Inspection Reports for
Fountainview Living LLC

All previously cited deficiencies were corrected as of the revisit date, with each deficiency fully identified by regulation number and marked as completed.

The report confirms that the previously cited deficiency related to regulation 28-39-158(a) was corrected as of 06/30/2017. No other deficiencies or uncorrected issues are noted.

The survey found the most serious deficiencies to be 'F' level, widespread, constituting no actual harm but with potential for more than minimal harm that is not immediate jeopardy. The facility submitted a plan of correction and was found to be in substantial compliance based on credible allegation of compliance and evidence of correction effective June 30, 2017.

The visit was triggered by complaint investigations #98427 and #102897.

The facility failed to retain the services of a full-time certified dietary manager to oversee the dietary staff and maintain a clean and sanitary dietary department for food storage, preparation, and service to residents.

The plan outlines corrective actions taken to address multiple deficiencies including comprehensive care planning, prevention of pressure ulcers, urinary tract infection prevention, medication management, dietary services, and bowel monitoring. The facility asserts substantial compliance and ongoing interventions to maintain regulatory standards.

The survey found the most serious deficiencies at the facility to be at an 'F' level, indicating no harm but with potential for more than minimal harm that is not immediate jeopardy. Remedies including denial of payments and possible termination of provider agreement were recommended if substantial compliance is not achieved.

This plan of correction is related to a complaint investigation identified by complaint number 01272016.

The plan outlines corrective actions taken to address an elopement risk, including relocating trash removal routes, installing new door alarm annunciators, and staff education to ensure compliance with safety regulations.

The complaint investigation #95873 found that the facility failed to prevent a cognitively impaired resident with a history of wandering and exit seeking from leaving the facility unsupervised and without staff knowledge. The resident was found outside the facility with a walker and blanket, was not cold or shivering, and was returned safely. Staff did not hear the alarm and were uncertain when the resident left. The facility policy on elopements was reviewed but not effectively followed.

The facility failed to implement effective interventions and provide adequate supervision to prevent one resident with cognitive impairment and wandering behaviors from leaving the facility without staff knowledge. The resident was found outside the facility unsupervised, despite use of wanderguards and increased observation.

All deficiencies previously cited with specific regulation numbers were corrected as of the revisit date, November 3, 2015.

The report confirms that all previously identified deficiencies were corrected by the revisit date of 11/03/2015, with no uncorrected deficiencies remaining.

The inspection included a complaint investigation #92386 as stated in the initial comments.

The facility failed to maintain sanitary and comfortable conditions in resident areas including halls and shower rooms, did not follow physician orders for blood sugar notifications, failed to document self-administration of medications in service agreements, lacked quarterly pharmacist medication regimen reviews for a resident, and failed to maintain sanitary food storage and preparation conditions.

The plan details corrective actions including maintenance improvements, staff re-education on blood sugar monitoring, updating negotiated service agreements for self-administered medications, ensuring quarterly pharmacist medication reviews, and improving kitchen sanitation.

The survey found the most serious deficiencies to be 'F' level, widespread, constituting no actual harm but with potential for more than minimal harm that is not immediate jeopardy. The facility submitted a plan of correction which was accepted, resulting in a finding of substantial compliance effective November 3, 2015.

The facility addressed multiple deficiencies including housekeeping and maintenance issues, toileting plans and assessments, medication monitoring, food sanitation, pharmacy consultant communication, and infection control practices. Corrective actions and staff re-education were implemented with ongoing quality assurance monitoring.

The visit was triggered by a complaint investigation #90283 focusing on housekeeping, maintenance, toileting care, medication monitoring, food sanitation, infection control, and related issues.

The facility failed to maintain sanitary housekeeping and maintenance in multiple resident areas, failed to provide an effective toileting plan for a dependent resident, failed to monitor blood pressure weekly for a resident on antihypertensive medication, failed to maintain sanitary food preparation conditions, failed to identify medication monitoring deficiencies by the pharmacist, and failed to maintain infection control practices including proper cleaning and hand hygiene.

