Inspection Reports for
Paintbrush Assisted Living and Memory Support

The visit was complaint-related, investigating complaint Control Number 24-AS-20250910145648 regarding a medication error involving Resident (R1) on 9/3/2025. The complaint was substantiated as a deficiency was cited and a civil penalty assessed.

A deficiency was cited for failure to assist a resident with self-administered medications, resulting in a medication error where a resident was given another resident's medication. This posed an immediate health and safety risk. A civil penalty was assessed for a repeat violation.

The complaint was substantiated based on interviews and record review confirming medication errors on 7/21/25 and failure to report the incident as required.

The investigation substantiated that on 2025-07-21, two residents were given wrong medications by staff and the incident was not reported to the residents' representatives or to the licensing agency. Deficiencies were cited and a plan of correction was developed and accepted during the visit.

The complaint investigation was substantiated for the allegation that a resident was injured while in care due to multiple falls and lack of safety interventions. Other allegations were unsubstantiated due to insufficient evidence.

The investigation substantiated the allegation that a resident experienced multiple falls resulting in a fracture due to lack of updated service plans and safety interventions. Other allegations regarding soiling, bed sores, blood sugar monitoring, and safeguarding belongings were unsubstantiated. An immediate civil penalty of $500 was assessed for failure to provide regular observation of the resident's physical and mental condition.

The complaint investigation was substantiated. Allegations included staff mismanaging resident's medication and not providing resident's authorized representatives with resident's records. Evidence included medication administration records, interviews, and email correspondence. The facility was found to have violated regulations related to incidental medical care and resident records.

The investigation substantiated that staff mismanaged resident R1's medications, including missed doses, incorrect medication administration, and running out of medications. Additionally, the facility administrator refused to provide R1's MAR documentation to the designated representative, citing company policy, which was also substantiated.

The facility was generally clean and well-maintained with proper furnishings, food service, and safety measures. However, deficiencies were cited in personnel requirements, storage space, and incidental medical and dental care services, including unsecured medications and cleaning supplies, and staff lacking proper first aid certification.

The facility was toured and inspected, with observations including proper furnishings, safety measures, and storage of medications. However, deficiencies were cited related to medication storage, dementia care assessments, facility cleanliness, and maintenance issues such as mold in the ice machine.

The visit was triggered by complaints/incidents including an altercation with staff, a resident fall, and a medication error. Deficiencies were substantiated related to medication administration and notification failures.

Deficiencies were cited related to personnel training and observation/documentation requirements. Specifically, a medication error occurred due to improper assistance by a Med Tech, and failure to notify the resident's responsible party after medication was not given as ordered.

The complaint investigation was substantiated for the allegation that staff did not notify resident authorized representatives of incidents such as falls or hospitalizations. Other allegations including resident falls with injury, unexplained injuries, staff yelling, inappropriate handling, odor control, pest control, and failure to report suspected abuse were unsubstantiated.

The investigation substantiated one allegation related to staff failing to notify resident authorized representatives of incidents such as falls or hospitalizations. Other allegations including resident falls, unexplained injuries, staff yelling, and suspected abuse were found to be unsubstantiated due to lack of preponderance of evidence. Deficiencies were cited related to failure to ensure changes in resident condition were documented and communicated appropriately.

The complaint investigation was substantiated for allegations of medication mismanagement, untimely laundry services, and failure to abide by the admissions agreement. Other allegations including inadequate observation of resident condition, unmet hygiene needs, malodorous room, and failure to provide water were unsubstantiated or unfounded.

The investigation substantiated allegations that staff mismanaged medications, failed to provide timely laundry services, and did not comply with the admissions agreement regarding reassessments. Other allegations regarding observation of resident condition, hygiene assistance, malodorous room, and water provision were found unsubstantiated or unfounded. Deficiencies were cited related to medication assistance, laundry services, and admissions agreement compliance, with plans of correction developed.

The complaint investigation was substantiated for the allegation that staff allowed residents to AWOL from the facility. The allegations that staff were not meeting residents' needs and that the facility was understaffed were unsubstantiated and unfounded, respectively.

The investigation substantiated the allegation that staff allowed residents R1 and R2 to leave the facility unsupervised through a side gate, posing an immediate health and safety risk. Other complaints regarding staff not meeting residents' needs and understaffing were found to be unsubstantiated or unfounded based on interviews and record reviews.

The complaint alleging staff did not respond to call buttons in a timely manner was substantiated based on review of the facility's pendent report and interviews. The resident's call button was not cleared for 38 minutes, resulting in emergency medical care.

The investigation substantiated that a resident's call button was activated and not cleared by staff for 38 minutes, resulting in the resident requiring emergency medical care. The facility failed to ensure timely response to call buttons, posing an immediate health and safety risk.

The complaint investigation was substantiated for allegations of filthy resident room, inadequate laundry service, soiled bedding, and malodorous room. The allegation of staff not meeting resident's hygiene needs was unsubstantiated. The complaint regarding a resident fall was unfounded.

The investigation substantiated several allegations including that a resident's room was filthy and malodorous, staff did not provide basic laundry services, and the resident was allowed to sleep in soiled bedding for extended periods. One allegation regarding staff not meeting the resident's hygiene needs was unsubstantiated, and a complaint about a resident fall was found unfounded.

The complaint investigation was initiated due to allegations that the facility was not coordinating resident's medical care with the authorized representative, did not notify the authorized representative of a change in condition, and did not dispense medication as prescribed. The first allegation was unsubstantiated; the latter two were substantiated based on interviews, record reviews, and documentation.

The investigation found one allegation unsubstantiated regarding coordination of medical care with the authorized representative. Two allegations were substantiated: failure to notify the authorized representative of a change in the resident's condition and failure to dispense resident's medication as prescribed, with documentation confirming missed medication doses.