Inspection Reports for
Magic Valley Manor

.410. Requirements for emergency actions and fire drills: the facility failed to conduct fire drills on a bi-monthly basis, with only one drill conducted in 2024 and a total of four drills from May 2023 to May 2024 (previously cited 8/30/2021 and 8/19/2022).

.305.03 Resident health status: the facility nurse did not conduct nursing assessments when residents experienced changes in physical or mental health status, including multiple falls and injuries; this issue was previously cited on 8/10/2017 and 2/7/2018.

.330.04.c.xi Resident care records: the administrator had not consistently documented investigations of residents' incidents and accidents nor the interventions to prevent recurrence, despite stating corrective actions were put in place.

.330.13.e Personnel records: five of seven staff members did not have documentation of completing 16 hours of orientation, although the executive director stated the orientation was completed.

.155.01 Relocation agreements: only one relocation agreement documented, with a location subject to the same inherent geographical risks as the facility; facility must have at least two agreements reviewed annually.

.404 Fire and life safety standards for existing buildings: emergency action plan lacks designated point of assembly; no documented fire alarm smoke detector sensitivity testing; no documentation for ABHR dispenser testing; UL 300 hood system fire suppression inspections were seven months apart with unresolved issues from 2021; smoke barrier door would not release from lock hindering exit; no documentation of emergency light testing; no documentation for five-year internal piping inspection.

.405.01 Electrical installations and equipment: outlet for fire suppression system air compressor missing cover; two open breaker spots in shutoff panel in basement.

.410 Requirements for emergency actions and fire drills: only two emergency egress and relocation drills conducted in past twelve months; drills did not document evacuation to designated point of assembly.

.155.01 Relocation agreements: the facility had only one relocation agreement instead of two, and the agreement had not been updated annually since 6/5/2017.

.404 Fire and life safety standards: the facility lacked documentation for quarterly sprinkler inspections, 3-year full trip test of dry system, weekly inspections of gauges and control valves, 5-year testing of kitchen sprinkler, testing of alcohol-based hand rub dispensers, semi-annual ANSUL system inspection, semi-annual kitchen hood cleaning, monthly and annual emergency lighting tests, annual oxygen use training, had unsecured magnetic locks without delayed egress, non-self-closing doors, and outdated smoke detector sensitivity testing (last in 2016).

.410 Requirements for emergency actions and fire drills: the facility failed to perform required bimonthly emergency egress and relocation drills, with documentation showing only drills in May and June 2021 and December 2020.

.319.04 Maladaptive Behaviors: the facility did not evaluate residents who exhibited maladaptive behaviors, including reports of sexual abuse and inappropriate behaviors; behavior management evaluations were lost.

.330.06.b Behavior Documentation: the facility did not have behavior plans including interventions for maladaptive behaviors; behavior management plans were lost (previously cited 8/10/2017).

.330.06.c Behavior Documentation: the facility did not have documentation of maladaptive behaviors exhibited by residents; not all behaviors were documented by staff.

.330.14 As Worked Schedules: the facility did not maintain as worked schedules for all staff including caregivers, the administrator, the nurse, and contracted physician's assistant; schedules were not available.

.350.02 Administrator or Designee Investigation Within Thirty Days: the administrator did not document his investigation when Resident #1 made an allegation of inappropriate touching against another resident.

.100.04 Licensed Administrator: the facility's administrator's license expired on 8/10/19 and was not reinstated until 9/24/19.

.405.01 Medical Gases: four inch junction box/light fixture mount in basement storage unsecured and exposing live wire connections; all exposed live wire connections must be covered in accordance with NFPA 70, section 110.

.405.01.b Electrical Installations and Equipment: extension cords and multiple plug adapters are prohibited; Room 13 using 6-2 multiple plug adapter and Room 21 using 3-1 non-grounded extension cord.

.405.05 Structure, Maintenance, Equipment to Assure Safety: door to resident room 6 would not close and resist 5 lbf; west side door of smoke barrier doors by room 1 would not release and open when activated and closed; only 3 of 12 monthly emergency light tests documented for January, February, and June 2018; laundry chute door does not latch when self-closing and door to hall is not designed to self-close; staff unable to identify and confirm facility copies to resident rooms equipped with keyed privacy locks; salon converted to storage of combustibles over 50 square feet without self-closing door; handrail by room 19 and nurse's station ripped from wall and will not safely support residents.

