Deficiencies (last 20 years)
Deficiencies (over 20 years)
6.7 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
26% better than West Virginia average
West Virginia average: 9 deficiencies/year
Deficiencies per year
16
12
8
4
0
Census
Latest occupancy rate
5 residents
Based on a March 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Annual Inspection
Census: 5
Deficiencies: 0
Mar 27, 2025
Visit Reason
The inspection was conducted as an annual survey of the facility.
Findings
The annual survey found no deficiencies cited at the facility during the inspection period.
Report Facts
Census: 5
Inspection Report
Annual Inspection
Census: 5
Deficiencies: 0
Mar 24, 2025
Visit Reason
The inspection was an annual environmental survey conducted to assess the facility's compliance with health and safety regulations.
Findings
The inspection found no deficiencies cited during the visit, indicating compliance with applicable standards.
Report Facts
Census: 5
Inspection Report
Complaint Investigation
Census: 5
Deficiencies: 0
Feb 27, 2025
Visit Reason
Investigation of Complaint #36995 regarding facility conditions and care.
Findings
The complaint was unsubstantiated, and no deficiencies were cited during the investigation.
Complaint Details
Complaint #36995 was investigated and found to be unsubstantiated with no deficiencies cited.
Report Facts
Complaint number: 36995
Census: 5
Inspection Report
Annual Inspection
Census: 5
Deficiencies: 0
Mar 14, 2024
Visit Reason
Annual survey conducted from 03/13/24 to 03/14/24 to assess compliance with regulatory standards at Central Ave Assisted Living.
Findings
No deficiencies were cited during this annual inspection.
Report Facts
Census: 5
Inspection Report
Annual Inspection
Census: 5
Deficiencies: 0
Mar 13, 2024
Visit Reason
Annual environmental inspection of the facility to assess compliance with health and safety regulations.
Findings
The inspection found no deficiencies cited during the visit. The facility was assessed for environmental compliance and safety.
Report Facts
Census: 5
Inspection Report
Routine
Census: 6
Deficiencies: 2
Mar 9, 2023
Visit Reason
Routine inspection to assess the physical facilities and overall environment of Central Ave Assisted Living for compliance with health and safety regulations.
Findings
The facility was found to have a leak in the ceiling above the kitchen and dining area and issues with housekeeping and maintenance including carpet damage and missing bathroom fixtures. The facility failed to maintain a safe, sanitary, and accident-free living environment.
Deficiencies (2)
| Description |
|---|
| Leak in the ceiling above the kitchen and dining room area. |
| Inadequate housekeeping and maintenance including carpet damage, bleach spots, iron burn, torn chair, missing towel bar and toilet paper holder, and dirty sink. |
Report Facts
Deficiencies cited: 450
Census: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| House Manager | Interviewed to verify findings about ceiling leak | |
| Operations Supervisor | Conducted tour of residence and rooms with Treatment Coordinator | |
| Treatment Coordinator | Participated in tour of residence and rooms |
Inspection Report
Routine
Census: 5
Deficiencies: 0
Feb 9, 2023
Visit Reason
Routine inspection of Central Ave Assisted Living was conducted from February 8 to February 9, 2023, to assess compliance with health and safety regulations.
Findings
The inspection found no citations or deficiencies noted during the visit. The census at the time was 5 residents.
Report Facts
Census: 5
Inspection Report
Annual Inspection
Census: 5
Deficiencies: 0
Feb 8, 2023
Visit Reason
The inspection was conducted as an annual survey to review facility documentation, staff interviews, observations, and performance testing to determine compliance with state requirements.
Findings
The residence was found to be in substantial compliance with the licensing rule based on the review of documentation, interviews, observations, and testing.
Report Facts
Sample size: 100
Inspection Report
Plan of Correction
Deficiencies: 2
Mar 23, 2022
Visit Reason
The document is a plan of correction submitted by Central Ave Assisted Living following a behavioral health survey conducted February 9-11, 2004, addressing deficiencies related to safety and supervision in the facility.
Findings
The survey found that the facility did not provide a safe environment for adolescent consumers, specifically noting lack of alarms on outside doors and insufficient awake staff supervision on weekend nights. The provider submitted a plan to employ staff or make alternate sleeping arrangements to ensure awake-night supervision by July 1, 2004.
Deficiencies (2)
| Description |
|---|
| The adolescent girls' bedrooms have outside doors without alarms or alert devices, and staff are not awake on weekend nights to monitor consumers. |
| An outside door in the TV room does not lock. |
Report Facts
Center census: 6
Sample size: 3
Inspection Report
Annual Inspection
Census: 5
Deficiencies: 2
Feb 1, 2022
Visit Reason
Annual survey conducted from 01/31/22 to 02/01/22 to assess compliance with health and safety regulations and review resident records.
Findings
The facility failed to ensure that legal authority documentation for residents' representatives was available for two of four records reviewed. Additionally, there were deficiencies in housekeeping and maintenance, including damaged carpet, missing bathroom fixtures, and unclean areas.
Deficiencies (2)
| Description |
|---|
| Failed to ensure documents granting legal authority to a resident's representative were available for two of four resident records reviewed. |
| Failed to ensure adequate housekeeping and maintenance, including damaged carpet, missing towel bars and toilet paper holders, and unclean sink. |
Report Facts
Resident records reviewed: 4
Facility census: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #2 | Mentioned in relation to conversation with Resident #5's cousin about health care surrogate. |
Inspection Report
Annual Inspection
Census: 4
Deficiencies: 0
Feb 1, 2022
Visit Reason
The inspection was conducted as an annual environmental survey to assess compliance with licensing requirements.
Findings
The residence was found to be in substantial compliance with the licensing rule following record review, staff interview, and facility tour.
Report Facts
Sample size: 100
Inspection Report
Routine
Census: 5
Deficiencies: 0
Aug 4, 2021
Visit Reason
Routine survey conducted to assess compliance and facility conditions at Central Ave Assisted Living.
Findings
The survey found no new citations and cleared previous citations. The facility had a census of 5 residents at the time of the visit.
Report Facts
Census: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sherry Rapp | HFNSII | Named as part of the survey team |
Inspection Report
Re-Inspection
Census: 5
Deficiencies: 1
May 24, 2021
Visit Reason
The visit was a re-inspection conducted to verify that all previously cited deficiencies were corrected.
Findings
All deficiencies cited in the prior inspection were corrected as of the re-inspection date.
Deficiencies (1)
| Description |
|---|
| Deficiencies 0440, 0445, 0450, and 0452 were cited in the initial survey. |
Report Facts
Deficiencies cited: 4
Facility census: 6
Facility census: 5
Inspection Report
Annual Inspection
Census: 6
Deficiencies: 3
Mar 29, 2021
Visit Reason
Annual survey conducted to assess compliance with health and safety regulations and licensing requirements at Central Ave Assisted Living.
