Inspection Reports for
Orchard Ridge Senior Living

.305.02.b. Current Medication Orders and Treatment Orders: Resident #10's PEG tube feeding was delayed after readmission, multiple doses of medications were missed for Residents #10 and #5, and the facility had trouble obtaining feeding and medications from the supplier.

.310.01.c. Medication Distribution System: The facility failed to monitor or document temperatures in two medication refrigerators containing insulin, with documented temperatures only sporadically recorded and several out-of-range temperature readings.

.310.04.e. Psychotropic or Behavior Modifying Medication: Several residents were taking psychotropic medications longer than six months without required six-month medication reviews including behavioral updates.

.320.03. Signature, Date, and Approval of Agreement: NSAs were not signed and dated by Residents #1, #3, #4, and #5 or their legal representatives, confirmed by the facility administrator.

.330.14. As Worked Schedules: The facility's as-worked records did not document employees' full names, positions, or exact work times, confirmed by the assistant administrator and administrator.

.404. Fire and life safety standards for existing buildings licensed for seventeen or more residents and multi-story buildings: the facility lacked documentation for weekly sprinkler gauge inspections, staff training on oxygen safety, carbon monoxide detectors were not installed, quarterly waterflow alarm testing was missing, one semi-annual kitchen hood suppression inspection was not documented, and trash cans at smoking areas were used for both cigarette butts and combustible trash (repeat deficiency).

.155.03 Emergency generators: the facility could not produce documentation for monthly conductivity tests of the battery or annual fuel quality tests of the diesel fuel as required by NFPA Standard 110.

.250.10.b Heating, ventilation, and air-conditioning (HVAC): the facility had a natural gas fireplace in the living area that was not equipped with a safety barrier.

.405.01 Medical gases: relocatable power taps were used to supply power to microwave, coffee maker, and hair dryer, which must comply with NFPA 70 and UL 1363 XBYS.

.405.05 Structure, maintenance, equipment to assure safety: hazardous areas were not properly protected as the kitchen door was propped open with a rubber door chock; hold-open devices must be interconnected with the fire alarm system.

.415.05 Automatic fire extinguishing system service and testing: no record of five-year internal piping inspection since 4/8/2013; no records of weekly dry system gauge inspections per NFPA 25; no documentation of monthly control valve inspections; dry barrel pendants dated 2006 with no testing or replacement records for kitchen walk-in freezer and refrigerator in last 10 years.

.009.01 Criminal history and background check: two of ten employees who required a Department criminal history and background check did not have one.

.100.04 Licensed administrator: the facility's administrator's license had expired on 9/24/18.

.225.01 Evaluation for behavior management: the facility did not evaluate residents' behaviors, including yelling, physical aggression, sexual inappropriateness, and allegations of theft and abuse among residents.

.300.01 Licensed professional nurse (RN): the current facility nurse did not delegate assistance with medications to five caregivers who were administering medications to residents.

.350.02 Administrator or designee investigation within thirty days: the administrator did not complete an investigation and written report for allegations of physical abuse, theft, resident altercations, or injuries of unknown origin.

.350.05 Facility notification to appropriate agencies: the facility did not notify Adult Protection of a pattern of resident to resident altercations involving multiple residents in the memory care unit from May 2018 to 11/30/18.

.711.08 Care notes: the facility did not ensure care notes were signed and dated by the person providing care and services; caregivers reported incidents to medication technicians who documented the information.

.415.05 Automatic fire extinguishing system service and testing: missing the second quarter sprinkler inspection 2017, missing first semi-annual inspection of the ANSUL system for 2017, and deficiencies identified on annual and quarterly sprinkler inspections have not been corrected including outdated sprinklers and a painted sprinkler that needs replacement.

.405.01.b Electrical installations and equipment: multiple rooms had unsafe electrical setups including refrigerators plugged into relocatable power taps, daisy chained power taps and multi-plug adapters, and extension cords.

.405.03 Medical gases: two unsecured "E" tanks of oxygen were found in room #220.

