Inspection Reports for
Truewood by Merrill, Boise

.215. Requirements for a facility administrator: the facility operated without a licensed administrator for 25 days, leaving no administrator overseeing day-to-day operations during that time.

.215.08.g. Identify and monitor patterns: the facility did not consistently track and trend incident patterns nor develop effective interventions to prevent recurrences of resident-to-resident physical altercations.

.300.01. Licensed Registered Nurse (RN): the facility's RN did not perform quarterly assessments within 90 days of survey entrance for 8 of 9 sampled residents.

.305.03. Resident health status: the facility nurse did not consistently assess residents after condition changes, and medication technicians administered PRN medications without contacting the nurse; change of condition assessments were previously cited.

.450. Requirements for food and nutritional care services: the facility did not have a Certified Food Protection Manager at the time of survey; the dietary manager's certification had expired and was in the process of renewal.

.215.01 Administrator Responsibility: the facility's abuse/neglect/exploitation policy did not include all required elements such as education for residents and visitors, reporting procedures, investigation steps, documentation storage, and interventions to prevent further abuse (previous technical assistance provided on 5/5/23).

.215.08.a Administrator Notification: the administrator was not informed timely when an allegation of abuse was voiced by an outside agency staff member involving Resident #2 on 11/08/23 and only learned of it on 11/15/23.

.215.08.b Investigation within Thirty Days: the administrator did not conduct thorough investigations into abuse allegations, only interviewing the alleged abuser and the resident, without interviewing other staff or residents (previously cited 7/22/22 and 5/5/23).

.215.08.c Resident Protection: the alleged abuser continued working alone with residents after the abuse report on 11/08/23; staff were not instructed to prevent the abuser from caring for Resident #2, and the administrator was unaware of the abusive situation.

.215.08.e Corrective Action: the administrator did not implement corrective actions to prevent recurrence after Resident #2 fell on 11/27/23 and other residents had falls or injuries in November and December 2023, and was unaware of these incidents.

.305.03 Resident Health Status: nursing assessments were not conducted for residents with changes in condition, including bruises, falls, pain, and injuries for Residents #2 and #4 (previously cited 5/5/23).

.320.01 Use of NSA: residents' nursing service agreements did not clearly reflect their needs or describe services, including transfer methods, fall mats, behaviors, mobility, and treatment for injuries (previously cited 11/10/21 and 5/5/23).

.330.04.c.vi Resident Care Records: the facility lacked a system to ensure the nurse was notified of residents' changes in condition, such as Resident #4's ankle sprain requiring outside treatment.

.330.04.c.vii Resident Care Records: nursing assessments for changes in condition were not consistently documented, including a fall with bruising for Resident #3 and pain for Resident #2; assessments were conducted but not documented (previously cited 5/5/23).

.330.06.a Behavior Documentation: the facility did not evaluate Resident #2's behaviors interfering with cares and accusations toward male caregivers; evaluations for maladaptive behaviors were not completed.

.009.01 Criminal History and Background Check: one of ten employees did not have a Department Criminal History and Background Check completed (previously cited on 8/19/16 and 3/4/21).

.009.06.a Use of Previous Criminal History and Background Check: the facility used a previous Criminal History and Background check for one employee that was not completed within the previous three years of their hire date.

.009.06.c Use of Previous Criminal History and Background Check: two of ten employees did not have an Idaho State Police background check completed (previously cited on 11/10/21 and 3/4/21).

.215.08.b Investigation within Thirty Days: the administrator did not conduct investigations within 30 days for multiple incidents involving Resident #9 and Resident #1 (previously cited 7/2/22).

.215.08.f Notification to Licensing Agency within One Business Day: the facility did not notify Licensing and Certification within one business day for falls involving Resident #10 and Resident #8.

.300.02 Licensed Nurse: change of condition assessments were not consistently completed for Residents #5 and #2 (previously cited 11/10/21 and 3/4/21).

.305.06.a Self-Administered Medication: the facility nurse did not assess Resident #2 to ensure safe self-administration of medication after hospice admission; medications were not audited and included discontinued and unordered medications.

.310.01.c Medication Distribution System: medication refrigerator temperatures containing insulin were not monitored and documented daily, with incomplete logs for March 2023 and April 2022.

.310.04.e Psychotropic or Behavior Modifying Medication: Residents #3, #5, #6, and #8 were taking psychotropic medications longer than six months without completed six-month medication reviews.

.320.01 Use of NSA: Residents' Negotiated Service Agreements did not clearly reflect needs or describe services; some NSAs lacked instructions for staff on assisting residents and managing behaviors (previously cited 11/10/21).

.320.03 Signature, Date, and Approval of Agreement: NSAs were not signed and dated by assisted living residents or their legal representatives; documentation was not provided.

.330.04.c.vii Resident Care Records: pre-admittance assessments were conducted but not retained in residents' records for multiple residents.

.330.11.b Dietary Records: the facility did not document any menu substitutions observed on 5/3/22.

