Deficiencies per Year
8
6
4
2
0
Unclassified
Inspection Report
Complaint Investigation
Capacity: 70
Deficiencies: 1
Feb 28, 2024
Visit Reason
The inspection was conducted in response to a complaint alleging that Resident C did not receive prescribed medications from June 2023 to December 2023.
Findings
The investigation found that Resident C's prescribed eye drops, iron pills, and melatonin were not administered as prescribed, despite documentation indicating otherwise. Staff falsified medication administration records, and corrective measures were implemented to ensure proper medication administration.
Complaint Details
The complaint alleged that Resident C was not given prescribed medications from June 2023 to December 2023. The allegation was substantiated based on interviews and evidence of surplus medications and inaccurate medication administration records.
Deficiencies (1)
| Description |
|---|
| Resident C did not receive prescribed medications (eye drops, iron pills, melatonin) from June 2023 to December 2023 despite documentation indicating administration. |
Report Facts
Capacity: 70
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Helen Sheets | Operations Specialist | Interviewed regarding medication administration issues and corrective measures |
| Carol DelRaso | Authorized Representative | Received findings of the report |
| Lauren Wohlfert | Licensing Staff | Author of the report |
Inspection Report
Complaint Investigation
Census: 41
Capacity: 70
Deficiencies: 2
Jul 11, 2023
Visit Reason
The investigation was initiated due to a complaint alleging that residents were not provided appropriate care in accordance with service plans and that the facility was short staffed.
Findings
The investigation found that residents were generally provided care according to their service plans, except for one incident where Resident A fell due to lack of supervision during showering. The facility was not found to be short staffed. Additionally, medication administration records for Resident C showed several missed entries, indicating possible missed medications.
Complaint Details
The complaint alleged residents were not provided appropriate care in accordance with service plans and that the facility was short staffed. The allegation of inappropriate care was substantiated due to the fall of Resident A and missed medication documentation for Resident C. The allegation of short staffing was not substantiated.
Deficiencies (2)
| Description |
|---|
| Resident A was not provided supervision, cueing, or care in accordance with the service plan resulting in a fall with a skin tear. |
| Review of Resident C's medication administration record revealed several missed medications on 6/23/2023 with incomplete documentation. |
Report Facts
Residents in assisted living: 27
Residents in memory care: 14
Total residents present: 41
Facility capacity: 70
Date of Resident A fall: Jun 9, 2023
Date of missed medications: Jun 23, 2023
Number of missed medication entries: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marianne Love | Administrator | Interviewed regarding resident care, staffing, and provided resident records |
| Julie Viviano | Licensing Staff | Conducted investigation and authored report |
Inspection Report
Original Licensing
Capacity: 70
Deficiencies: 8
Jun 5, 2023
Visit Reason
The visit was conducted as an original licensing study for Maple Lake Assisted Living & Memory Care to determine compliance with applicable licensing statutes and administrative rules for issuance of a temporary license.
Findings
The study identified several items of non-compliance during the on-site inspection on 06/05/2023, which were subsequently addressed by the authorized representative through documentation, photos, videos, and communications. The facility was found to be in substantial compliance with Public Health Code Act 368 of 1978 and administrative rules, supporting issuance of a temporary 6-month license with a capacity of 70 beds.
Deficiencies (8)
| Description |
|---|
| Exhaust ventilation was not functioning in all required rooms, including two community resident rooms outside the memory care unit and the memory care shower room. |
| Thermometers were not present in all refrigerators and freezers in resident rooms and community areas. |
| Building and equipment were not kept in good repair, including memory care unit exit door alarm malfunction, shower room door damage, and non-functioning dishwasher in memory care kitchen. |
| Memory care unit windows had lock devices that allowed full opening, posing safety risks. |
| Resident room #35 had a container of urine accessible to all memory care residents. |
| Resident rights poster was outdated and did not contain current required language. |
| Lack of an organized program of protection and safety regarding a bedside assistive device with potential entanglement hazards and insufficient policy and staff training. |
| Weekly menus were undated and therapeutic diet menus were identical to regular menus without modifications. |
Report Facts
Licensed capacity: 70
Number of residential units: 46
Double occupancy rooms: 24
Single occupancy memory care units: 14
Thermometers purchased: 150
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Carol DelRaso | Authorized Representative | Named in relation to submission of documentation, attestation letters, and responses to findings. |
| Marianne Love | Administrator | Named in relation to on-site inspection and communication about findings. |
| Larry Lamb | Bureau of Fire Services Inspector | Named in relation to fire safety inspections and approval of fire safety compliance. |
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