Findings
The licensee failed to report a major incident involving a resident missing for approximately eleven hours. Additionally, deficiencies were noted related to environmental safety and housekeeping, including unsecured doors and maintenance issues such as carpet damage and missing bathroom fixtures.
Severity Breakdown
Class III: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to report a major incident to the Office of Health Facility Licensure and Certification involving a resident missing for approximately eleven hours. | Class III |
| Unsecured outside doors without alarms or locking mechanisms, and lack of awake staff supervision on weekend nights. | — |
| Inadequate housekeeping and maintenance including personal belongings left behind furniture, carpet damage (iron burn and bleach spots), torn chair, missing towel bar and toilet paper holder, and dirty sink. | — |
Report Facts
Resident missing duration (hours): 11
Facility census: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Resident Director | Notified about the resident missing incident. | |
| Employee #1 | Notified On-call Team Leader about the resident missing incident and interviewed regarding incident reporting. |
Inspection Report
Routine
Census: 6
Deficiencies: 12
Mar 29, 2021
Visit Reason
The inspection was conducted to assess the facility's compliance with health, safety, housekeeping, maintenance, fire safety, disaster and emergency preparedness regulations.
Findings
The facility was found to have multiple deficiencies including failure to maintain a safe, sanitary, and accident-free living environment, inadequate housekeeping and maintenance, lack of documented emergency preparedness procedures for missing residents, and failure to document annual emergency preparedness rehearsals.
Deficiencies (12)
| Description |
|---|
| Bathroom toilet not sealed at floor and stained with mold/mildew. |
| Shower wall not sealed at seam and stained with mold/mildew. |
| Exposed wood paneling not painted/sealed in Resident Room 5 closet. |
| Damaged and exposed drywall in Dining Room corner and Resident Rooms 2 and 3. |
| Unpackaged paper products stored outside, exposed to insects and rodents. |
| Exposed wood in window seal of 2nd Floor Restroom/Shower Room. |
| No documented procedures in emergency preparedness plan for missing residents. |
| Ceiling fan loaded with dust/debris in Resident Room 6. |
| Missing flooring under kitchen sink loaded with dirt/debris. |
| Shower curtain in 2nd floor restroom appeared rusty. |
| Ceiling heating/cooling air supply register loaded with dust/debris. |
| No documentation of annual emergency preparedness plan rehearsal or critique. |
Report Facts
Facility census: 6
Deficiency tags cited: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Residential Director | Verified and acknowledged findings during interviews and exit interview | |
| Operations Supervisor | Participated in facility tour and observations | |
| Treatment Coordinator | Participated in facility tour and observations |
Inspection Report
Routine
Census: 7
Deficiencies: 0
Jan 12, 2021
Visit Reason
The inspection was conducted as an Infection Control Survey at Central Avenue Assisted Living.
Findings
No deficiencies were identified during the infection control survey conducted on January 12, 2021.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Adkins | Administrator | Exited the inspection with the survey team. |
| Ben Porta | Team Leader | Exited the inspection with the survey team. |
Inspection Report
Annual Inspection
Census: 7
Deficiencies: 0
Dec 1, 2020
Visit Reason
The visit was a second revisit to the annual survey to verify compliance and clearance of previous deficiencies.
Findings
All previously cited deficiencies were cleared during this revisit, with no outstanding tags remaining at the time of exit.
Report Facts
Census: 7
Inspection Report
Annual Inspection
Census: 7
Deficiencies: 4
Oct 26, 2020
Visit Reason
This was the first revisit to the annual survey to assess compliance with previously cited deficiencies and to conduct an annual inspection of the assisted living facility.
Findings
The inspection found deficiencies related to the secure storage and availability of resident records, failure to send required documentation during resident transfers, and incomplete medication administration records with multiple missed or undocumented doses. Additionally, housekeeping and maintenance issues were noted in the facility environment.
Severity Breakdown
Class I: 1
Class III: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Resident records were not maintained on-site and had to be retrieved off-site, potentially affecting all seven residents. | Class III |
| Failure to send Resident #4's Advanced Directives, Functional Needs Assessment, Service Plan, and Progress Notes with transfer to the Emergency Room. | — |
| Failure to keep complete medication administration records for Residents #2, #4, and #5, including missed or undocumented doses. | Class I |
| Inadequate housekeeping and maintenance including personal belongings behind furniture, carpet damage, torn furniture, missing bathroom fixtures, and unclean sink. | — |
Report Facts
Census: 7
Missed medication doses: 15
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tracie Hall | Administrator | Responsible party for plans of correction related to record keeping, transfer documentation, and medication administration |
| Michelle Mullins | RN | Responsible party for medication administration retraining and MAR review |
| Team Leader #13 | Interviewed regarding record keeping and medication documentation issues |
Inspection Report
Deficiencies: 1
May 6, 2020
Visit Reason
The inspection was conducted to assess compliance with health and safety regulations at Central Ave Assisted Living.
Findings
The inspection identified deficiencies related to safety measures, including lack of alarms on outside doors and inadequate awake staff supervision during weekend nights.
Deficiencies (1)
| Description |
|---|
| Adolescent girls' bedrooms have outside doors without alarms or alert devices; staff are not awake on weekend nights to monitor consumers; an outside door in the TV room does not lock. |
Report Facts
Center census: 6
Sample size: 3
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 4
Mar 17, 2020
Visit Reason
Annual survey conducted to assess compliance with health care standards, housekeeping, medication administration, and facility maintenance.
Findings
The facility failed to send complete transfer/discharge summaries with residents to hospitals, maintain furniture in good repair, keep accurate medication administration records for one resident, and ensure adequate housekeeping and maintenance. Plans of correction were submitted for all deficiencies.
Severity Breakdown
Class I: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to send complete transfer or discharge summaries including advanced directives and pertinent progress notes with residents to hospital emergency room visits. | — |
| Failed to maintain furniture that was clean, odor free, and in good repair; specifically a torn sofa cushion exposing foam lining. | — |
| Failed to keep a record of all medications given to one resident indicating each dose administered; medication administration record (MAR) was incomplete. | Class I |
| Failed to ensure adequate housekeeping and maintenance including presence of personal belongings behind furniture, carpet damage, torn chair, missing towel bars and toilet paper holders, and dirty sink. | — |
Report Facts
Census: 8
Sample Size: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Approved Medication Assistive Personnel #6 | Failed to sign medication administration record after giving medication | |
| Team Leader | Interviewed regarding missing transfer documentation and medication administration | |
| Registered Nurse | RN | Provided training on medication administration and signing MAR |
Inspection Report
Census: 8
Deficiencies: 2
Mar 12, 2020
Visit Reason
The inspection was conducted to assess the physical facilities and overall maintenance of the residence to ensure it is clean and in good repair.