.330.14 As Worked Schedules: assisted living and memory care as-worked schedules did not include all staff, last names, or exact times; memory care schedule was not maintained.

.600.04.b Sufficient Personnel: three of eight sampled staff did not have current certification and worked without other certified staff during night shifts in assisted living.

.625.02 Timeline for Completion of Training: four of ten employees' charts documented orientation training was not completed within thirty days of hire; documentation was not provided.

.215.08.b Investigation within Thirty Days: the administrator did not complete an investigation after a facility nurse left early leaving residents unattended, with calls unanswered and a resident found with feces on their clothing.

.155.01 Relocation agreements: the two relocation agreements were dated 2019 and involved facility administrators no longer employed at the facility or relocation location.

.330.15 Fire and life safety records: documentation was missing for fire life safety inspections including fire suppression quarterly inspections, fuel-fired heating inspection, annual fire alarm inspection, semi-annual hood inspection and suppression inspections, and UL testing for dry system pendants.

.405.01 Electrical installations and equipment: the rear mechanical and fire alarm room main electrical disconnect panel was missing an approximately six inch by 24 inch cover, exposing live wiring.

.405.01.a Electrical installations and equipment: multiple plug adapters were used in rooms 110 and 225; room 225 also had a microwave plugged into one of the two 3-1 MPAs in use.

.405.03 Medical gases: no documented inservice for staff on oxygen risks; multiple unsecured oxygen cylinders in rooms 107, 122, 219, and staff corridor; storage room housing three LOX liberators exceeding 300 cubic feet was not signed for oxygen storage.

.405.04 Fuel-fired heating: no documentation for annual fuel-fired heating inspection.

.404 Fire and life safety standards for existing buildings: no documentation for annual fire alarm inspection and sensitivity testing; no documented inspections for fire suppression system quarterly waterflow alarm testing, dry system preaction valve full trip, 2020 annual inspection, UL testing for dry system heads; no documented semi-annual hood cleaning; fire extinguishers past due for annual inspection and monthly inspection not documented; no records for emergency preparedness training for staff and residents; no documentation for testing of alcohol based hand rub dispensers; room 248 door did not positively latch and was under construction; mechanical room had unsealed penetration exposing wall cavity.

.410 Requirements for emergency actions and fire drills: emergency egress and relocation drills were not conducted for evacuation to designated outside parking area assembly points.

.009.06.c Use of Previous Criminal History and Background Check: one of two employees requiring a state police background check did not have one completed, confirmed by the business office director (previously cited 3/4/21).

.260.06 Housekeeping and Maintenance Services: the facility was not maintained in a clean, safe, and orderly manner with stained carpets, cracked patios and walkways, damaged flooring and ceiling tiles, dirty air ducts, plugged dryer air duct, and improper vent coverings (previously cited 3/4/21).

.300.01 Licensed Registered Nurse (RN): five medication technicians were not delegated by the current facility nurse to pass medications (previously cited 3/4/21).

.300.02 Licensed Nurse: resident #1 was not assessed by the facility nurse after falls on 7/3/21 and 10/4/21, confirmed by the facility nurse (previously cited 3/4/21).

.215.07 Notification to Adult Protection and Law Enforcement: the administrator failed to report all allegations of abuse, including when a staff member pushed resident #3 causing a fall and hip fracture, not realizing the requirement to report to Adult Protection.

.600.04.a Sufficient Personnel: the facility did not schedule sufficient staff during all hours to meet resident needs, with only two staff on night shift for memory care and assisted living units despite high care demands and family concerns about resident care.

.320.01 Use of NSA: residents #2, #6, #7, and #8 did not receive showers as scheduled twice weekly, only receiving one shower per week since August 2021, acknowledged by the administrator.

.009.01 Criminal history and background check: 1 of 10 employees did not have a criminal history background check (previously cited 8/19/2016).

.009.06.c Use of previous criminal history and background check: 3 of 3 employees who required Idaho State Police background checks did not have one.

.215.05 Responsibility for acceptable admissions: the facility admitted and retained Resident #16 who required a secure environment.

.260.06 Housekeeping and maintenance services: carpets in multiple rooms and hallways were heavily stained and worn; the courtyard and dumpster area had debris, broken equipment, and accessible chemicals; dryer vent had excessive lint buildup; a courtyard window had a broken screen (technical assistance previously given 8/19/2016 and 8/16/2019).

.300.01 Licensed registered nurse (RN): 3 of 5 medication technicians lacked documentation of delegation; one technician stated they were not delegated by the current nurse and the delegation signature was not theirs.

.300.02 Licensed nurse: facility nurse did not assess multiple residents when they had changes of condition, including wounds, falls, skin tears, unresponsive episodes, weight loss, and other health issues.

.305.02.c Current medication orders and treatment orders: residents #1, #3, #4, #9, and #15 did not have signed physician orders in their records at the time of survey.