The survey found the most serious deficiencies to be 'F' level deficiencies, widespread, with no harm but with potential for more than minimal harm that is not immediate jeopardy. A plan of correction was required and enforcement remedies were recommended.

The report indicates that the previously reported deficiency identified by regulation 26-41-204 (i) with ID prefix S3171 was corrected as of 03/03/2015.

The complaint investigation focused on the care of a resident who experienced multiple falls, including one resulting in serious injuries such as fractured hip, fractured ribs, and pneumothorax. The facility failed to implement fall prevention interventions and adequately document the resident's falls and care needs. The resident was admitted to inpatient hospice after the second fall and expired two days later.

The facility failed to provide care according to acceptable standards of practice by not implementing timely and appropriate interventions following a resident's physical decline and falls. One resident experienced multiple falls resulting in a fractured hip, fractured ribs, and pneumothorax, with inadequate fall prevention interventions and documentation.

The plan outlines corrective actions taken and ongoing interventions to address identified deficiencies, including fall reporting and investigation procedures, staff inservices, and quality assurance monitoring to ensure compliance.

The report confirms that the previously cited deficiency under regulation 26-41-205 (d) (1-2) with ID prefix S3200 was corrected as of 11/07/2014.

The investigation was based on complaints #79215 and #78362. The deficiency was substantiated as the facility failed to administer medications as ordered for resident #3.

The facility failed to administer medications in accordance with physician's orders for one resident (#3), who did not receive prescribed medications for at least three days due to unavailability and pharmacy issues.

The plan of correction was submitted as a result of findings from a complaint survey exiting 10/28/14.

The facility addressed deficiencies related to medication administration, specifically ensuring timely receipt and proper transcription of medications for residents, including Resident #3. Staff were inserviced on new admission medication procedures and ongoing compliance measures were implemented.

The revisit report confirms that the previously cited deficiency with ID prefix F0323 related to regulation 483.25(h) was corrected on 2014-10-10.

The facility addressed deficiencies related to accident hazards, supervision, and door monitoring systems, including discharge of a resident to a more appropriate unit, re-education of staff on alarm and elopement policies, and plans for improved security measures such as keypad systems and daily monitoring of wander guard bracelets.

Complaint investigation #78625 focused on the facility's failure to prevent elopement of resident #1, who was found outside the facility without staff knowledge for approximately two hours due to alarm system failures and inadequate supervision.

The facility failed to provide adequate supervision and secure exit door alarms, resulting in a resident at risk for elopement leaving the facility unnoticed for approximately two hours. The door alarms were found deactivated, and staff failed to properly monitor the resident despite care plans and risk assessments identifying the resident as an elopement risk.

The survey found the most serious deficiency to be at a 'D' level, indicating non-compliance. Enforcement remedies including denial of payment for new Medicare admissions were imposed and will continue until substantial compliance is achieved.

The denial of payment action was based on deficiencies found during this revisit and a Complaint investigation conducted on October 28, 2013.

The revisit found the most serious deficiency to be a 'G' level deficiency related to pressure ulcers (F314). Due to noncompliance, a denial of payment for all new Medicare admissions was imposed effective September 16, 2014, and further enforcement remedies may be considered if substantial compliance is not achieved.

The visit was complaint-related involving investigations of allegations of sexual abuse, falls with injury, and bruising of unknown origin. The facility failed to thoroughly investigate and report these allegations as required.

The facility failed to thoroughly investigate and report allegations of sexual abuse, falls with injury, and bruising. Additionally, the facility failed to promote dignified care, maintain a sanitary environment, conduct comprehensive assessments, develop and revise care plans, provide necessary treatments and services including pressure ulcer prevention, urinary continence management, range of motion maintenance, and ensure adequate staffing and supervision. Infection control practices were also deficient, and pharmaceutical services failed to ensure timely medication administration.