Findings
The facility failed to maintain the building in good repair, with observed issues including holes and cracks in the floor covering in room 3 exposing the wood subfloor, a one-inch gap between floor covering and baseboard in the storage room filled with debris, and other maintenance concerns verified by the facility manager.
Deficiencies (2)
| Description |
|---|
| Floor covering in room 3 had holes and cracks exposing wood subfloor. |
| Floor covering in storage room had a one-inch gap filled with debris. |
Report Facts
Facility Census: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alyce Crist | Team Leader | Responsible party for maintenance and plan of correction |
| Tracie Hall | Administrator | Responsible party for maintenance and plan of correction |
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 0
Mar 11, 2019
Visit Reason
The inspection was conducted as an annual licensure survey of Central Ave Assisted Living to assess compliance with regulatory requirements.
Findings
The annual licensure survey found no deficiencies cited during the inspection conducted from March 11 to March 14, 2019.
Report Facts
Census: 8
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 0
Mar 4, 2019
Visit Reason
The visit was conducted as an annual licensure survey focusing on the annual environmental conditions of the facility.
Findings
The inspection found no deficiencies cited during the annual environmental survey of the facility.
Report Facts
Census: 8
Deficiencies cited: 0
Inspection Report
Annual Inspection
Deficiencies: 0
Apr 12, 2018
Visit Reason
The visit was conducted as an annual environmental licensure survey of the facility.
Findings
The survey included an 80% sample size and cited tags (0259), (0272), and (0279) with related concerns. No complaints were substantiated during this inspection.
Report Facts
Sample Size: 80
Tags Cited: 3
Inspection Report
Annual Inspection
Census: 7
Deficiencies: 4
Mar 12, 2018
Visit Reason
The inspection was conducted as an annual environmental licensure survey to assess compliance with physical facility regulations and other licensing requirements.
Findings
The facility was found deficient in providing an adequate call system accessible from each bed, proper closet/wardrobe space dimensions, and furniture in good repair in the leisure area. Additional housekeeping and maintenance issues were noted, including damaged carpet, missing bathroom fixtures, and worn furniture.
Severity Breakdown
CLASS II: 1
CLASS III: 2
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to provide a call system that is audible to staff and accessible from each bed and other necessary areas. | CLASS II |
| Failed to provide a closet, locker, or wardrobe space with minimum dimensions of 20" by 22" by 60" excluding shelf and storage space. | CLASS III |
| Failed to provide furniture in the leisure area that is in good repair, including a couch and love seat with peeling exterior finish. | CLASS III |
| Failed to ensure adequate housekeeping and maintenance, including iron burns and bleach spots on carpet, torn chair, missing towel bar and toilet paper holder, and dirty sink. | — |
Report Facts
Facility census: 7
Sample size: 80
Tags cited: 3
Date of completion for call system correction: Apr 1, 2018
Date of completion for furniture and wardrobe: May 12, 2018
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 1
Feb 14, 2018
Visit Reason
The visit was conducted as an annual licensure survey to assess compliance with health care standards and licensing requirements at Central Ave Assisted Living.
Findings
The inspection found deficiencies related to failure to ensure resident care was provided by appropriately licensed personnel, specifically regarding untimely quarterly reviews of Approved Medication Assistive Personnel (AMAP). Additionally, there were environmental and housekeeping issues noted in a behavioral health survey from 2004 included in the document.
Severity Breakdown
CLASS I: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure resident care was provided by appropriately licensed health care professionals, with six of nine employees lacking timely quarterly reviews as required. | CLASS I |
Report Facts
Census: 8
Number of employees with deficient quarterly reviews: 6
Days late for quarterly reviews: 93
Days late for quarterly reviews: 77
Days late for quarterly reviews: 94
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 1
Feb 12, 2018
Visit Reason
The inspection was conducted as an annual licensure survey of the facility on February 12 and 14, 2018, with a follow-up survey on March 27, 2018.
Findings
The annual licensure survey identified deficiencies that were subsequently corrected by the follow-up survey conducted on March 27, 2018.
Deficiencies (1)
| Description |
|---|
| Deficiency Corrected |
Report Facts
Census: 8
Census: 8
Inspection Report
Annual Inspection
Census: 7
Deficiencies: 7
Feb 27, 2017
Visit Reason
The inspection was conducted as an annual licensure survey focusing on environmental conditions and compliance with physical facility maintenance requirements.
Findings
The facility was found deficient in establishing a written preventive maintenance program and scheduled equipment tests and cleaning. Specific maintenance issues included non-operational emergency exit lighting, dirty return air grills, and cigarette butts on the grounds.
Deficiencies (7)
| Description |
|---|
| Facility does not have a written Preventive Maintenance Program or scheduled equipment tests and cleaning process. |
| Emergency exit lighting at the top of the staircase not operational. |
| Egg crate light cover in kitchen needs cleaning. |
| Emergency exit lighting in the back hallway and at the back door not operational. |
| Return air grill in the back hallway dirty. |
| Furnace room door and return air grill need cleaning. |
| Cigarette butts laying on back porch and surrounding grounds. |
Report Facts
Deficiencies cited: 253
Census: 7
Inspection Report
Annual Inspection
Census: 7
Deficiencies: 1
Feb 27, 2017
Visit Reason
The visit was conducted as an annual licensure survey to assess environmental and regulatory compliance at the facility.
Findings
The survey identified 253 deficiencies which were subsequently corrected during a follow-up visit on April 10, 2017.
Deficiencies (1)
| Description |
|---|
| Environmental deficiencies identified during the annual licensure survey. |
Report Facts
Deficiencies cited: 253
Census: 7
Inspection Report
Annual Inspection
Census: 7
Deficiencies: 0
Feb 15, 2017
Visit Reason
Annual licensure survey conducted from February 13-15, 2017 to assess compliance with regulatory requirements.
Findings
No deficiencies were cited during the annual licensure survey.
Report Facts
Census: 7
Inspection Report
Follow-Up
Census: 7
Deficiencies: 0
Apr 13, 2016
Visit Reason
The visit was a follow-up survey to verify correction of deficiencies identified during the annual licensure survey conducted from February 29 to March 2, 2016.
Findings
The follow-up survey found that the previously cited deficiencies were corrected. The census at the time of follow-up was 7 residents.
