocation agreements: both of the two required relocation agreements had not been revised since 2022 (previously cited 01/14/2022).

.155.03 Emergency generators: facility failed to provide documentation of annual diesel fuel testing and a three-year, four-hour load bank test for the on-site emergency generator (previously cited 1/14/2022 and 11/18/2020 three-peat).

.161.04 Designated smoking areas: facility policies did not specify a smoking location for residents, and the identified smoking area was not clearly marked.

.330.15 Fire and life safety records: facility could not provide documentation for semi-annual inspection and testing of water-flow alarm devices and testing of smoke detector sensitivity within the last five years.

.404 Fire and life safety standards for existing buildings licensed for seventeen or more residents and multi-story buildings: facility failed to provide documentation for smoke detector sensitivity testing, emergency lighting testing, fire rated door security, fire extinguisher placard, oxygen transfilling room mechanical ventilation inoperable, and oxygen reservoir tanks present.

.405.01.a Electrical installations and equipment: multi-plug adapters were used in the maintenance office and room #120, which are prohibited.

.405.02.a Prohibited applications: a microwave and miniature refrigerator in room #120 were powered by a relocatable power tap, which is prohibited.

.405.02.c Prohibited applications: an oxygen concentrator in room #113 was powered by a relocatable power tap, which is prohibited.

.009.02.b Scope of a Criminal History and Background Check: one of seven employees did not have a completed State Police background check; results had not been received yet.

.300.01 Licensed Registered Nurse (RN): the facility's RN did not complete all quarterly nursing assessments for multiple residents and was behind on completing them.

.310.01.f Medication Distribution System: medication technicians did not watch all residents take their medications, and medications were observed left on a resident's nightstand during the initial tour.

.310.04.a Psychotropic or Behavior Modifying Medication: residents were taking psychotropic medications prior to having behavior management plans in place, confirmed by the administrator.

.320.03 Signature, Date, and Approval of Agreement: NSAs for several residents were not signed or dated by the residents or their legal representatives, confirmed by the administrator.

.330.09 Resident Admission and Discharge Register: the facility did not maintain an accurate admission and discharge register; discrepancies existed between the register and facility roster.

.625.03.k Content for Training: seven of ten employees did not have documentation of infection control training, which was stated as not completed by the business office manager.

.630 Training Requirements for Facilities Admitting Residents with a Diagnosis of Dementia, Mental Illness, Developmental Disability, or Traumatic Brain Injury: five of ten employees lacked documented specialized training for these diagnoses, and two lacked training for mental illness, developmental disability, and traumatic brain injury; training was not completed.

.600.04.a. Sufficient Personnel: the facility administrator did not schedule sufficient personnel during all hours to meet residents' needs, including toileting assistance and timely call light response; multiple resident falls on night shift were documented.

.405.03 Medical Gases: Resident room #161 had an unsecured oxygen cylinder.

.405.01.a Electrical Installations and Equipment: The nurse's office had two Multi-Plug Adapters in use.

.405.02.c Prohibited Applications: Resident room #120 had a microwave and small refrigerator plugged into a Relocatable Power Tap.

.404 Fire and life safety standards: Facility missed semi-annual kitchen hood suppression and cleaning inspections, had bent baffle filters allowing grease vapors into ducts, lacked required placard for class K fire extinguisher, could not produce documentation for sprinkler inspections and dry sprinkler system visual inspections, missing date for sprinkler pendant installation, missing 5-year sensitivity data for smoke detectors, lacked documentation for monthly emergency exit lighting tests and 90-minute annual test, had a non-self-closing door to combustible storage room, lacked testing documentation for Alcohol Based Hand Rub dispensers, and had a rated door to oxygen transfilling area that did not self-close and latch (previously cited).

.155.03 Emergency Generators: Facility could not produce documentation for consistent weekly inspections or monthly load tests for all months, and lacked an annual fuel quality test for diesel fuel stored for the generator; this is a repeat finding.

.405.04 Fuel-Fired Heating: Facility could not produce documentation showing annual inspection, servicing, and cleaning of fuel-fired heating devices and systems; last known inspection was 11/20/2020.

.155.01 Relocation Agreements: Facility had two relocation agreements but had not updated them annually; last reviews were in 2020 and 2010.

.305.03 Resident Health Status: the facility nurse did not assess two residents after changes in condition, including falls and dehydration, and some assessments were incomplete due to staff turnover.

.155.03 Emergency Generators: the facility was missing the annual fuel test for the diesel fuel stored for the generator and the 3-year, 4-hour load test.

.404 Fire and life safety standards for existing buildings licensed for seventeen or more residents and multi-story buildings: the facility lacked documentation for a 5-year sensitivity test of smoke detectors, staff training on oxygen use and handling at hire and annually, inspection and testing of alcohol-based hand rub dispensers, had an ABHR dispenser installed over a light switch creating an ignition hazard, multiple penetrations in walls and conduits, a painted sprinkler head in the theater/lounge, rated doors at the elevator shaft that would not close and latch properly due to coordinator preventing closure, and a door to the 2nd floor laundry/housekeeping room that did not self-close.

