Inspection Report
Complaint Investigation
Census: 57
Capacity: 95
Deficiencies: 2
Jun 12, 2025
Visit Reason
The inspection was conducted in response to a complaint alleging the facility was short staffed, with additional allegations regarding resident protection, food quality, showering, and laundry completion.
Findings
The investigation substantiated violations related to inadequate staffing and lack of designated shift supervisors. Allegations regarding resident protection, food quality, showering, and laundry were not substantiated. The facility maintained organized systems for personal care and laundry, but staffing schedules showed multiple deficiencies.
Complaint Details
The complaint alleged the home was short staffed, Resident C lacked protection, the food was unhealthy, residents were not being showered, and residents' laundry was not completed. Only the short staffing and supervisory staffing allegations were substantiated; others were not.
Deficiencies (2)
| Description |
|---|
| The home did not have adequate and sufficient staff on duty at all times to meet residents' needs. |
| The home failed to designate one person on each shift as supervisor of resident care, with multiple instances of no supervisor or two supervisors assigned. |
Report Facts
Capacity: 95
Census: 57
Staffing levels: 3
Staffing levels: 1
Staffing levels: 2
Staffing levels: 1
Dates with no memory care staff assigned: 3
Dates with no shift supervisor assigned: 10
Dates with two shift supervisors assigned: 11
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jami McDaniel | Administrator | Provided statements and clarifications during the investigation. |
| Jessica Rogers | Licensing Staff | Conducted the inspection and authored the report. |
| Andrea L. Moore | Manager, Long-Term-Care State Licensing Section | Approved the report. |
Inspection Report
Renewal
Deficiencies: 0
Jul 23, 2024
Visit Reason
The document serves as a renewal notification for the Home for the Aged license following an administrative review of licensing activity for the past year.
Findings
The administrative review revealed substantial compliance with the public health code and administrative rules regulating home for the aged facilities, resulting in the renewal of the facility's license.
Report Facts
License duration: 12
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jessica Rogers | Licensing Staff | Signed the renewal notification letter |
Inspection Report
Complaint Investigation
Capacity: 95
Deficiencies: 2
Sep 25, 2023
Visit Reason
The inspection was conducted in response to a complaint received on 09/21/2023 regarding misadministration of Resident A's medication and lack of adequate action taken to protect Resident A.
Findings
The investigation confirmed multiple medication errors involving Resident A between April and July 2023, including administration of Metoprolol when it should have been held and a double dose of Propafenone. These errors led to Resident A's fall, hospitalization, decline in health, and eventual death. The facility failed to maintain compliance with medication administration protocols despite corrective measures.
Complaint Details
Complaint received on 09/21/2023 alleging misadministration of Resident A’s medication, including a double dose of Propafenone on 06/17/2023 and multiple improper administrations of Metoprolol. The complaint was substantiated with violations established.
Deficiencies (2)
| Description |
|---|
| Misadministration of Resident A’s medication and lack of adequate action taken to protect Resident A. |
| Failure to properly document medication administration with staff initials on several dates. |
Report Facts
Capacity: 95
Dates of medication errors: 6
Complaint Receipt Date: Sep 21, 2023
Investigation Initiation Date: Sep 25, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jami McDaniel | Administrator | Interviewed regarding the medication errors and investigation |
| Aaron Clum | Licensing Staff | Author of the report and investigator |
| Andrea L. Moore | Manager, Long-Term-Care State Licensing Section | Approved the report |
Inspection Report
Renewal
Census: 23
Capacity: 95
Deficiencies: 7
Aug 29, 2023
Visit Reason
The inspection was conducted as a Renewal Licensing Study for Provision Living at Canton to assess compliance with licensing requirements and to determine if the facility meets standards for license renewal.
Findings
The facility was found to be non-compliant with multiple rules including employee tuberculosis screening, staff supervision designation, staff training, medication administration and documentation, meal and food records, and kitchen sanitation. Several violations were established related to employee health screenings, medication logs, incomplete training, food safety, and record keeping.
Deficiencies (7)
| Description |
|---|
| Employee tuberculosis screenings were not completed within 10 days of hire and before occupational exposure; annual TB risk assessment was lacking until 8/30/2023. |
| Staffing schedule lacked designation of one supervisor of resident care for each shift. |
| Staff training program was incomplete; some employees lacked required training in reporting, personal care, resident rights, safety, infection control, and disaster plan knowledge. |
| Medication administration records were incomplete or inaccurate, including missing narcotic count signatures, missing handwritten medication records during power outage, and lack of specific instructions for PRN medications. |
| Meal census records were incomplete, lacking documentation for the preceding three-month period. |
| Daily sanitizing checklist records for heat sanitizing dish machine were incomplete for July and August 2023. |
| Food items in facility kitchen and memory care unit refrigerators and freezer were not dated. |
Report Facts
Facility capacity: 95
Number of residents observed/interviewed: 23
Number of staff observed/interviewed: 9
Dates of incomplete narcotic count log: 17
Temporary license expiration date: Jan 16, 2024
Inspection Report
Original Licensing
Capacity: 95
Deficiencies: 0
Jul 17, 2023
Visit Reason
The document is an original licensing study report for Provision Living at Canton to determine compliance with applicable licensing statutes and administrative rules for issuance of a temporary license.
Findings
The study determined substantial compliance with licensing statutes and administrative rules. The facility is approved for a temporary 6-month license with a maximum capacity of 95 beds, providing care for aged individuals and those with Alzheimer's disease or related conditions.
Report Facts
Licensed capacity: 95
Residential units: 65
Assisted living beds: 81
Memory care beds: 14
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Hescott | Authorized Representative | Submitted attestations and correspondence related to licensing and compliance |
| Dolanda Scott | Administrator | Facility administrator at time of report |
| Jessica Rogers | Licensing Staff | Author of the licensing study report |
| Andrea L. Moore | Manager, Long-Term-Care State Licensing Section | Approved the licensing study report |
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