Report Facts
Census: 6
Census: 7
Inspection Report
Annual Inspection
Census: 7
Deficiencies: 10
Apr 6, 2016
Visit Reason
The inspection was conducted as an annual licensure survey to assess environmental and physical facility conditions and compliance with health and safety regulations.
Findings
The facility was found to have multiple deficiencies related to cleanliness, maintenance, and safety, including trash accumulation outside, damaged furniture, unsecured oxygen bottles, missing sprinkler escutcheon covers, poor condition of wardrobes, presence of rodents, and non-GFCI electrical receptacles. Corrective actions and maintenance plans were proposed and partially implemented.
Deficiencies (10)
| Description |
|---|
| Failed to keep the interior and exterior of the residence clean and in good repair, including trash and garbage strewn over the small front yard. |
| Unsecured small oxygen bottle in room #3. |
| Walls in room #7 in need of patching and painting. |
| Two wardrobes in sleeping rooms #2 and #3 in very poor condition and need replacement. |
| Window curtain in upstairs restroom very dirty and needing replacement. |
| Sleeping room #6 has strong scent of human urine; floor coverings and furniture need replacement and sanitation. |
| Wall surfaces in rooms #7 and #8 very dirty and in need of patching and painting. |
| Kitchen receptacle powering toaster is not GFCI type. |
| Missing escutcheon cover on sprinkler head in sleeping room 'GC'. |
| Presence of rodents evidenced by a gray mouse seen running across kitchen counter. |
Report Facts
Census: 7
Deficiencies cited: 1
Inspection Report
Annual Inspection
Census: 6
Deficiencies: 3
Mar 2, 2016
Visit Reason
The inspection was conducted as an annual licensure survey of the assisted living facility to assess compliance with health and safety regulations, management of resident funds, and health care standards.
Findings
The facility was found deficient in ensuring a surety bond was filed to cover resident funds, maintaining adequate housekeeping and maintenance, and obtaining required waivers for residents receiving ongoing nursing care injections. Plans of correction were submitted to address these deficiencies.
Severity Breakdown
Class I: 1
Class III: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to ensure a bond with sufficient surety was filed to cover all resident funds at all times. | Class III |
| Failure to ensure adequate housekeeping and maintenance required to carry out services, including presence of personal belongings behind furniture, carpet damage, missing bathroom fixtures, and unclean sink. | — |
| Failure to obtain required waivers for ongoing nursing care injections for two residents. | Class I |
Report Facts
Census: 6
Residents with funds exceeding limits: 5
Residents without required waivers: 2
Monthly income for Resident #3: 659.7
Monthly income for Resident #4: 659.7
Monthly income for Resident #6: 893
Monthly income for Resident #7: 769
Monthly income for Resident #8: 766
Inspection Report
Annual Inspection
Census: 6
Deficiencies: 7
Mar 2, 2016
Visit Reason
The inspection was conducted as an annual licensure survey to assess environmental and physical facility compliance at Central Ave Assisted Living.
Findings
The facility was found deficient in maintaining the interior and exterior of the residence in clean and good repair, including issues such as dirty window curtains, strong odors in sleeping rooms, damaged furniture, missing sprinkler escutcheon, unsecured oxygen bottle, and non-GFCI electrical receptacle.
Deficiencies (7)
| Description |
|---|
| Window curtain in the upstairs restroom was very dirty and needed replacement. |
| Sleeping room #6 had a strong scent of human urine requiring floor covering removal, subfloor sealing, furniture replacement, and painting. |
| Walls in rooms #7 and #8 were very dirty and needed patching and painting. |
| Small oxygen bottle in room #7 was standing unsecured. |
| Kitchen receptacle powering the toaster was not the required GFCI type. |
| Sprinkler head in sleeping room 'GC' was missing its escutcheon cover. |
| Two wardrobes in sleeping rooms #2 and #3 were in very poor condition and needed replacement. |
Report Facts
Deficiencies cited: 1
Census: 6
Inspection Report
Annual Inspection
Census: 9
Capacity: 8
Deficiencies: 5
Mar 9, 2015
Visit Reason
The inspection was conducted as an annual licensure survey to ensure compliance with the terms of the assisted living residence's license and applicable federal, state, and local laws.
Findings
The facility was found to be out of compliance with licensing terms due to exceeding licensed capacity temporarily, incomplete and outdated resident service plans for multiple residents, and failure to ensure medications and treatments were administered according to applicable laws. Additionally, housekeeping and maintenance deficiencies were noted, including damaged carpets, missing bathroom fixtures, and unclean areas.
Severity Breakdown
Class II: 3
Class I: 1
Deficiencies (5)
| Description | Severity |
|---|---|
| The licensee failed to ensure the home complied with the terms of the assisted living residence's license, including temporary over-occupancy beyond the licensed capacity of eight residents. | Class II |
| Failure to complete resident service plans within seven days of admission for three residents (#2, 5, and 7). | Class II |
| Failure to update resident service plans annually or as indicated by significant change for three residents (#1, 4, and 8). | Class II |
| Failure to ensure medications and treatments were administered as required by applicable federal and state law for five employees (#9, 10, 14, 15, and 18), including missed quarterly reviews and expired CPR/first aid certification. | Class I |
| Inadequate housekeeping and maintenance including iron burn and bleach spots on carpet, torn chair, missing towel bar and toilet paper holder, and dirty sink. | — |
Report Facts
Census: 9
Total licensed capacity: 8
Number of employees with medication administration deficiencies: 5
Number of residents with incomplete service plans: 3
Number of residents with outdated service plans: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #9 | Medication Assistive Personnel (AMAP) | Had missed quarterly reviews and expired CPR/first aid certification; scheduled for refresher training |
| Administrator | Interviewed regarding licensing compliance and deficiencies | |
| Registered Nurse (RN) | Responsible for nursing/medical section of service plans; acknowledged deficiencies | |
| Team Leader | Provided information about resident temporary placement and census |
Inspection Report
Annual Inspection
Census: 9
Deficiencies: 0
Mar 9, 2015
Visit Reason
The document reports on the Annual Licensure Survey conducted on March 9-10, 2015, and a follow-up survey conducted on May 19, 2015, for Central Ave Assisted Living.
Findings
The report includes the annual licensure survey and a follow-up survey with census counts of 9 and 8 respectively. No specific deficiencies or severity levels are detailed in the provided text.
Report Facts
Census: 9
Census: 8
Inspection Report
Annual Inspection
Census: 7
Deficiencies: 0
Mar 4, 2015
Visit Reason
The inspection was conducted as an annual licensure survey to assess environmental and regulatory compliance at Central Ave Assisted Living.
Findings
The survey found no deficiencies during the inspection, indicating compliance with applicable standards.