.405.03 Medical Gases: oxygen storage room door would not fully self-close and latch; rooms used for storage of compressed medical gas cylinders must have one-hour construction and self-closing door in accordance with NFPA 99, section 4-3.1.1.2.

.410.02 Fire Drills: fire drills not documented for PM and NOC shifts for first quarter 2019; day shift for third quarter 2018; PM and NOC shifts for fourth quarter 2018; fire drills must be performed quarterly for each shift.

.415.05 Automatic Fire Extinguishing System Service and Testing: sprinkler system is a complete dry system with no documentation of weekly dry system gauge inspections; no documentation for third quarter 2018 sprinkler waterflow alarm testing; sprinkler report dated 4/11/18 indicated vendor disabled accelerator due to leaks and no repair documentation; only one of two semi-annual hood system fire suppression inspections documented; kitchen hoods must be inspected semi-annually in accordance with NFPA 96 and 17A.

.215.01 Administrator Responsibility: the facility administrator did not implement the facility's policies and procedures to ensure documentation was accurate and authenticated; the facility nurse signed and dated assessments when not present, NSAs were dated in advance, and caregivers documented medication administration when medications were unavailable or unnecessary.

.225 Requirements For Behavior Management: Residents #1 and #7 lacked documented behavior management plans describing behaviors and interventions; Resident #1's hitting, scratching, and hair-pulling and Resident #7's punching behaviors were not addressed (previously cited 8/10/2017).

.300.01 Licensed Professional Nurse (RN): the licensed nurse did not delegate catheter care to 7 of 7 caregivers and injectables to 6 of 7 medication technicians, and did not document assessing Resident #3 every 90 days (previously cited 8/10/2017).

.305.02.b Current Medication Orders and Treatment Orders: residents were not assisted to take medications per physician orders; examples include Resident #1 missing donepezil for 8 days, Resident #2's blood glucose not documented thrice daily, medications missing from MAR, discontinued medications given, unavailable prophylactic and psychotropic medications, and Resident #7 missing Zyprexa and anticonvulsant medications for multiple days (previously cited 8/10/2017).

.305.03 Resident Health Status: nursing assessments were not conducted when residents experienced health changes, including wounds and infections for Residents #2 and #4 (previously cited 8/10/2017).

.305.06 Self-Administered Medication: the nurse did not assess Resident #4's ability to self-administer medications every 90 days (previously cited 8/10/2017).

.320.01 Use of Negotiated Service Agreement: NSAs did not clearly identify residents, describe services or frequency; examples include missing details for Residents #1, #2, #4, #5, #6, and #7, including assistance needs, wound monitoring, oxygen use, and laundry frequency (previously cited 8/10/2017).

.350.02 Administrator or Designee Investigation Within Thirty Days: the administrator did not complete investigations and written reports for altercations involving Residents #2, #7, and two others.

.711.08 Care Notes: signed and dated care notes by direct care staff were not maintained, including documentation of residents' condition changes and unusual events such as dry heaves, nausea, and attempts to leave the building.

.711.11 Medications Not Taken: caregivers did not document reasons for medications not given to Residents #1 through #7 (previously cited 8/10/2017).

.725.01 Admission and Discharge Register: the facility did not maintain an up-to-date admission and discharge register.

.215.03 Thirty Day Operation Limit: the facility operated without a licensed administrator for 163 days from 8/26/2017 to 2/5/2018; the shared plan of operation expired on 8/26/2017 and was not renewed, violating IDAPA 16.03.010.21.

.161.01 Policy on Smoking: missing elements in the smoking policy including prohibitions on smoking near flammable materials and unsupervised smoking by certain residents; cigarette butts were improperly disposed of, and signage was recommended at the designated smoking area.

.405.01 Medical Gases: missing blanks at electrical panels in the North Hallway and Basement, including one blank missing on the very bottom of the basement panel as identified by the local AHJ during a prior inspection.

.405.01.b Electrical Installations and Equipment: the dish-washing machine in the kitchen was plugged into an extension cord.

.405.05 Structure, Maintenance, Equipment to Assure Safety: self-closing basement doors were held open or missing parts allowing smoke and fire passage; no documentation for monthly or annual emergency lighting testing; emergency lights and exit sign were not operational; missing weekly generator inspections from November 2016 to June 2017 and missing monthly generator load tests from April 2017 to present.

