Deficiencies per Year
8
6
4
2
0
Unclassified
Inspection Report
Complaint Investigation
Deficiencies: 5
Jul 28, 2023
Visit Reason
The inspection was conducted as a health care licensure and follow-up combined with a complaint investigation at Orchard Ridge Assisted Living.
Findings
The facility failed to ensure timely medication administration and availability, did not properly monitor medication refrigerator temperatures, lacked six-month psychotropic medication reviews for several residents, had unsigned and undated resident agreements, and incomplete as-worked employee schedules.
Complaint Details
The visit was triggered by a complaint and included follow-up to verify compliance.
Deficiencies (5)
| Description |
|---|
| Resident #10's PEG tube feeding was delayed and medication doses missed; Resident #5 lacked insulin availability multiple times. |
| Medication refrigerator temperatures were not monitored or documented adequately and were frequently out of the required range. |
| Residents taking psychotropic medications for longer than six months did not have required six-month medication reviews completed. |
| Resident service agreements (NSAs) were not signed and dated by residents or their legal representatives. |
| As-worked employee schedules lacked documentation of employee names, positions, and exact work times. |
Report Facts
Missed medication doses: 9
Insulin unavailability: 7
Temperature documentation counts: 11
Temperature documentation counts: 5
Out of range temperature occurrences: 8
Inspection Report
Life Safety
Deficiencies: 8
Mar 21, 2022
Visit Reason
The inspection was conducted as a fire life safety and sanitation licensure survey for Orchard Ridge Assisted Living facility.
Findings
The facility failed to maintain compliance with multiple fire and life safety standards including missing documentation for weekly sprinkler system inspections, lack of staff training on oxygen safety, absence of carbon monoxide detectors, missing waterflow alarm testing, incomplete kitchen hood suppression inspections, improper use of trash cans in smoking areas, missing emergency generator maintenance documentation, and a natural gas fireplace without a safety barrier.
Deficiencies (8)
| Description |
|---|
| Facility unable to produce documentation for weekly visual inspections of dry sprinkler system gauges over multiple dates. |
| Facility could not produce documentation showing staff are trained periodically on safety guidelines and risks associated with oxygen handling. |
| Facility did not have carbon monoxide detectors installed. |
| Facility could not produce documentation for quarterly waterflow alarm testing for second quarter 2021. |
| Facility missing one of two semi-annual kitchen hood suppression system inspections for 2021. |
| Trash cans at designated smoking areas were used for both cigarette butts and combustible trash. |
| Facility could not produce documentation for monthly conductivity test of emergency generator battery or annual fuel quality test. |
| Natural gas fireplace in living area was not equipped with a safety barrier. |
Report Facts
Facility License Number: RC-863
Survey Date: 03/21/2022
Response Due Date: 04/20/2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ann Johnson | Administrator | Named as facility administrator |
| Linda Chaney | Survey Team Leader | Named as survey team leader |
| Maintenance Director | Interviewed regarding carbon monoxide detector installation |
Loading inspection reports...