Report Facts
Census: 7
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 0
Mar 11, 2014
Visit Reason
Annual licensure survey conducted to assess compliance with state regulations for the assisted living facility.
Findings
The annual licensure survey found no deficiencies at the facility during the inspection.
Report Facts
Census: 8
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 0
Mar 11, 2014
Visit Reason
Annual licensure survey conducted to assess compliance with regulatory requirements.
Findings
The facility was found to have no deficiencies during the annual licensure survey conducted on March 10-11, 2014.
Report Facts
Census: 8
Inspection Report
Follow-Up
Census: 8
Deficiencies: 2
May 2, 2013
Visit Reason
The visit was a follow-up survey to verify correction of deficiencies identified during the annual licensure survey conducted on March 13, 2013.
Findings
The facility was found to have ongoing deficiencies related to housekeeping, maintenance, and hot water temperature safety. Issues included dust accumulation, cigarette butt littering, damaged furnishings, and hot water temperatures outside the safe range. Plans of correction were submitted to address these issues.
Severity Breakdown
Class II: 1
Class I: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to keep the interior and exterior of the residence clean and in good repair, including dust-filled ceiling registers, dirty exhaust fans, cigarette butts littering the yard, and damaged furnishings. | Class II |
| Hot water temperatures exceeding safe levels (above 120°F) posing an immediate and serious threat to residents. | Class I |
Report Facts
Census: 8
Hot water temperature: 121
Hot water temperature: 118
Hot water temperature: 89.2
Hot water temperature: 114.8
Inspection Report
Annual Inspection
Census: 6
Deficiencies: 0
Mar 13, 2013
Visit Reason
The visit was conducted as an annual licensure survey of the facility.
Findings
No deficiencies were cited during the survey, and technical assistance was provided.
Report Facts
Census: 6
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 7
Mar 13, 2013
Visit Reason
Annual licensure survey conducted to assess environmental, dietary services, disaster preparedness, physical facilities, and safety compliance at Central Ave Assisted Living.
Findings
The facility was found deficient in multiple areas including failure to conduct timely kitchen inspections, inadequate housekeeping and maintenance, unsafe hot water temperatures, and missing or damaged bedroom furnishings. Corrective actions and maintenance plans were proposed for each deficiency.
Severity Breakdown
CLASS I: 2
CLASS II: 2
CLASS III: 1
Deficiencies (7)
| Description | Severity |
|---|---|
| Failure to have the required inspection conducted for the kitchen/food prep areas; ice tray in freezer filled with unlabeled orange substance. | CLASS II |
| Failure to rehearse disaster and emergency preparedness plan with documentation of all staff participation. | CLASS I |
| Failure to provide adequate housekeeping and maintenance; observations included personal belongings behind dresser, iron burn and bleach spots on carpet, torn chair, missing towel bar and toilet paper holder, dirty sink, greasy kitchen surfaces, soiled walls, cluttered resident room, and other cleanliness issues. | — |
| Failure to establish and conduct a program of preventive maintenance; grease-laden exhaust fan filter and non-functioning emergency lights. | — |
| Failure to keep interior and exterior clean and in good repair; dusty ceiling registers and vents, cigarette butts in backyard, missing ceiling tile, and need for sprinkler head adjustment. | CLASS II |
| Failure to provide bedroom furnishings in good repair; missing handles on dressers and night stands. | CLASS III |
| Hot water temperatures exceeding 120°F at hand sink, shower, and tub, posing immediate and serious threat. | CLASS I |
Report Facts
Census: 8
Inspection date: Mar 13, 2013
Hot water temperature: 121
Completion date for corrective actions: May 3, 2013
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 0
Mar 13, 2013
Visit Reason
The inspection was conducted as an Annual Licensure Survey to assess environmental conditions and compliance at Central Ave Assisted Living.
Findings
The report documents an annual licensure survey and subsequent follow-up visits, noting that deficiencies identified were corrected by the second follow-up visit on May 29, 2013.
Report Facts
Census: 8
Inspection Report
Annual Inspection
Census: 7
Deficiencies: 0
Mar 20, 2012
Visit Reason
Annual licensure survey conducted to assess compliance with regulatory requirements for the assisted living facility.
Findings
No deficiencies were cited during the survey. Technical assistance was provided to the facility.
Report Facts
Census: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Keith Carpenter | Surveyor | Conducted the annual licensure survey |
Inspection Report
Annual Inspection
Census: 6
Deficiencies: 13
Feb 13, 2012
Visit Reason
Annual licensure survey conducted to assess compliance with health, safety, staffing, training, medication administration, dietary, and physical facility standards.
Findings
The facility was found deficient in multiple areas including failure to report major incidents timely, inadequate staffing with current CPR certification, delayed employee training, incomplete resident health assessments and functional needs assessments, missing allergy documentation, medication administration errors, inadequate resident monitoring after incidents, failure to provide therapeutic diets as ordered, and lack of sanitary hand drying facilities in bathrooms. Housekeeping and maintenance issues were also noted.
Severity Breakdown
Class I: 1
Class II: 5
Class III: 3
Deficiencies (13)
| Description | Severity |
|---|---|
| Failure to report major incidents to licensing agency within required timeframe. | Class III |
| At least one employee on duty lacked current CPR certification and worked alone on multiple days. | Class I |
| New employees did not receive required training within 15 days of hire. | Class II |
| Resident allergy information missing from records and MARs for multiple residents. | Class III |
| Incomplete or missing health assessments including TB screening for residents. | Class II |
| Functional needs assessment not completed within 7 days of admission for one resident. | Class II |
| Assessments and service plans not updated annually for multiple residents. | Class II |
| Quarterly reviews for approved medication assistive personnel (AMAP) not completed timely; one AMAP lacked current CPR certification. | — |
| Medications not administered or documented according to physician orders for multiple residents. | — |
| Residents not monitored every 8 hours for 24 hours following accidents or significant episodes as required. | Class II |
| Therapeutic or modified diets not provided as ordered; required foods not available in the home. | — |
| Toilet and bathing facilities lacked sanitary method for drying hands; hand towel dispenser was inoperable. | Class III |
| Inadequate housekeeping and maintenance including damaged carpet, missing bathroom fixtures, and dirty sinks. | — |
Report Facts
Residents present: 6
Sample size: 3
Days worked alone: 13
Quarterly reviews missing: 5
Residents with missing allergy info: 3
Residents with incomplete health assessments: 4
Residents with outdated assessments: 3
Residents with medication administration errors: 4
Residents not monitored post-incident: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| JE | Approved Medication Assistive Personnel (AMAP) | Worked alone on 13 days without current CPR certification; overdue quarterly reviews; scheduled for CPR retraining |
| JH | Team Leader | Interviewed regarding staffing and CPR training issues |
| TH | Administrator | Interviewed regarding incident reporting and training deficiencies |
| JD | Registered Nurse (RN) | Interviewed regarding missing documentation, medication errors, and monitoring deficiencies |
| JHa | Employee preparing meals | Interviewed regarding grocery shopping and food availability |
| GD | Employee | Responsible for grocery shopping |
| JHo | Employee conducting tour | Noted hand towel dispenser issue during bathroom tour |
Inspection Report
Annual Inspection
Census: 6
Deficiencies: 0
Feb 13, 2012
Visit Reason
The inspection was conducted as an annual licensure survey of Central Ave Assisted Living to assess compliance with regulatory requirements.
