Inspection Reports for
Palouse Hills Assisted Living

.310.01.c Medication Distribution System: the facility did not consistently maintain medication refrigerator temperatures between 38 and 45 degrees F; the refrigerator was below 38 degrees on 32 occasions in March and April 2024 (previously cited 2/8/2023).

.330.13.h Personnel Records: the facility failed to obtain documented evidence of a Criminal History and Background Check clearance for one of seven employees, although the administrator confirmed the check was completed and the staff member was cleared to work.

.330.14 As Worked Schedules: the facility's as-worked schedule did not document dates and times for maintenance and activities managers nor exact times for kitchen staff members; the administrator stated efforts were ongoing to improve documentation.

.404 Fire and life safety standards for existing buildings: the kitchen class-K fire extinguisher lacked a required placard stating the fire protection system must be actuated prior to use, and the facility could not produce documentation for an annual fire alarm inspection.

.410 Requirements for emergency actions and fire drills: the facility failed to perform bimonthly emergency egress and relocation drills and could not provide documentation for drills from September to November 2022 and March to April 2023.

.151. Activity requirements: no activities were observed to be offered to residents during the survey, and staff stated activities were provided only every few days due to lack of staffing and were not consistent.

.215.08.b. Investigation within thirty days: the administrator did not conduct investigations within 30 days for multiple residents who had injuries or falls between 2022 and 2023, and investigations had not been completed.

.215.08.e. Corrective action: the administrator did not implement corrective actions to ensure incidents did not recur for residents with injuries and falls, and investigations had not been completed.

.305.03. Resident health status: the facility nurse did not conduct nursing assessments when residents experienced changes in physical or mental health status, including falls, stroke, infection, hospital admission, and repeated falls; change of condition assessments were not completed.

.310.01.c. Medication distribution system: the facility did not maintain the medication refrigerator containing insulin within the required temperature range, with temperatures out of range throughout January 2023 and multiple times in February 2023.

.310.04.e. Psychotropic or behavior modifying medication: several residents were taking psychotropic medications for longer than six months without six-month medication reviews completed; the facility nurse stated the reviews were not completed.

.330.04.c.i. Resident care records: the facility did not document comprehensive assessments for multiple residents; the administrator stated assessments were completed but not documented.

.405.01.a Electrical installations and equipment: extension cords and multiple plug adapters are prohibited; a beauty salon used a 2-1 non-grounded extension cord (corrected on site), and the furnace room had two daisy-chained extension cords supplying power to an LED purifier (repeat).

.404 Fire and life safety standards for existing buildings licensed for seventeen or more residents and multi-story buildings: no documentation for quarterly waterflow alarm testing or dry system full trip testing (three-peat and repeat), UL 300 hood system inspection reports were invoicing only, fire dampers testing was undocumented, no documented testing of alcohol-based hand rub dispensers upon refill, doors to hazardous areas did not fully self-close and latch, and no documented bi-monthly inservices for staff on emergency plan roles (repeat).

.155.01 Relocation agreements: relocation agreements are not dated, demonstrating lack of annual review; the Emergency Care and Notification Policy and Procedure is dated 2019, and all relocation agreements with at least two separate locations must be reviewed annually.

.161.04 Designated smoking areas: designated smoking areas must be clearly marked; the smoking area is determined by staff to be the interior courtyard, but no signs for smoking regulations as specified in the policy or area were posted.

.330.15 Fire and life safety records: documentation for fire/life safety survey was not available at the time of survey, including annual fire suppression system inspection from 11/31/21, quarterly waterflow alarm inspections (three-peat), and hood system inspection reports which were invoices only.

.410 Requirements for emergency actions and fire drills: emergency egress and relocation drills must be conducted at least six times per year with at least two on the evening shift when residents are sleeping; drills were not documented as all evacuating to the designated assembly point outside the building across the parking lot as outlined in the disaster plan.

.215.08.f. Notification to Licensing Agency within One Business Day: the administrator did not notify the licensing agency within one business day after Resident #3 eloped from the facility on 7/17/21 (previously cited 3/26/2021).

.319.04. Maladaptive Behaviors: the facility did not evaluate behaviors for Residents #1, #3, and #4, including elopement history and refusal of care (previously cited 3/26/2021).

.151 Activity requirements: the facility did not provide an activity program designed to promote residents' highest potential; no activities were observed during the survey and staff stated they could not do activities with dementia residents.

.215.01 Administrator responsibility: the administrator failed to ensure policies were implemented to be free from restraints when a 'onesie' restraint was used on Resident #7 at the family's request.