.330 Requirements for facility records: facility records were not maintained for three years; 24-hour communication logs containing resident information were shredded after 5 days in memory care and 30 days in assisted living.

.330.04 Resident care records: resident care records were not completed by the person providing the care; medication technicians documented care when it was provided by someone else.

.625.01 Number of hours of training: all 10 staff did not have 16 hours of orientation training documented and signed within 30 days of hire.

.630.02 Mental illness: 7 of 10 staff did not have mental illness training.

.630.03 Developmental disability: 7 of 10 staff did not have developmental disability training.

.520-11 Inadequate care - acceptable admission and retention: the facility retained Resident #16, who had cognitive impairment and a history of elopement, in an unsecured facility placing the resident at risk for injury or death.

.405.01 Medical gases: Relocatable Power Tap 6 Outlet Power Strip located in the fire sprinkler riser room revealed the power cord was cut and spliced and then re-connected to the main building power. Reference NFPA 70, National Electrical Code.

.405.05.f Structure, maintenance, equipment to assure safety: Portable space heater located in the fire riser room was powered by the spliced Relocatable Power Tap 6 Outlet Power Strip.

.405.05 Structure, maintenance, equipment to assure safety: Cadet wall heater located in the first floor stairwell showed signs of charring on the vents and was very hot to the touch.

.415.05 Automatic fire extinguishing system service and testing: No documentation or service tags showing quarterly sprinkler inspections for the NFPA 13 fire sprinkler system (Wet and Dry).

.300. Requirements For Nursing Services: the facility did not have a licensed professional nurse between 2/19/19 and 5/25/19; a licensed practical nurse was overwhelmed and the regional RN visited only twice during that period.

.305.02.a. Current Medication Orders and Treatment Orders: medications were not consistent with physician orders, including missed doses, unavailable medications, incorrect labeling, and discrepancies in inhaler instructions.

.405.08 Portable Fire Extinguishers: fire extinguishers at multiple locations were mounted over 60 inches in height, not in accordance with NFPA 10; due to the number of findings, this condition was deemed widespread.

.405.05 Structure, Maintenance, Equipment to Assure Safety: exit signs were improperly installed directing egress into walls; mats prevented fire doors from closing; doors had wrapping paper increasing load; oxygen transfill room door tags were removed and modified; smoke and fire barrier doors were warped or did not latch; heating duct penetrations were not properly sealed.

.405.01 Medical Gases: cadet heaters blocked by combustibles; missing outlet cover in housekeeping storage; exposed electrical wiring in maintenance office; kitchen freezer plugged into relocatable power tap; broken electrical cover plate by handwashing sink; daisy-chained power taps in Activities Director office; oxygen concentrator power supply ran through closet door; no record of emergency light testing; open electrical junction box wired to extension cord compressed by paint buckets.

.405.01.b Electrical Installations and Equipment: extension cords and multiple plug adapters used improperly for decoration lighting; power cords ran through holes in walls and doorways; extension cord taped to door frame at front entry.

.404.02 Any Change in Ownership of Facility: repairs and construction in Memory Care unit were not performed according to NFPA 101; plastic sheeting was the only barrier separating construction from residents; fire barrier door left open; sprinkler heads taped over limiting system capabilities; multiple electrical installations left open and exposed; no notification or interim life safety measures documented.

.415.01 Maintenance of Equipment and Systems: semi-annual inspection and fire suppression system inspection on kitchen range hood were not performed timely; inspections were seven months apart and cleaning is now scheduled with seven months between completions.

.009.06.c Use of previous criminal history and background check: one of four employees did not have a completed Idaho State Police background check.

.305.02.b Current medication orders and treatment orders: the facility nurse did not ensure physician's orders were followed, including TED hose, inconsistent home health orders, discontinued prednisone without tapering, and Ensure not implemented as ordered.

.305.03 Resident health status: the facility nurse did not assess residents' physical health status, including lack of documentation for trach discontinuation, unassessed wounds, and unassessed chest pain complaints.

.310.01 Medication distribution system: the facility did not have all medications as ordered and some medication labels did not match physician's orders.

.310.04.e Psychotropic or behavior modifying medication: the facility did not ensure six month psychotropic medication reviews were conducted or behavioral updates provided for several residents.

.320.01 Use of negotiated service agreement: a resident's NSA was not implemented as specified, including missed toileting and meal escort times.

.350.02 Administrator or designee investigation within thirty days: the facility did not complete an investigation or written report when a resident received another resident's medications.

.620 Requirements for training of facility personnel: housekeeping and maintenance staff did not have documented orientation training.

.630.01 Dementia: three of ten employee records reviewed did not contain specialized training for dementia (previously cited 7/27/2012).

.630.03 Developmental disability: ten of ten employee records reviewed did not contain specialized training for developmental disability.

.711.08.e Care notes: the facility staff did not document when they notified the facility nurse of residents' changes of condition.

.711.13 Nursing assessments: residents' nursing assessments were not signed or dated by the nurse completing them.