Findings
The report notes that deficiencies identified during the annual survey were subsequently corrected as confirmed by a follow-up survey conducted on April 4, 2012.
Report Facts
Census: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Deborah Dodrill | LSW, HFS II | Surveyor during the annual licensure survey |
| Donna Williamson | RN, HFNS II | Surveyor during the annual licensure survey |
| Pam Martin | RN, HFNS II | Surveyor during the follow-up survey |
| Bev Randolph | RN, HFNS I | Surveyor during the follow-up survey |
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 0
Mar 16, 2011
Visit Reason
Annual licensure survey conducted to assess compliance with regulatory requirements for the assisted living facility.
Findings
No deficiencies or technical assistance were identified during the annual licensure survey.
Report Facts
Census: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Keith Carpenter | Named in the report summary |
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 0
Feb 14, 2011
Visit Reason
The visit was conducted as an annual licensure survey of the facility.
Findings
The survey found no deficiencies and provided only technical assistance.
Report Facts
Census: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Deborah Dodrill | HFSII Surveyor | Named as a surveyor conducting the annual licensure survey |
| Ernie Chafin | HFNSII Surveyor | Named as a surveyor conducting the annual licensure survey |
Inspection Report
Annual Inspection
Census: 7
Deficiencies: 0
Mar 29, 2010
Visit Reason
The visit was conducted as an annual licensure survey to assess compliance with regulatory requirements for the assisted living facility.
Findings
No deficiencies were identified during the survey. Only technical assistance was provided.
Report Facts
Census: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Keith Carpenter | Surveyor | Named as the surveyor conducting the annual licensure survey |
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 3
Jan 27, 2010
Visit Reason
The visit was an annual licensure survey conducted to assess compliance with state regulations for personnel records, dietary services, and overall facility maintenance and safety.
Findings
The inspection found deficiencies including failure to complete tuberculosis screenings prior to hire for three employees, inadequate housekeeping and maintenance issues such as damaged carpets and missing bathroom fixtures, and failure to provide therapeutic or modified diets according to physician orders for four residents.
Deficiencies (3)
| Description |
|---|
| Failure to ensure tuberculosis screening was completed prior to hire for three employees. |
| Inadequate housekeeping and maintenance including damaged carpet, missing towel bars and toilet paper holders, and dirty sink. |
| Failure to provide therapeutic or modified diets as ordered by physicians for four residents, including improper portion control and serving inappropriate foods. |
Report Facts
Census: 8
Number of employees with late TB screening: 3
Number of residents on special diets: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tracie Hall | Administrator | Named in relation to failure to ensure TB screening prior to hire and dietary compliance. |
| Ashley Crowe | Team Leader | Named in relation to dietary services and staff training. |
| Jennifer Dorsey | RN | Named in relation to dietary services and resident diet training. |
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 0
Jan 27, 2010
Visit Reason
The inspection was conducted as an annual licensure survey to assess compliance with regulatory requirements for the facility.
Findings
The report documents the annual licensure survey findings and a follow-up survey to verify correction of deficiencies. The follow-up survey noted that deficiencies were corrected.
Report Facts
Census: 8
Census: 9
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Deb Dodrill | LSW, HFS II | Surveyor during the annual licensure survey |
| Donna Williamson | RN, HFNS II | Surveyor during the annual licensure survey |
| Pam Martin | HFNS II | Surveyor during the follow-up survey |
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 5
Mar 25, 2009
Visit Reason
The visit was conducted as an annual licensure survey to assess the environment and compliance with physical facility maintenance and housekeeping standards.
Findings
The facility failed to maintain a safe, sanitary, and accident-free living environment, including unlocked chemical closets, residents smoking inside the facility, improper food date marking, contamination risks from food and debris, and exterior drainage issues creating mosquito breeding grounds.
Deficiencies (5)
| Description |
|---|
| Chemical closets in the laundry room and upstairs bathroom were not locked at all times, exposing hazardous cleaning supplies. |
| Residents were smoking inside the facility, with evidence including tobacco odor, cigarette butts, and ashes found in resident rooms and bathrooms. |
| Ready-to-eat, potentially hazardous foods were not properly date marked in the refrigerator, risking foodborne illness. |
| A bowl of raw apples with partially consumed fruit and sunflower seed shells under beds created contamination and insect attractant issues. |
| A gutter downspout was not draining properly, causing pooling water that could attract mosquitoes. |
Report Facts
Census: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jason T. Lintner | Surveyor | Conducted the annual licensure survey |
| Keith Carpenter | Surveyor | Conducted the annual licensure survey |
| Tracie Hall | Administrator | Responsible party for corrective actions |
| Rachel Moss | Team Leader | Responsible party for corrective actions |
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 0
Mar 25, 2009
Visit Reason
The inspection was conducted as an annual licensure survey to assess the environment and compliance of Central Ave Assisted Living.
Findings
The report notes an annual licensure survey conducted on March 25, 2009, with a census of 8 residents. A follow-up survey on April 29, 2009, confirmed that deficiencies previously identified were corrected.
Report Facts
Census: 8
Census: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jason T. Lintner | Surveyor during the annual licensure and follow-up surveys | |
| Keith Carpenter | Surveyor during the annual licensure and follow-up surveys |
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 7
Mar 10, 2009
Visit Reason
The annual licensure survey was conducted to assess compliance with state regulations governing the care and safety of residents at Central Ave Assisted Living.
Findings
The inspection identified multiple deficiencies including failure to develop and implement adequate policies governing care and safety, inadequate housekeeping and maintenance, missing health assessments, functional needs assessments, service plans for residents, medication availability issues, and inconsistent nursing documentation.