.221.04 Written Notice of Discharge: the facility informed Resident #1 they were discharged without providing a written notice, confirmed by the administrator.

.153.01 Response of Staff to Abuse, Neglect or Exploitation of Residents: the facility's abuse policy did not include that the initial reporter was to contact law enforcement immediately in the event of sexual assault or serious injury, failed to instruct the person witnessing or told about the allegation to complete an initial report, and did not include steps to protect a resident if the alleged perpetrator was a visitor.

.300.01 Licensed Professional Nurse (RN): the facility nurse did not conduct nursing assessments when resident #4 experienced condition changes including a fall and insulin administration errors, and did not conduct 90-day nursing assessments for multiple residents (previously cited 1/6/2017).

.305.02.a Current Medication Orders and Treatment Orders: the facility did not ensure all medications were available as ordered for several residents, including sodium phosphate enema, nebulizer medication, antihistamines, albuterol, Miralax, and furosemide (previously cited 1/6/17 and 5/18/17).

.305.02.b Current Medication Orders and Treatment Orders: the facility did not implement diet orders for residents, served food inconsistent with therapeutic diets, held insulin incorrectly on multiple occasions, and failed to administer omeprazole or bisacodyl for five days (previously cited 1/6/17 and 5/4/18).

.305.06.b Self-Administered Medication: the facility nurse did not re-assess residents' ability to self-administer medication every 90 days, and two residents self-administered medications without assessment (previously cited 1/6/17).

.310.04.e Psychotropic or Behavior Modifying Medication: six month psychotropic medication reviews were not completed for several residents (previously cited 1/6/17).

.711.08 Care Notes: the facility did not ensure care notes were signed and dated by the person providing care and services, and this information was not included in the resident's record; caregivers reported observations to Med Techs who documented in the records.

.405.01 Medical Gases: extension cords were used improperly for power to relocatable power taps in multiple rooms, including daisy-chaining and use with coffee maker (corrected on site 6/3/19).

.405.01.b Electrical Installations and Equipment: extension cords and multiple plug adapters were prohibited but found in multiple rooms including Room 107, 120, 157, 158, 258, and 226.

.405.05 Structure, Maintenance, Equipment to Assure Safety: a 12 inch by 16 inch hole was found in the one-hour ceiling of the second floor sitting room.

.405.03 Medical Gases: three unsecured LOX O2 cylinders were found in the transfill room, not secured per NFPA 99.

.405.05 Structure, Maintenance, Equipment to Assure Safety: the O2 transfill room door would not positively latch when activated to self-close, not meeting NFPA 99 requirements.

.415.02 Fuel-Fired Heating: no record was available for the annual fuel-fired heating inspection; last inspection was February 2018.

.415.05 Automatic Fire Extinguishing System Service and Testing: no record for last ten-year testing or replacement on dry system pendants, no record for last full-trip on dry system within past three years, and no documentation for weekly dry system gauge inspections or monthly control valve inspections.

.009.01 Criminal history and background check: one employee did not have a Department criminal history and background check.

.305.02.b Current medication orders and treatment orders: residents were not observed to receive mechanical soft diets as ordered, medication dosage was not adjusted as ordered, and a multi-vitamin was not given as prescribed.

.405.05.f Structure, maintenance, equipment to assure safety: there was a portable space heater in use in Resident Room 103.

.645 Assistance with medication certification requirement: a medication technician on the night shift was delegated to pass medications without documented evidence of passing a medication assistance course.

.250.13.l Resident sleeping rooms: resident room #227 has no closet door and no variance on file for its removal.

.405.01 Medical gases: electrical panels were blocked with items stored in front of them in the upper and lower floor mechanical rooms.

.405.01.b Electrical installations and equipment: multiple areas had multi-plug adapters, daisy chains, and zip extension cords in various resident rooms and administrative areas.

.415.02 Fuel-fired heating: no documentation for a current inspection of the fuel fired systems and devices; last known inspection was 10/13/2016.

.415.05 Automatic fire extinguishing system service and testing: obstructed sprinkler head in resident room #202 closet with paper and tape, missing escutcheon rings in closets of resident rooms #149 and #151, and foreign material on medical room sprinkler.

.305.02.a Current Medication Orders and Treatment Orders: the facility did not ensure medications were given as ordered for Residents #2, #5, and #7; Resident #2's Risperdal order was held over 3 days without physician direction, Resident #5's PRN eye drops were unavailable, and Resident #7's insulin was not given due to lack of needles (previously cited 1/6/2017).

.305.03 Resident Health Status: the facility nurse did not conduct nursing assessments when residents experienced changes in health status, including wounds, unconscious episodes, falls, weight loss, lethargy, and lung congestion, with no documentation of assessments.