.215.08.b Investigation within thirty days: the facility did not conduct investigations within 30 days for incidents involving Residents #7, #8, and #10, including falls, altercations, injuries, and missing property.

.215.08.d Written response to complaint within thirty days: the administrator did not provide written responses to all complainants within 30 days, including complaints about stolen items, and responses lacked resolution or reasons for no action.

.215.08.e Corrective action: the facility did not implement adequate preventative measures after falls, elopements, and injuries for Residents #3, #6, #7, and #10, resulting in repeated incidents.

.215.08.f Notification to licensing agency within one business day: the administrator failed to notify the licensing agency timely of reportable events including elopements and injuries involving Residents #3, #7, and #10.

.260.07 Toxic chemicals: toxic chemicals including bleach were stored in a storeroom near the kitchen that was accessible to residents with cognitive impairment.

.319.04 Maladaptive behaviors: the facility did not evaluate behaviors for Residents #3, #6, #7, #8, #9, and #10 despite observed and reported behaviors such as hitting, undressing, verbal abuse, and exit seeking.

.330.04 Resident care records: nursing assessments were not documented for Residents #5, #7, #8, and #10 after changes in condition; caregivers failed to document permission and efficacy of PRN medications for Residents #3, #7, #8, and #10.

.330.06 Behavior documentation: the facility did not document times, interventions, or effectiveness of behaviors for Residents #3, #7, #8, #10 despite observed incidents.

.330.07.c Discharge records: the facility failed to provide discharged Residents #8, #9, and #10 with records of disposition of belongings as required; Resident #10 reported missing items not returned.

.330.14 As worked schedules: the facility's as-worked schedules did not document the time each staff member was present each day.

.600.04.a Sufficient personnel: the administrator did not schedule sufficient personnel to supervise residents at all times; Residents #3 and #9 eloped unsupervised, with Resident #9's elopement resulting in death.

.520-04 Inadequate care - supervision: the facility failed to provide appropriate supervision to prevent elopements, falls, and resident-to-resident altercations for Residents #3, #7, #8, #9, and #10, resulting in harm and death.

.520-10 Inadequate care - resident rights: the facility failed to protect Resident #7's right to be free from physical restraint by using a onesie restraint that the resident could not remove independently, violating their rights.

.404 Fire and life safety standards for existing buildings licensed for seventeen or more residents and multi-story buildings: no annual inservice for staff qualifications on oxygen risks and no documentation for staff and resident training on the emergency plan roles and responsibilities.

.405.01.a Electrical installations and equipment: extension cords and multiple plug adapters were used improperly, including an extension cord supplying power to an LED air purifier running through a doorway.

.410.01 Report of fire: no fire incident report for a fire event occurrence from 9/8/2020.

.404 Fire and life safety standards for existing buildings licensed for seventeen or more residents and multi-story buildings: no documentation of door testing for installed delayed-egress door magnetic locking arrangements.

.404 Fire and life safety standards for existing buildings licensed for seventeen or more residents and multi-story buildings: no documentation for second and fourth quarter 2020 waterflow alarm testing and no documentation for three-year full trip on dry system due to excessive air leaking and unknown last full trip date.

.404 Fire and life safety standards for existing buildings licensed for seventeen or more residents and multi-story buildings: no documentation for hood suppression system inspection and cleaning for one of two inspections in accordance with NFPA 96 and NFPA 17A.

.405.07 Exit door locks: the northeast exit door's magnetic locking and signage indicate release in 15 seconds, but it does not release until 30 seconds; locking arrangements must comply with NFPA 101, chapter 7, section 7.2.1.6.1.

.415.04 Fire alarm smoke detection system service and testing: no record of sensitivity testing completed after new installation of addressable fire alarm system; addressable systems are permitted to have sensitivity testing documentation printed at the panel.

.415.05 Automatic fire extinguishing system service and testing: painted head at main kitchen must be replaced; no record of last ten-year testing or replacement on dry barrel pendants; no record of five-year obstruction investigation; no record of three of four quarterly waterflow alarm inspections; no record of monthly control valve inspections.

.415.05 Automatic fire extinguishing system service and testing: semi-annual hood suppression system inspection incomplete, only one of two completed in past six months; semi-annual hood inspection and cleaning incomplete, only one of two completed in past six months.

.711.08 Care notes: signed and dated care notes by direct care staff were not documented in either the ongoing residents electronic or paper records; staff did not document when residents refused therapeutic diets, medications or cares, the amount of insulin administered, when the nurse was notified per blood glucose parameters, or when residents experienced a change in condition.