Inspection Reports for Allegria Village

The inspection was conducted in response to a complaint alleging that the facility was understaffed across all three shifts, including times when the midnight shift had only two staff working.

The investigation found that the facility was not understaffed as alleged, with staffing levels sufficient to meet resident needs. However, a violation was established due to numerous inconsistencies between staff schedules and daily assignment sheets, where schedules were not updated to reflect actual staffing changes.

The complaint alleged understaffing on all three shifts, including times when the midnight shift had only two staff working. The complaint was anonymous and did not provide specific dates or timeframes. The violation of understaffing was not established.

The investigation was initiated due to a complaint alleging that the Resident of Concern (ROC) did not receive appropriate care, including delayed response to call lights and issues with oxygen delivery.

The investigation found that residents, including the ROC, frequently experienced excessive wait times for assistance, sometimes over 20 minutes. The ROC's oxygen needs were managed as 'as needed' per hospice orders, but portable oxygen tanks were not always readily available. The call light system had malfunctions and the facility had not been adequately monitoring response times.

The complaint alleged that the ROC did not receive appropriate care, including lack of timely oxygen delivery and delayed response to call lights. The complaint was substantiated as violations were established.

The inspection was conducted in response to a complaint alleging lack of confidential treatment of resident medical documentation, specifically that a resident was asked to sign a do not resuscitate (DNR) document for another resident in a public area.

The investigation confirmed the allegation that Associate 1 asked an unrelated resident to sign a DNR form in the dining area with other residents present, violating confidentiality rules. Corrective measures, including formal counseling of Associate 1, were taken by the facility.

Complaint received on 07/02/2024 alleged that on 06/30/2024, Associate 1 asked a resident to sign a DNR document for another resident in the dining room with other residents present. The complaint was substantiated.

The inspection was conducted as a Renewal Licensing Study to assess compliance with licensing requirements and determine eligibility for license renewal.

The facility was found to be non-compliant with multiple rules including incomplete resident service plans, lack of annual tuberculosis risk assessment, absence of designated shift supervisors, medication management deficiencies, improper food storage, missing refrigerator thermometers, unsecured oxygen tanks, and incomplete staff training.

The inspection was conducted following a complaint alleging that Resident A lacked his oxygen and that call lights were not answered timely.

The investigation substantiated that Resident A's oxygen administration was inconsistent, with confusion over physician orders and staff requiring re-education on oxygen equipment use. Additionally, call light response times on Resident A's floor exceeded facility expectations, and Resident A sometimes removed his nasal cannula requiring staff reminders.

Complaint was received on 2024-02-23 regarding Resident A's oxygen not being available during lunch and delayed call light responses. The complaint was substantiated based on interviews, record reviews, and observations.

The investigation was initiated due to allegations received on 02/07/2024 regarding a choking incident where no staff was present, mold and blood stains in a former resident's room, leaking ceiling causing mold, improper medication storage and administration, concerns about a resident's physical appearance, and lack of hot water affecting resident bathing.

The investigation established a violation for lack of staff supervision during a choking incident on 01/29/2024 and failure to update Resident A's service plan after the incident. No violations were found regarding mold, medication storage and administration, resident E's care, or hot water availability beyond one day.

The complaint was received on 02/07/2024 from an anonymous source via Adult Protective Services alleging multiple issues including a choking incident with no staff present, mold and blood stains in a former resident's room, leaking ceiling, improper medication storage and administration, concerning physical appearance of Resident E, and lack of hot water for bathing. The choking incident and failure to update Resident A's service plan were substantiated; other allegations were not substantiated.

The inspection was conducted as a special investigation following a complaint received from adult protective services alleging lack of adequate dental care for Resident A, lack of adequate wound care for Resident B, short staffing, and insufficient linens at the facility.

The investigation found no violations regarding dental care for Resident A, wound care for Resident B, or staffing levels. However, a violation was established for insufficient linens as the facility did not maintain a sufficient supply of extra linens. Additionally, a violation was found for failure to update Resident B's service plan to include wound care instructions.

Complaint alleged lack of adequate dental care for Resident A, lack of adequate wound care for Resident B, facility short staffed, and insufficient linens. Dental care, wound care, and staffing allegations were not substantiated. Insufficient linens allegation was substantiated. Additional finding of missing wound care instructions in Resident B's service plan was also substantiated.

The document serves as a renewal notification for the Home for the Aged license of Allegria Village, confirming substantial compliance with public health code and administrative rules over the past year.

An administrative review revealed substantial compliance with applicable regulations, resulting in the renewal of the facility's license for a 12-month period effective 03/31/2023.

The inspection was conducted in response to a complaint alleging that Resident A was provided inadequate care, including lack of bathing, dressing, housekeeping, and dietary adherence, especially during a COVID-19 quarantine period.

The investigation found no violation regarding inadequate care for Resident A, as staff provided reasonable alternatives during quarantine and maintained care consistent with the service plan. However, a violation was established due to failure to maintain shower sheet documentation for at least a month.

The complaint alleged Resident A did not receive adequate care according to her service plan, including lack of bathing, dressing, housekeeping, and dietary adherence during a COVID-19 quarantine from 10/23/2022 to 11/02/2022. The violation for inadequate care was not established, but additional findings related to documentation were noted.

The visit was conducted as an original licensing study to determine compliance with applicable licensing statutes and administrative rules for Allegria Village, a home for the aged facility.

The study determined substantial compliance with the home for the aged public health code and administrative rules. The facility was found to be suitable for licensing with a temporary 6-month license issued for a maximum capacity of 132 beds.