.305.06.a Self-Administered Medication: the facility nurse did not assess Resident #4's ability to safely self-inject insulin and did not assess Resident #6 for self-administration of eye drops.

.350.01 Notification of Accidents, Incidents, and Complaints: the administrator was not notified when Resident #3 had bruising or multiple falls, nor when Resident #5 had bruises on the left buttock and right tricep.

.520-04 Inadequate Care - Supervision: the facility failed to provide adequate supervision to ensure Residents #3, #5, and #8 were assessed after changes in condition, including failure to provide wound care and supervision after burns, multiple falls without preventative measures, and unassessed unresponsive episode, resulting in inadequate care.

.009.01. Criminal History and Background Check: one of ten staff, who required a criminal history and background check, did not have one.

.009.06.c. Use of Previous Criminal History and Background Check: four of six current employees, who were required to have an Idaho State Police background check, did not have documentation of those checks in their records.

.152.05.a. Policies of Acceptable Admissions: the facility admitted and retained residents when they did not have the capability or capacity to provide them care. Additionally, the facility did not arrange for services they did not provide.

.215.08. Procedures for Investigations: the administrator failed to implement policies related to the thorough investigation of incidents, accidents, injuries of unknown origin and allegations of abuse and neglect. For example, Resident #2's APS investigation and Resident #3's two choking incidents.

.220.03.a. Services, Supports, and Rates: the Admission Agreement did not identify all items included in the basic services.

.220.03.c. Services, Supports, and Rates: the facility's admission agreement did not disclose all prices, formulas, and calculations used to determine the residents' basic service rate. For example, it did not clearly describe what the resident would be charged based on their personal needs. Additionally, charges were listed that should be included in the basic service rates. The facility documented they would charge a fee for not using the facility preferred pharmacy, which is not allowed.

.220.03.d. Services, Supports, and Rates: the facility did not describe the services and rates charged for personal caregiver services.

.220.04. Staffing: the facility did not identify staffing patterns in their admission agreement.

.220.16. Contested Charges: the facility did not provide methods by which a resident may contest charges. See also 550.23.b.

.300.01. Licensed Professional Nurse (RN): the facility nurse did not conduct a 90-day nursing assessment for Residents #2, #3, #5 and #7.

.305.02.a. Current Medication Orders and Treatment Orders: the facility did not ensure that PRN medications were available as ordered for Residents #1, #3, and #10.

.305.02.b. Current Medication Orders and Treatment Orders: the facility did not implement orders for Residents #6's home health for PT & OT and did not implement the Carbohydrate Controlled diet for Resident #8.

.305.02.c. Current Medication Orders and Treatment Orders: the facility did not have current, signed orders for Residents #1, #9 and #10.

.305.05. Progress of Previous Recommendations: the facility nurse did not follow-up to determine whether the intervention for Resident #2's weight loss was effective.

.305.06.b. Self-Administered Medication: the facility nurse did not re-assess Resident #8's ability to self-administer medication every 90 days.

.310.02. Unused Medication: the facility did not ensure expired medications were removed and destroyed from Resident #8's room.

.310.04.e. Psychotropic or Behavior Modifying Medication: the facility did not provide behavioral updates to physicians to facilitate an informed decision on the continuing use of behavior modifying medications for Residents #1, #5 and #8.

.320.01. Use of Negotiated Service Agreement: residents' NSAs did not clearly reflect the resident's needs. For example Resident #1's did not reflect the resident was on hospice, the level of ADL assistance needed, behaviors, fall precautions, and outside services, etc. Resident #2's did not reflect removal of facial hair, drying her hair, her nutritional drink, etc. Resident #9's did not reflect outside services such as home health PT/OT, personal caregiver, memory issues, etc.

.430.05. Basic Services: the facility required residents to hire private caregivers to provide cares beyond the level the facility was willing to provide.

.451.02. Snacks: the facility did not offer snacks to residents between meals and at bedtime.

.600.05. Supervision: the administrator did not provide supervision to ensure all outside providers had a contract with the facility. Also, the administrator did not provide supervision to ensure Resident #3's family was not determining the use of pain medications.

.625.01. Number of Hours of Training: there was no documented evidence that 16 hours of orientation training had been completed for 2 of 10 employees.

.630.01. Dementia: four of ten caregivers, whose records were reviewed, did not have documentation of dementia training.

.630.02. Mental Illness: four of ten caregivers, whose records were reviewed, did not have documentation of mental illness training.

.630.03. Developmental Disability: four of ten caregivers, whose records were reviewed, did not have documentation of developmental disability training.

.640 Continuing Training Requirements: four of ten employees, who required 8 hours of continuing education, did not have documented evidence of training.

.730.02.a. Work Records: the facility as work schedule did not document the times the administrator, nursing staff, and the corporate nurse worked at the facility.