Severity Breakdown
Class I: 1
Class II: 4
Class III: 1
Deficiencies (7)
| Description | Severity |
|---|---|
| Failure to develop and implement policies governing care and safety of residents. | Class III |
| Inadequate housekeeping and maintenance including damaged carpet, missing towel bars, and dirty sinks. | — |
| Failure to obtain written, signed, and dated health assessments for residents within required timeframes. | Class II |
| Failure to complete individualized functional needs assessments within seven days of admission. | Class II |
| Failure to complete service plans based on functional needs assessments within seven days of admission. | Class II |
| Medications not available for administration as ordered for two residents. | Class I |
| Failure to consistently document weekly nursing progress notes for one resident. | Class II |
Report Facts
Census: 8
Deficiencies cited: 7
Medication unavailability days: 3
Medication unavailability days: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tracie Hall | Administrator | Named as responsible party for multiple deficiencies and plan of correction |
| Jennifer Dorsey | Registered Nurse | Named as responsible party for health care standards and medication administration deficiencies |
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 0
Mar 9, 2009
Visit Reason
Annual licensure survey conducted to assess compliance with regulatory requirements for the assisted living facility.
Findings
The report documents the findings from the annual licensure survey and a subsequent follow-up survey. Deficiencies identified during the annual survey were corrected by the follow-up visit.
Report Facts
Census during annual survey: 8
Census during follow-up survey: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ernie Chafin | HFNS II | Surveyor during both annual and follow-up surveys |
| Betty Marine | HFS II, LSW | Surveyor during annual licensure survey |
| Pamala Martin | HFNS I | Surveyor during follow-up survey |
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 1
Apr 15, 2008
Visit Reason
The visit was conducted as an annual licensure survey and a follow-up survey to assess compliance with health care standards and facility regulations.
Findings
The facility failed to seek immediate treatment and implement appropriate interventions for a resident with behaviors placing them at risk of serious harm, including elopement. Additionally, deficiencies were noted related to safety supervision and environmental maintenance.
Severity Breakdown
Class I: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to seek immediate treatment for a resident whose behaviors place the resident at risk of serious harm and failure to implement appropriate interventions to ensure the resident's safety. | Class I |
Report Facts
Census: 8
Sample Size: 3
Timeframe: 48
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 2
Mar 19, 2008
Visit Reason
The inspection was conducted as an annual licensure survey to assess the environment and compliance with health and safety regulations at Central Ave Assisted Living.
Findings
The facility was found to have deficiencies related to maintaining a safe, clean, and sanitary environment, including issues in the kitchen area and resident rooms such as dirt, grease stains, missing equipment, and improper storage near sprinkler heads. Plans of correction were provided with specific timelines for remediation.
Severity Breakdown
Class II: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| The administrator failed to provide and maintain a safe, clean, and sanitary environment including dirt, dust, cigarette butts behind and under the refrigerator, dirty hood exhaust filter, old dried food on appliances, grease stains on deep fryer, and an uncovered trash container. | Class II |
| Resident room #1 had combustible books stacked in direct contact with the sprinkler head, violating safety spacing requirements. | Class II |
Report Facts
Census: 8
Completion date for carpet replacement: Sep 30, 2004
Completion date for cleaning and repairs: Apr 30, 2008
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tracie Hall | Administrator | Responsible party for plan of correction |
| Rachel Moss | Team Leader | Responsible party for monitoring plan of correction |
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 0
Mar 19, 2008
Visit Reason
Annual licensure survey conducted to assess the environment and compliance of the facility.
Findings
The survey included an environmental assessment and a follow-up visit where deficiencies were corrected. The census was 8 residents during both visits.
Report Facts
Census: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Keith Carpenter | Surveyor | Conducted the annual licensure survey and follow-up visit |
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 3
Mar 11, 2008
Visit Reason
The annual licensure survey was conducted to assess compliance with health and safety regulations, incident reporting, resident monitoring, and housekeeping standards at Central Ave Assisted Living.
Findings
The facility failed to report major incidents involving resident elopements to the licensing agency in a timely manner, did not adequately monitor residents' conditions following incidents as required, and had deficiencies in housekeeping and maintenance including damaged carpets and missing bathroom fixtures.
Severity Breakdown
Class III: 1
Class II: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to report major incidents (resident elopements) to the licensing agency as required. | Class III |
| Failure to monitor and document residents' conditions at least every eight hours for 24 hours following an accident or illness. | Class II |
| Inadequate housekeeping and maintenance including damaged carpet, missing towel bars and toilet paper holders, and dirty sink. | — |
Report Facts
Census: 8
Incident reports reviewed: 4
Residents with elopements: 2
Incident reports reviewed: 3
Residents with inadequate monitoring: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tracie Hall | Administrator | Named in plan of correction for incident reporting and resident monitoring deficiencies |
| Rachel Moss | Team Leader | Named in plan of correction for incident reporting deficiencies |
| Jennifer Dorsey | RN | Named in plan of correction for resident monitoring deficiencies |
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 0
Mar 11, 2008
Visit Reason
The inspection was conducted as an annual licensure survey of the facility.
Findings
The report documents the annual licensure survey conducted on March 11-12, 2008, with follow-up surveys on April 15 and May 21, 2008. Census counts during these visits ranged from 7 to 8 residents, including 2 residents in hospital during the initial survey.
Report Facts
Census: 8
Census: 8
Census: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Deborah Dodrill | HFSII | Surveyor during annual licensure survey |
| Louise Hall | HFNSII | Surveyor during annual licensure survey |
| Betty Marine | LSW, HFS II | Surveyor during follow-up surveys |
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 6
Mar 27, 2007
Visit Reason
The inspection was conducted as an annual licensure survey to assess the environment and compliance with regulatory standards at Central Ave Assisted Living.
Findings
The facility was found to have multiple deficiencies including failure to maintain a safe, clean, and sanitary environment, inadequate disaster and emergency preparedness plans, and housekeeping and maintenance issues such as cluttered and unsanitary resident rooms, damaged furniture, and lack of emergency transportation policy. Plans of correction were provided with completion dates.
Severity Breakdown
Class I: 2
Class II: 1
Class III: 1
Deficiencies (6)
| Description | Severity |
|---|---|
| Failure to maintain a safe and appropriate environment for consumers, including lack of awake-night supervision on weekends and unsecured outside doors. | — |
| Inadequate housekeeping and maintenance including personal belongings clutter, iron burns and bleach spots on carpet, torn furniture, missing towel bars and toilet paper holders, and dirty sinks. | — |
| Failure to incorporate and maintain an emergency transportation policy in the disaster and emergency preparedness plan. | Class II |
| Failure to provide copies of the disaster and emergency preparedness plan at all staff stations and ensure staff know the location of the plan. | Class I |
| Failure to review and update the disaster and emergency preparedness plan on an annual basis with administrator signature and date. | Class III |
| Failure to provide maintenance and housekeeping to maintain a safe, sanitary, and accident-free living environment, including cluttered and unorganized resident rooms, use of electrical extension cords, cigarette smoke odor, unsanitary conditions with food debris, stained furniture and mattresses, and lack of regular cleaning. | Class I |
Report Facts
Census: 8
Sample Size: 3
Completion Date: Apr 6, 2007
Completion Date: Apr 10, 2007
Completion Date: Apr 13, 2007
Completion Date: Apr 26, 2007
Completion Date: Apr 27, 2007
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tracy Hall | Administrator | Responsible party for disaster and emergency preparedness plan corrections and monitoring. |
| Amanda Logue | Team Leader | Responsible party for monitoring housekeeping and maintenance corrections. |
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 0
Mar 27, 2007
Visit Reason
Annual licensure survey conducted to assess the environment and compliance of the facility.