The plan outlines corrective actions taken and ongoing interventions to address multiple deficiencies related to abuse investigation, dignity and respect, housekeeping, assessments, care planning, professional standards, skin care, infection control, medication management, staffing, and quality assurance. The facility asserts substantial compliance with regulations by September 26, 2014.

All previously cited deficiencies identified by regulation or Life Safety Code provisions were corrected as of the revisit date.

The facility identified multiple deficiencies including late functional capacity screenings, admission negotiated service agreements, routine maintenance issues, health care services standards, self-administration of medications assessments, staff qualifications and employee records, and food storage practices. Corrective actions and ongoing interventions have been implemented to ensure compliance with regulations.

The inspection included complaint investigations for complaint numbers 75348 and 74323.

The facility failed to complete required functional capacity screenings and negotiated service agreements upon admission for a resident, did not provide adequate housekeeping and maintenance, failed to provide care according to acceptable standards including medication administration and laboratory testing, failed to complete self-administration medication assessments, did not timely request criminal background checks for employees, and failed to maintain a clean and sanitary dietary environment.

The survey found the most serious deficiencies in the facility to be at an "F" level, resulting in enforcement remedies including denial of payment for new Medicare admissions effective September 23, 2014, until substantial compliance is achieved or the provider agreement is terminated.

The facility had multiple deficiencies including failure to thoroughly investigate elopement, failure to promote dignity and respect for residents, inadequate housekeeping and maintenance, incomplete comprehensive assessments and care plans, failure to provide timely repositioning and toileting, medication errors, expired medications, lack of immunization consent documentation, insufficient nursing staff, unsanitary food storage and preparation, and inadequate infection control practices.

The facility identified multiple deficiencies related to investigation and reporting of allegations, dignity and respect of residents, housekeeping and maintenance, comprehensive assessments, care planning, medication management, infection control, and other regulatory requirements. The Plan of Correction outlines corrective actions including staff re-education, policy reinforcement, audits, and ongoing monitoring to achieve substantial compliance by July 22, 2014.

The report confirms that the deficiency identified under regulation 483.25(h) with ID prefix F0323 was corrected on 2014-04-18. No other deficiencies or uncorrected issues are noted.

The complaint investigation (#72958) found that the facility did not follow proper mechanical lift sling size recommendations, leading to a resident falling during transfer and sustaining injuries.

The facility failed to follow mechanical lift sling size recommendations, resulting in a resident falling from the sling during transfer and sustaining abrasions and skin tears. The resident weighed 122 pounds but was transferred using an x-large sling instead of the appropriate small sling.

The survey found the most serious deficiencies to be isolated 'D' level deficiencies with no harm but potential for more than minimal harm that is not immediate jeopardy. Remedies including denial of payments and possible termination of provider agreement were recommended if substantial compliance is not achieved.

The report confirms that the deficiency identified under regulation 483.25(h) with ID prefix F0323 was corrected on 03/01/2014. No other deficiencies or uncorrected issues are noted.

This Plan of Correction is linked to the Fountainview 022414 Complaint, indicating the visit was complaint-related.

The facility was found deficient in ensuring the resident environment was free of accident hazards and that residents received adequate supervision and assistance devices to prevent accidents. Specifically, a Wanderguard device was not properly placed, posing a risk to the resident.

Investigation of complaint #71958 found the facility failed to prevent elopement of resident #01, who left the facility without staff knowledge and sustained a skin tear. The front door alarm failed to sound and the resident's wanderguard bracelet was missing at the time of elopement.

The facility failed to adequately supervise and ensure adequate assistive devices for a resident identified as an elopement risk, who left the facility without staff knowledge and sustained a skin tear. The front door alarm did not sound during the incident, and the resident was out of the facility for approximately 15 minutes without supervision.

This Plan of Correction addresses a complaint investigation related to resident safety and proper sling use during transfers.

