4 Reports
Inspection Report — Aug 11, 2022
Routine
Date: Aug 11, 2022
Visit Reason
A health care licensure and follow-up survey was conducted to assess compliance with applicable regulations.
Findings
Six deficiencies were cited related to housekeeping and maintenance, psychotropic medication management, resident care records, behavior documentation, and menu adherence.
Deficiencies (5)
.260.06 Housekeeping and Maintenance Services: the facility was not maintained in a clean, safe and orderly manner, with missing paint, broken furniture, dirty bathrooms, unstable patio planks, stained carpets, and a hole in a resident's wall.
.310.04.a Psychotropic or Behavior Modifying Medication: Resident #1 exhibited multiple maladaptive behaviors without a behavior plan; medication adjustments were made without prior development of a behavior plan.
.330.04.c.vii Resident Care Records: change of condition assessments were not consistently documented for residents with various health issues, despite assessments being performed.
.330.06.b Behavior Documentation: the facility did not develop a behavior plan with interventions for each maladaptive behavior exhibited by Resident #1, leaving caregivers without guidance.
.451.01.d Menu: the facility did not follow a dietician approved menu, with 29 of 31 days having substitutions and residents receiving different meals than documented.
Inspection Report — Sep 23, 2021
Life Safety
Date: Sep 23, 2021
Visit Reason
A fire life safety and sanitation licensure survey was conducted to assess compliance with applicable regulations.
Findings
Two deficiencies were found related to relocation agreements and fire and life safety standards. The facility had only one relocation agreement instead of two, and staff were not adequately instructed on the disaster plan; additionally, a laundry door had a locking device not operable from the inside.
Deficiencies (2)
.155.01 Relocation agreements: the facility had only one relocation agreement on site instead of the required two, which must be reviewed at least annually.
.403 Fire and life safety standards for existing buildings licensed for three through sixteen residents: facility staff were not instructed on the disaster plan as required, and the laundry door had a hasp locking device creating a locking arrangement not readily operable from the inside.
Inspection Report — Mar 28, 2019
Life Safety
Date: Mar 28, 2019
Visit Reason
A Fire Life Safety Survey was conducted to assess the safety environment of Pleasant Valley Shelter Home.
Findings
Three non-core deficiencies were identified related to electrical panel clearance, fire alarm inspection records, and fire drill documentation.
Deficiencies (3)
.405.01 Medical Gases: electrical panels were blocked by a chair and miscellaneous storage, preventing the required 36-inch clearance in accordance with NFPA 70, Section 110.
.415.04 Fire Alarm Smoke Detection System Service and Testing: no record of annual fire alarm inspection or five-year sensitivity testing was available on site.
.410.02 Fire Drills: fire drills were missing for the noc shift (10 p.m. to 6 a.m.) for the second, third, and fourth quarters; documented fire drills were performed only at 8:00 p.m.
Inspection Report — Dec 11, 2017
Life Safety
Date: Dec 11, 2017
Visit Reason
A Fire Life Safety Survey was conducted to assess the safety environment of Pleasant Valley Shelter Home.
Findings
Two non-core deficiencies were identified related to medical gases and electrical installations. The facility must correct these deficiencies within thirty calendar days.
Deficiencies (2)
.405.01 Medical Gases: missing outlet cover in basement and dead emergency light in hall with no record of required monthly and annual testing.
.405.01.b Electrical Installations and Equipment: use of a 6 to 2 multiple plug adapter in the northwest bedroom.
Viewing
Loading inspection reports...