Findings
The report documents an annual licensure survey and a follow-up survey, with deficiencies noted initially but corrected by the follow-up visit.
Report Facts
Census: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Keith Carpenter | Surveyor | Conducted both the annual licensure survey and the follow-up survey |
Inspection Report
Annual Inspection
Census: 8
Deficiencies: 0
Mar 14, 2007
Visit Reason
The visit was conducted as an annual licensure survey of the facility.
Findings
No deficiencies were identified during the survey. Only technical assistance was provided.
Report Facts
Census: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ernie Chafin | HFNS II | Surveyor during the annual licensure survey |
| Deb Dodrill | HFS II | Surveyor during the annual licensure survey |
Inspection Report
Original Licensing
Census: 8
Deficiencies: 0
May 11, 2006
Visit Reason
The visit was conducted as an initial licensure survey and a follow-up survey to assess compliance with licensing requirements for Central Ave Assisted Living.
Findings
The initial licensure survey was conducted on April 11-12, 2006, with a census of 8 residents. A follow-up survey on May 11, 2006, confirmed that deficiencies identified during the initial survey were corrected and technical assistance was provided.
Report Facts
Census: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ernie Chafin | HFNSII | Surveyor during initial licensure survey |
| Deborah Dodrill | HFSII | Surveyor during initial licensure survey |
| Betty Marine | LSW, HFS II | Surveyor during follow-up survey |
| Kathy Beauchamp | HFNS II | Surveyor during follow-up survey |
Inspection Report
Original Licensing
Census: 8
Deficiencies: 7
Apr 12, 2006
Visit Reason
Initial licensure survey conducted to assess compliance with health care standards, housekeeping, maintenance, dietary services, medication administration, nursing documentation, and activities programming at Central Ave Assisted Living.
Findings
The facility was found deficient in multiple areas including inadequate housekeeping and maintenance, improper medication administration practices, lack of weekly nursing notes for diabetic residents, failure to maintain an adequate activity calendar and documentation, failure to provide therapeutic diets according to physician orders, and failure to weigh residents monthly as required.
Severity Breakdown
Class I: 2
Class II: 1
Class III: 3
Deficiencies (7)
| Description | Severity |
|---|---|
| Failure to ensure a safe and appropriate environment for adolescent consumers, including lack of awake-night supervision on weekends and unsecured outside doors. | — |
| Inadequate housekeeping and maintenance including personal belongings left behind furniture, carpet damage, missing bathroom fixtures, and dirty sinks. | — |
| Failure to ensure medications are administered as required by law, including lack of physician orders for self-administration and incomplete medication administration records. | Class I |
| Failure to document weekly nursing notes reflecting diabetic residents' status for two of two applicable records. | Class II |
| Failure to maintain an activity calendar with time and duration of activities and failure to document activities consistently. | Class III |
| Failure to provide therapeutic or modified diets according to physician orders and failure to ensure diets meet minimum calorie requirements and ADA standards. | Class I |
| Failure to weigh residents monthly and document weights, with some residents refusing to be weighed. | Class III |
Report Facts
Census: 8
Sample Size: 8
Deficiencies cited: 7
Completion Dates: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Dorsey | Registered Nurse | Named in medication administration and nursing documentation deficiencies. |
| Tracie Hall | Named as responsible party for medication administration and nursing documentation corrections. | |
| Amanda Logue | Named as responsible party for activities programming corrections. | |
| Karen Craze | Registered Dietician | Named in dietary services deficiencies and corrective actions. |
Inspection Report
Follow-Up
Census: 8
Deficiencies: 0
Feb 15, 2006
Visit Reason
This was a follow-up survey conducted to verify correction of deficiencies identified during the initial licensure survey.
Findings
The follow-up survey found that the previously cited deficiencies had been corrected.
Report Facts
Census: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Garry Taylor | Surveyor | Surveyor for the initial licensure survey |
| Keith Carpenter | Surveyor | Surveyor for the follow-up survey |
Inspection Report
Original Licensing
Census: 8
Deficiencies: 6
Jan 3, 2006
Visit Reason
The inspection was conducted as an initial licensure survey for Central Ave Assisted Living to assess compliance with applicable licensure and safety regulations.
Findings
The facility was found deficient in multiple areas including disaster and emergency preparedness, physical facilities maintenance, and housekeeping. Specific issues included lack of posted disaster plans at all staff stations, failure to update emergency plans annually, inadequate documentation of resident emergency evacuation training, unsafe physical conditions such as missing grab bars, unsafe door locks, and poor housekeeping conditions.
Severity Breakdown
Class I: 5
Class III: 1
Deficiencies (6)
| Description | Severity |
|---|---|
| Failure to provide copies of disaster and emergency preparedness plans at all staff stations. | Class I |
| Failure to review and update disaster and emergency preparedness plans annually. | Class III |
| Failure to post emergency call information near each telephone in the residence. | Class I |
| Failure to show and document resident evacuation training within 24 hours of admission. | Class I |
| Failure to maintain physical facilities according to licensure requirements, including missing grab bars, unsafe walkways, and inadequate ventilation. | Class I |
| Failure to provide maintenance and housekeeping to maintain a safe, sanitary, and accident-free environment, including electrical hazards, locked doors blocking egress, and unsanitary laundry room conditions. | Class I |
Report Facts
Census: 8
Sample Size: 3
Completion Dates: Jan 17, 2006
Completion Dates: Jan 18, 2006
Completion Dates: Jan 31, 2006
Completion Dates: Sep 30, 2004
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Garry Taylor | Surveyor | Conducted the initial licensure survey. |
| Amanda Logue | Responsible party for disaster and emergency preparedness corrective actions. | |
| Tracie Hall | Responsible party for disaster and emergency preparedness and physical facility corrective actions. | |
| Carlis Spaulding | Responsible party for physical facility corrective actions. |
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