.405.05 Structure, maintenance, equipment to assure safety: missing monthly load tests and weekly inspections on the generator for January and February 2017, and a fire rated door at the elevator near the front desk would not self-close and latch.

.305.02.b. Current Medication Orders and Treatment Orders: residents were not assisted to take their medications in accordance with physician's orders, including wrong doses and missed medications (previously cited 2/26/2016).

.305.06 Self-Administered Medication: the facility nurse did not assess Resident #3's ability to self-administer medications.

.725.01. Admission and Discharge Register: the facility did not maintain an up-to-date admission and discharge register; this was previously given as technical assistance on 2/26/2016.

.520-06 Inadequate Care - Assistance and Monitoring of Medications: the facility failed to provide assistance and monitoring of medications for Resident #7, resulting in inadequate care due to failure to reorder Levothyroxine and monitor its administration, causing worsening health conditions.

.405.03 Medical gases: one unsecured oxygen cylinder in room 209 was leaning against the wall; another unsecured oxygen cylinder in room 225 was secured in a rack on 08/01/16.

.415.02 Fuel-fired heating: no record of annual fuel-fired heating inspection for gas fired furnaces and fireplace.

.405.05 Structure, maintenance, equipment to assure safety: southwest hall means of egress by room 224 was blocked with storage of three carts; the diesel-fueled generator was not being tested for load monthly or load bank annually as required by NFPA 110.

.225.01 Evaluation for Behavior Management: the facility did not evaluate behaviors for Residents #1, #2, #3, #4, #5, #6, #7, #8 and #9.

.225.02 Intervention: the facility did not develop interventions for each behavior residents exhibited.

.300.01 Licensed Professional Nurse (RN): the RN did not conduct delegation according to the Idaho Board of Nursing rules. The facility RN did not assess residents every 90 days.

.305.01 Resident Response to Medications and Therapies: the facility RN did not conduct a nursing assessment of Resident #4's response to a psychotropic medication.

.305.02 Current Medication Orders and Treatment Orders: medication orders were outdated.

.305.02.b Current Medication Orders and Treatment Orders: physician PRN standing orders were not implemented.

.305.02.c Current Medication Orders and Treatment Orders: copies of signed orders were not present in residents' records.

.305.03 Resident Health Status: the facility RN did not document she had assessed residents' changes of condition. For example: Resident #1's heel wound; Resident #2's knee injury; Resident #3's skin/wound status; Resident #4's wound; Resident #5's edema; Resident #6's possible TIA; Resident #7's rash after antibiotic; Resident #8's possible TIA; Resident #10's blisters and leg pain.

.305.04 Recommendations: the facility nurse did not make recommendations to the facility administrator regarding residents' changes of condition.

.305.07 Medication Interactions and Usage: the facility nurse did not conduct a review of residents' medication for side-effects and interactions. For example: Resident #7's rash after starting an antibiotic and Resident #4's response to antipsychotic medication.

.310.04.a Psychotropic or Behavior Modifying Medication: the facility did not document they had attempted non-drug interventions prior to implementing behavior modifying medications.

.310.04.e Psychotropic or Behavior Modifying Medication: the facility did not ensure that 6 month psychotropic medication reviews were completed by the residents' provider.

.320.01 Use of Negotiated Service Agreement: the NSA did not clearly describe the residents' current needs. (8 of 10 residents) Further, the NSA was not implemented to ensure Resident #6 received thickened liquids.

.335.03 Standard Precautions: the caregivers were not observed washing their hands between tasks.

.350.02 Administrator or Designee Investigation Within Thirty Days: the administrator did not complete an investigation of all incidents, accidents, and bruises of unknown origin.

.350.04 Written Response to Complaint Within Thirty Days: the facility administrator did not respond to all complaints in writing.

.711.01 Ongoing Resident Care Records: the facility did not track all behaviors, the interventions used or the effectiveness of the interventions.

.711.08 Care Notes: caregivers did not document what they saw when they witnessed an incident or accident.

.711.08.e Care Notes: the facility discarded documentation of when the caregiver notified the nurse of changes of condition.

.711.08.f Care Notes: the facility did not obtain the notes from the visiting provider (NP).