Deficiencies per Year
8
6
4
2
0
Unclassified
Inspection Report
Follow-Up
Deficiencies: 5
Aug 11, 2022
Visit Reason
The inspection was a health care licensure and follow-up survey conducted to assess compliance with regulatory requirements and verify correction of previous deficiencies.
Findings
The facility was found to have multiple deficiencies including poor housekeeping and maintenance, lack of behavior plans for residents exhibiting maladaptive behaviors, inconsistent documentation of change of condition assessments, failure to follow a dietician approved menu, and inadequate behavior documentation.
Deficiencies (5)
| Description |
|---|
| Facility was not maintained in a clean, safe and orderly manner with issues such as peeling paint, broken furniture, dirty bathrooms, and stained carpets. |
| Resident #1 exhibited multiple maladaptive behaviors without a developed behavior plan; medication adjustments were made without prior behavior interventions. |
| Change of condition assessments for residents were not consistently documented despite known health issues. |
| No behavior plan was developed with interventions for Resident #1's maladaptive behaviors. |
| Facility did not follow a dietician approved menu; substitutions were made on 29 of 31 days in the menu cycle. |
Report Facts
Menu substitutions: 29
Menu cycle days: 31
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Joy Cook | Administrator | Named as facility administrator and licensed practical nurse involved in statements about behavior plans and assessments |
| Bradley Perry | Survey Team Leader | Named as survey team leader conducting the inspection |
Inspection Report
Life Safety
Deficiencies: 3
Sep 23, 2021
Visit Reason
The inspection was conducted as a fire life safety and sanitation licensure survey of the Pleasant Valley Shelter Home.
Findings
The facility was found to have non-core issues including only one relocation agreement instead of the required two, and fire and life safety concerns such as staff not being instructed on the disaster plan bi-monthly and a laundry door locking mechanism that is not readily operable from the inside.
Deficiencies (3)
| Description |
|---|
| Only one relocation agreement on site instead of the required two. |
| Facility staff not instructed on the disaster plan and reviewed bi-monthly as required. |
| Laundry door equipped with a hasp locking creating a locking arrangement not readily operable from the inside. |
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