Inspection Report
Renewal
Census: 2
Deficiencies: 3
Dec 10, 2018
Visit Reason
The inspection was a licensure resurvey conducted on 12/6/18 and 12/10/18 to assess compliance with regulatory requirements for Ellinwood Country Living.
Findings
The facility failed to ensure a licensed nurse provided or coordinated necessary health care services for one resident regarding altered food and fluid consistency. Staff did not provide the mechanically altered diet according to the negotiated service agreement and medical orders. Additionally, over-the-counter medications for residents were not labeled with the full resident names as required.
Severity Breakdown
SS=D: 2
SS=F: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to ensure a licensed nurse provided or coordinated necessary health care services to meet the needs of a resident regarding altered food and fluid consistency. | SS=D |
| Failed to ensure staff provided the mechanically altered diet in accordance with the negotiated service agreement, medical care provider's order, and licensed dietitian instructions. | SS=D |
| Failed to ensure all over-the-counter medications were labeled with the full name of the resident. | SS=F |
Report Facts
Census: 2
Deficiencies cited: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Licensed nurse C | Licensed Nurse | Named in findings related to failure to update negotiated service agreement and diet order coordination |
| Certified medication aide A | Certified Medication Aide | Observed preparing and serving food and medications during inspection |
| Licensed nurse B | Licensed Nurse | Interviewed regarding medication labeling requirements |
Inspection Report
Re-Inspection
Census: 53
Deficiencies: 6
Jan 4, 2017
Visit Reason
Licensure re-survey conducted at an assisted living facility over multiple days in January 2017 to assess compliance with regulatory requirements.
Findings
The facility was found deficient in multiple areas including failure to complete negotiated service agreements in collaboration with residents, failure to obtain physician orders for special care admissions, inadequate coordination of health care services especially related to fall risks and medication administration, incomplete documentation of incidents and illnesses, and failure to provide therapeutic diets as ordered.
Severity Breakdown
E: 2
D: 3
G: 1
Deficiencies (6)
| Description | Severity |
|---|---|
| Failure to ensure negotiated service agreements were completed in collaboration with residents and contained required information about services, providers, and payment responsibilities. | E |
| Failure to obtain a written order from a medical care provider for admission to a special care unit. | D |
| Failure to ensure licensed nurse provides or coordinates necessary health care services meeting residents' needs, including fall risk interventions and follow-up after falls. | G |
| Failure to ensure medication aides administer only medications they personally prepared, evidenced by pre-drawn insulin syringes without resident identification. | D |
| Failure to document all incidents, symptoms, and indications of illness or injury including date, time, actions taken, and results. | E |
| Failure to ensure therapeutic diet was prepared according to medical provider or licensed dietitian instructions. | D |
Report Facts
Facility census: 53
Number of residents in sample: 3
Number of focus review residents: 3
Fall risk scores: 12
Fall risk score: 15
Fall risk score: 16
Number of insulin syringes: 2
Number of insulin syringes: 6
Number of insulin units: 2
Number of insulin units: 4
Number of insulin units: 6
Number of insulin units: 8
Number of insulin units: 10
Number of insulin units: 12
Number of falls: 11
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Nurse | Licensed nurse #S interviewed regarding medication administration, fall interventions, and resident care | |
| Licensed Nurse | Licensed nurse #R interviewed regarding resident assessments and fall interventions | |
| Certified Staff | Certified staff #U interviewed regarding outside sitter services | |
| Dietary Staff | Dietary staff #T interviewed regarding therapeutic diet preparation |
Inspection Report
Follow-Up
Deficiencies: 4
Oct 1, 2015
Visit Reason
This revisit inspection was conducted to verify that previously reported deficiencies had been corrected and to document the dates such corrective actions were accomplished.
Findings
The report confirms that all previously cited deficiencies identified by regulation numbers 26-41-202 (a), 26-41-202 (h), 26-41-206 (d), and 26-41-206 (e)(1) were corrected as of 10/01/2015.
Deficiencies (4)
| Description |
|---|
| Deficiency related to regulation 26-41-202 (a) |
| Deficiency related to regulation 26-41-202 (h) |
| Deficiency related to regulation 26-41-206 (d) |
| Deficiency related to regulation 26-41-206 (e)(1) |
Inspection Report
Complaint Investigation
Census: 48
Deficiencies: 4
Sep 9, 2015
Visit Reason
The inspection was a resurvey with complaint investigation conducted on 9-2-15, 9-3-15, 9-8-15, and 9-9-15 at an assisted living facility.
Findings
The facility failed to ensure negotiated service agreements included required details such as service descriptions, providers, and payment responsibilities for residents #420 and #421. The facility also failed to ensure all involved individuals signed the agreements and copies were provided to residents or their representatives. Additionally, food preparation and storage practices were deficient, including incomplete food temperature documentation and unsafe food storage conditions.
Complaint Details
The visit was a resurvey with complaint investigation number 86874.
Severity Breakdown
E: 1
D: 1
F: 2
Deficiencies (4)
| Description | Severity |
|---|---|
| Negotiated service agreements lacked description of services, identification of providers, and payment responsibilities for residents #420 and #421. | E |
| Negotiated service agreements were not signed by all involved individuals and copies were not provided to residents or their legal representatives. | D |
| Food was not prepared using safe methods that conserve nutritive value, flavor, and appearance and was not served at proper temperatures; food temperature logs lacked documentation on multiple dates. | F |
| Facility staff failed to store all food under safe and sanitary conditions, including unlabeled repackaged cereals, raw chicken stored at improper temperature, and food stored on the floor. | F |
Report Facts
Census: 48
Deficiency counts: 4
Food temperature log missing entries: 31
Refrigerator temperature: 46
Refrigerator temperature: 50
Freezer temperature: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| licensed staff A | Interviewed regarding medication management and negotiated service agreement deficiencies for resident #420 | |
| licensed staff B | Signed notes regarding resident #420's exit seeking behavior and medication prescription | |
| licensed staff D | Signed multiple resident notes documenting exit seeking behaviors for resident #421 | |
| certified staff E | Reported observations of resident #421's exit seeking behavior | |
| dietary staff C | Interviewed regarding food temperature logs and kitchen observations | |
| administrator | Interviewed and confirmed deficiencies related to negotiated service agreements, food temperature logs, and food storage |
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