Inspection Reports for
Swan Falls Assisted Living
194 W White Way, Kuna, ID 83634, United States, ID, 83634
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Inspection Report — Jul 19, 2024
Routine
Date: Jul 19, 2024
Visit Reason
A health care licensure and follow-up survey with complaint investigation was conducted to assess compliance with Idaho RALF regulations and investigate complaints.
Complaint Details
The survey included a complaint investigation; however, specific complaint details and substantiation were not stated in the report.
Findings
Seventeen non-core deficiencies were identified related to provider responsibilities, written agreements, housekeeping, nursing assessments, medication orders, resident health status, comprehensive assessments, negotiated service agreements, resident care records, behavior documentation, staffing schedules, food and nutritional care services, and training requirements. Several deficiencies were previously cited and remain uncorrected.
Deficiencies (17)
.001.03 General Provider Responsibilities: the licensee did not provide necessary resources to ensure compliance with rules; the co-owner, administrator, and nurse lacked sufficient knowledge, leading to ongoing non-compliance and a failed kitchen inspection requiring re-inspection.
.216.02 Written Agreement: admission agreements for memory care residents did not include a complete breakdown of charges; residents were charged full amounts when out of the facility (previously cited 4/7/2023).
.260.06 Housekeeping and Maintenance Services: the facility was not maintained in a clean, safe, and orderly manner with issues including weeds, damaged fencing, inoperative lighting, scratched and worn furniture, bent downspouts, damaged siding, cracked plaster, and broken plastic fencing.
.300.01 Licensed Registered Nurse (RN): the facility nurse did not complete initial nursing assessments for all residents after admission.
.305.02.b Current Medication Orders and Treatment Orders: residents' diet orders were not followed; staff were unaware residents did not receive ordered diets (previously cited 4/7/2023).
.305.03 Resident Health Status: residents were not assessed by the nurse after changes in condition, including falls, inability to urinate, wounds, and dizziness.
.319 Comprehensive Assessment Requirements: resident demographics, personal assistance needs, maladaptive behaviors, preferences, and outside services were not assessed prior to admission for some residents.
.320 Negotiated Service Agreement (NSA) Requirements: several residents did not have completed interim care plans upon admission; the nurse was unaware of this requirement.
.320.01 Use of NSA: residents' NSAs were not implemented; one resident needing assistance with eating was not assisted as documented in their NSA, and staff were unaware.
.320.03 Signature, Date, and Approval of Agreement: NSAs were not signed and dated by residents or their representatives within 14 days of completion (previously cited 4/7/2023).
.320.08 Periodic Review: NSAs were not updated to reflect significant changes in residents' care needs or health status; the nurse confirmed NSAs had not been updated (previously cited 4/7/2023).
.330.04.c.vii Resident Care Records: documentation was missing for assessments after changes in residents' physical or mental conditions; the nurse stated assessments were done but not documented (previously cited 4/7/2023).
.330.06.a Behavior Documentation: the facility did not evaluate residents' histories of aggressiveness and refusing care; evaluations were not completed as confirmed by staff.
.330.06.b Behavior Documentation: the facility did not develop interventions for residents after maladaptive behaviors; see related deficiency .330.06.a.
.330.14 As Worked Schedules: the facility's as-worked schedule did not include last names and positions of care staff (previously cited 4/7/2023).
.450 Requirements for Food and Nutritional Care Services: the facility failed the kitchen inspection, lacked a Certified Food Protection Manager, and mandatory re-inspection was required within 10 days.
.645.01.a Training Requirements: two medication technicians did not have an Idaho Board of Nursing approved medication assistance course; their certifications were for an unapproved online course.
Report Facts
date: Apr 7, 2023
date: Jul 17, 2024
timeframe: 10
count: 2
count: 6
count: 11
count: 5
Inspection Report — Apr 7, 2023
Original Licensing
Date: Apr 7, 2023
Visit Reason
A health care initial licensure survey combined with a complaint investigation was conducted to assess compliance with licensing requirements and investigate complaints.
Complaint Details
The complaint investigation was combined with the initial licensure survey; deficiencies included medication administration errors, inadequate training, and documentation failures.
Findings
Multiple deficiencies were found related to criminal background checks, resident agreements, medication management, nursing assessments, documentation, staffing, training, and resident care records. Both initial licensure and complaint investigation issues were identified.
Deficiencies (16)
.009.01 Criminal History and Background Check: two of ten employees did not have a Department Criminal History and Background Check completed.
.216.02 Written Agreement: four of nine residents' admission agreements were not signed by the resident, legal representative, POA, or conservator after the change of ownership on 10/27/22.
.305.02.b Current Medication Orders and Treatment Orders: the facility nurse did not ensure residents received medications and treatments as ordered, including missed injections, incorrect doses, unavailable medications, and administration outside prescribed parameters.
.305.02.c Current Medication Orders and Treatment Orders: the facility did not ensure actual written, signed, and dated orders were present in residents' care records for oxygen, ibuprofen, sertraline, clonidine patch, and loperamide.
.310.01.g Medication Distribution System: not all residents' as-needed (PRN) medications were available, and medication technicians did not consistently document or audit PRN medication needs and reordering.
.320.03 Signature, Date, and Approval of Agreement: Negotiated Service Agreements (NSAs) were not signed and dated by residents or their legal representatives.
.320.08 Periodic Review: NSAs were not updated to reflect significant changes in residents' care needs or health status, including wound care, ambulation assistance, bathing services, insulin administration, and mobility status.
.330.04.c.vi Resident Care Records: the facility did not have a system for staff to document nurse notifications, with no documentation of nurse contacts for residents with elevated blood pressures and other conditions.
.330.04.c.vii Resident Care Records: the facility nurse did not conduct nursing assessments when residents experienced changes in physical or mental health status, including urinary tract infection, wounds, agitation, and toileting refusals.
.330.09 Resident Admission and Discharge Register: the facility did not maintain an up-to-date admission and discharge register, with discrepancies between the register and resident roster.
.330.14 As Worked Schedules: the facility's as-worked schedule did not document last names, positions, or exact times staff members were at the facility.
.451.01.a Menu: the facility served inadequate portion sizes, such as half-cup portions instead of one-cup portions, and did not follow the dietitian approved menu consistently.
.600.04.b Sufficient Personnel: five of seven sampled direct care staff who worked alone did not have current first aid and/or CPR certification.
.625 Orientation Training Requirements: two of ten employees did not receive sixteen hours of job-related orientation training including infection control, and three others reported not receiving this training.
.630 Training Requirements for Facilities Admitting Residents with Dementia, Mental Illness, Developmental Disability, or Traumatic Brain Injury: ten of twelve staff interviewed did not receive specialized training, and six of ten personnel records lacked evidence of required training.
.645.02 Delegation: two staff had not received gait belt training, a former staff was never trained on urinary catheter care, and an overnight medication passer was not delegated by the nurse.
Report Facts
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