The facility was found deficient in ensuring the resident environment was free of accident hazards and that residents received adequate supervision and assistance devices to prevent accidents, specifically related to the proper sizing and use of slings during transfers.

The report confirms that deficiencies previously cited under regulations 483.20(d)(3), 483.10(k)(2), and 483.25(h) have been corrected as of the revisit date.

The report confirms that all previously identified deficiencies have been corrected as of the revisit date, with corrections completed for multiple regulatory items.

The visit was triggered by complaints #69819, #70227, and #70305. The investigation found substantiated issues related to falls, inadequate care plan revisions, and insufficient supervision leading to repeated accidents and injuries.

The facility failed to review and revise care plans adequately for residents with cognitive impairments who continued to self-transfer and fall. The facility also failed to ensure adequate supervision and assistive devices to prevent repeated falls and accidents for two residents, resulting in injuries including lacerations and skin tears.

This Plan of Correction is in response to a complaint investigation identified as Fountainview 102813 Complaint.

The facility identified multiple deficiencies related to resident care, including failure to notify responsible parties of significant changes, inadequate skin and wound care, improper catheter care, and infection control issues. Corrective actions included staff training, skin assessments, wound care protocols, and ongoing monitoring by the Director of Nursing.

The survey was conducted in response to complaint investigations #69715, 69717, 69818, and #69795.

The facility failed to timely notify family and physician of resident injuries, failed to provide adequate care and treatment for skin tears and pressure ulcers, failed to conduct consistent skin assessments, and failed to prevent urinary tract infections by improper catheter care. Additionally, infection control practices were inadequate during wound dressing changes.

The report confirms that previously identified deficiencies with regulation numbers 28-39-158(g) and 26-41-205(l)(1) were corrected as of 08/09/2013.

All deficiencies previously cited on the CMS-2567 Statement of Deficiencies and Plan of Correction were corrected as of the revisit date, 08/09/2013.

The Plan of Correction details corrective actions for multiple deficiencies related to call light availability, care planning, pain and skin assessments, pressure sore prevention, medication administration, nutritional needs, food service sanitation, pharmacy recommendations, and medication storage and labeling. Staff training and monitoring plans are described to ensure substantial compliance.

The deficiencies cited involved sanitary conditions related to food storage, preparation, and service, and issues with obtaining and reporting laboratory results to physicians. Corrective actions included policy reviews, staff training, and monitoring by designated managers.

The facility was found deficient in multiple areas including failure to ensure residents had access to call lights, inadequate care plan revisions for pressure ulcers and skin conditions, failure to provide timely pain management, medication errors, improper food portioning, unsanitary food handling, and improper medication storage and labeling.

The facility failed to maintain sanitary conditions in food storage, preparation, and serving areas, including improper handling of food and utensils. Additionally, the facility failed to monitor laboratory tests and medication regimens for residents, resulting in potential medication-related problems.

The facility identified multiple deficiencies related to comprehensive assessments, care plan development and review, toileting and urinary care, environmental safety, assistance for cognitively impaired residents, medication monitoring and administration, dietary services, and infection control. The Plan of Correction outlines corrective actions including policy reviews, staff in-services, orientation for new employees, and monitoring responsibilities.

The inspection included a complaint investigation #55213.

The facility was found deficient in multiple areas including comprehensive assessments, care planning, infection control, medication administration, accident prevention, nutritional supervision, and sanitary food handling. Specific failures included inadequate assessment and care planning for urinary incontinence, failure to prevent repeated falls, failure to monitor bowel movements and medication side effects, medication errors, improper infection control practices, and unsanitary food storage and preparation.

This Plan of Correction is related to a complaint investigation identified as Fountainview 120513 RV Complaint.

The facility identified deficiencies related to fall risk assessments, care plan updates, and environmental safety to prevent accidents. Corrective actions include new fall assessments, care plan revisions, staff inservices, and ongoing audits to ensure compliance.