.405.07 Exit Door Locks: exit door locks were not single operational and required special knowledge; one exit door would not open even with a code; courtyard gates were locked with padlocks from the public side; storage rooms were secured with padlocks preventing exit when locked.

.415.05 Automatic Fire Extinguishing System Service and Testing: missing semi-annual Ansul inspection for the kitchen hood suppression with last documented inspection in April 2017; no documentation for 5-year inspection of fire suppression system though a schedule was provided.

.225 Requirements for behavior management: the facility did not develop a behavior management plan for Resident #2 who exhibited rude and inappropriate behavior.

.300.01 Licensed professional nurse (RN): the facility nurse did not delegate 5 of 6 staff responsible for passing medications and failed to complete 90 day assessments for Residents #4, #5, and #6.

.300.02 Licensed nurse: a licensed nurse was not available to address changes in residents' health or mental status, such as no assessment for Resident #3's pressure ulcer.

.305.01 Resident response to medications and therapies: the facility did not assess or document Resident #1's response to insulin or ability to follow a carbohydrate count sliding scale insulin method.

.305.02.b Current medication orders and treatment orders: the facility failed to correctly implement Resident #1's carbohydrate count method for sliding scale insulin.

.305.02.c Current medication orders and treatment orders: the facility did not have current, signed orders in each resident's record, including orders for Residents #1, #2, #3, #4, and #5.

.305.03 Resident health status: the facility nurse did not assess or document the condition of Resident #3's diabetic ulcer or Resident #1's brittle diabetic status.

.305.06 Self-administered medication: the facility nurse did not assess Residents #1, #2, #3, or #6's ability to self-administer medications safely.

.305.08 Resident and facility staff education: the facility nurse did not assess, document, or recommend health care related training for caregivers regarding Resident #1's insulin sliding scale and Resident #5's pureed diet.

.320.01 Use of negotiated service agreement: there were no NSAs for Residents #1, #4, #6, and #7, and existing NSAs were inaccurate or incomplete.

.630.02 Mental illness: four of seven employee records reviewed did not contain documentation of specialized training related to mental illness for residents with mental illness diagnoses.

.711.08 Care notes: signed and dated care notes by direct care staff were not maintained in residents' records for changes in condition, unusual events, NSA compliance, and medication administration reasons.

.711.11 Medications not taken: the facility did not document reasons why medications were not given; multiple MARs had blank areas or medications circled as not given without explanation.

.520-06 Inadequate care - assistance and monitoring of medications: the facility failed to provide adequate assistance and monitoring of medications for Resident #1 who received sliding scale insulin, resulting in immediate danger, inconsistent blood sugar monitoring, missed insulin doses, multiple falls, and emergency room visits for hyperglycemia and hypoglycemia.

.405.01 Medical Gases: open 4"x4" electrical box in basement with exposed wiring, coke machine plugged into relocatable power tap, daisy chained power taps in staff office, and oxygen concentrators plugged into relocatable power taps (corrected 11/10/16).

.405.03 Medical Gases: oxygen storage room door not self-closing.

.405.05 Structure, Maintenance, Equipment to Assure Safety: self-closing door to basement maintenance (bottom) tied open with cord.

.405.07 Exit Door Locks: exit door locks non-single operational at common area bath across from kitchen, back door off kitchen, linen by room #1, and storage by room #1.

.415.03 Portable Fire Extinguisher Service and Testing: fire extinguishers mounted over 60 inches in kitchen, dining, hall by linen, and basement; four extinguishers at basement stairwell sitting on concrete shelf.

.415.05 Automatic Fire Extinguishing System Service and Testing: Ansul system in kitchen has no record of semi-annual testing for six months prior to 8/10/16.

.215 Requirements For A Facility Administrator: the facility did not have a licensed administrator for 20 days, from 4/15-5/5/15.

.225.01 Evaluation for Behavior Management: the facility did not develop a behavior management plan for Resident #6.

.225.02 Intervention: the facility did not develop interventions to address Resident #6's behaviors. Further, interventions listed for residents' behaviors were not specific, such as "Other" was documented as an intervention to redirect Resident #3's behavior.

.350.02 Administrator or Designee Investigation Within Thirty Days: the administrator did not investigate incidents, accidents, complaints and a resident's allegation of theft (previously cited 9/11/2014 and 2/26/2015).