Inspection Reports for Legacy Senior Living

Investigation of Incident #126892-I at the assisted living facility Legacy Pointe.

No regulatory insufficiencies were cited during the investigation of Incident #126892-I.

Investigation of Incident #126892-I found no regulatory insufficiencies.

The inspection was conducted as an investigation of Complaints #119003-C and #120010-C related to tenant care and service adequacy.

The Program failed to provide adequate and appropriate care related to a tenant's COVID-19 diagnosis and symptoms, failed to complete evaluations as needed for another tenant, failed to update service plans to reflect tenant needs, and failed to maintain cold beverage temperatures at safe levels.

The investigation was triggered by complaints #119003-C and #120010-C. Tenant C1's care related to COVID-19 and code status was substantiated as deficient. Tenant C2's evaluations and service plans were found deficient. Food service temperature violations were also noted.

The visit was a recertification inspection conducted to determine compliance with certification rules for an Assisted Living Program and to investigate specific incidents and a complaint.

No regulatory insufficiencies were cited during the recertification visit and investigation of incidents and complaint.

The investigation included Incidents #109712-I, #110621-I, #111254-I and Complaint #113983-C; no deficiencies were found.

Investigation of Incident # 100481-C at the assisted living facility.

No regulatory insufficiencies were cited during the investigation of the incident.

Investigation of Incident # 100481-C with no regulatory insufficiencies cited.

The inspection was conducted as a recertification visit to determine compliance with certification for an Assisted Living Program.

The inspection identified regulatory insufficiencies related to nurse delegation training not completed within 30 days of employment for 5 staff, invalid background check for 1 staff member, and failure to develop individualized service plans reflecting tenants' identified needs and preferences for assistance for 2 tenants.

Recertification visit to determine compliance with the licensing rules for an Assisted Living Program.

No regulatory insufficiencies were cited during the recertification visit for the Assisted Living Program.

Recertification visit conducted to determine compliance with certification for an Assisted Living Program (ALP).

No regulatory insufficiencies were cited during the recertification visit for the Assisted Living Program.

The visit was conducted as a plan of correction following investigation of incidents #64006-I and #64625-I.

No regulatory insufficiencies were cited during the investigation of the incidents.

The inspection was conducted as a complaint/incident investigation following Complaint/Incident Intake #57802-C on March 1 and 2, 2016.

No regulatory insufficiencies were cited during the investigation of Complaint #57802-C. The State Fire Marshal approved the alarm system for the dementia-specific program, and the regulatory insufficiency was removed.

Complaint/Incident Intake #57802-C was investigated and found to have no regulatory insufficiencies.

The inspection was conducted as a final complaint/incident investigation for Legacy Pointe in Iowa City, IA, following a complaint intake #56587-C.

No regulatory insufficiencies were identified during the investigation. Allegations regarding staffing and service plans were found to be not substantiated after review of tenant files, incident reports, policies, and interviews with staff and administration.

The complaint involved allegations about staffing levels and service plans. Both allegations were found to be not substantiated based on interviews and documentation review.

The inspection was conducted as a Final Complaint Investigation and Recertification Monitoring Evaluation following a complaint (#51432-C) and a recertification visit at Legacy Pointe, Iowa City, IA.

Regulatory insufficiencies were cited related to record checks, tenant documents, service plans, and nurse review. The complaint allegation regarding admission/discharge was unsubstantiated. Deficiencies included failure to complete criminal history background checks prior to employment, incomplete documentation in tenant files, and failure to conduct nurse reviews every 90 days.

Complaint #51432-C alleged issues with admission/discharge. The allegation was unsubstantiated based on tenant file reviews, program documents, and staff interviews. Regulatory insufficiencies were found in record checks, tenant documents, service plans, and nurse review related to the complaint.

The inspection was conducted as a final complaint/incident investigation following a tenant incident involving impaired decision-making and elopement at Silvercrest Legacy Pointe.

No regulatory insufficiencies were identified. Staff interviews, tenant file review, and observations indicated adequate staffing and adherence to policies. The tenant was safely redirected and monitored, with no injuries or history of prior elopements.

The complaint involved a tenant with impaired decision-making who left the program without staff knowledge or authorization. The tenant was observed outside the building and redirected inside. Safety checks were initiated and later discontinued at the family's request. There were no prior elopements and no elopements after the incident. Staff followed applicable policies and procedures.

The visit was a Final Recertification Monitoring Evaluation conducted to review the Plan of Correction in response to previously identified regulatory insufficiencies and to evaluate compliance with assisted living program regulations.

The report found that the program did not receive any regulatory insufficiencies during the certification period. However, some service plans did not reflect tenant identified needs and preferences, and medication administration and documentation protocols were not fully followed.

An on-site monitoring evaluation was conducted at Silvercrest Legacy Pointe to assess compliance with regulatory requirements as part of the final recertification monitoring evaluation.

No regulatory insufficiencies were found during this onsite recertification monitoring evaluation. The program did not receive any regulatory insufficiencies during the certification period.

A monitoring evaluation and complaint investigation on-site visit were conducted at Silvercrest Legacy Pointe Assisted Living on June 2, 2009, in response to Complaint #22208-C regarding regulatory insufficiency and tenant care concerns.

The investigation found no regulatory insufficiencies in most areas such as tenant exclusion criteria, food service, staffing, and structural requirements. However, a regulatory insufficiency was noted for failure to notify the Department of Inspections and Appeals within 24 hours of an accident causing substantial injury. The program was assessed a $500 civil penalty, which was paid.

Complaint #22208-C alleged that a tenant exceeded the appropriate level of care, tenants requested smaller food portions which were not accommodated, administrative staff did not listen to tenant concerns, and a tenant's pendant was not working leading to delayed ambulance response. The complaint was substantiated with a regulatory insufficiency noted for failure to report a tenant's fall with substantial injury.

The visit was a re-certification monitoring evaluation conducted to assess compliance with regulatory requirements for the assisted living program at Legacy Pointe.

The program had several regulatory insufficiencies including failure to evaluate each tenant's functional and cognitive abilities within 30 days of occupancy and annually, failure to update service plans within 30 days, failure to obtain tenant signatures on updated service plans, and lack of appropriately trained direct care staff under the current RN's direction.