Inspection Report
Capacity: 60
Deficiencies: 15
Sep 4, 2024
Visit Reason
State-compiled facility profile showing 4 inspections from 2022-11 to 2024-09 with deficiency history and licensing violations.
Findings
Across multiple inspections, the facility exhibited deficiencies related to food sanitation, administration compliance, resident evaluations, infection prevention, medication administration, fire and life safety, staff training, nutrition and hydration, and activity planning. Some deficiencies were corrected while others remained uncorrected as of the latest visits.
Deficiencies (15)
| Description |
|---|
| C0240 - Resident Services Meals, Food Sanitation Rule: Failed to maintain kitchen and resident house kitchens in good repair and sanitary manner, including elevated refrigerator temperatures and damaged equipment. |
| Z0142 - Administration Compliance: Failed to comply with licensing rules for Residential Care and Assisted Living Facilities. |
| C0252 - Resident Move-In and Eval: Res Evaluation: Failed to ensure move-in evaluations addressed all required elements for sampled resident. |
| C0270 - Change of Condition and Monitoring: Failed to determine and document resident-specific interventions and monitor conditions weekly until resolution for sampled residents. |
| C0295 - Infection Prevention & Control: Failed to establish and maintain infection prevention protocols, including allowing residents in kitchens. |
| C0303 - Systems: Treatment Orders: Failed to ensure physician orders were carried out as prescribed for sampled residents, including insulin administration errors. |
| C0310 - Systems: Medication Administration: Failed to ensure MAR included resident-specific instructions for PRN medications for sampled residents. |
| C0420 - Fire and Life Safety: Safety: Failed to provide fire and life safety instruction on alternating months and incomplete fire drill records. |
| C0422 - Fire and Life Safety: Training For Residents: Failed to ensure residents received fire and life safety instruction at admission and annually. |
| Z0142 - Administration Compliance: Referral tag related to other deficiencies (C420 and C422). |
| Z0155 - Staff Training Requirements: Failed to ensure newly hired staff demonstrated competency within 30 days and long-term staff completed annual training. |
| Z0162 - Compliance With Rules Health Care: Failed to provide health care services in accordance with licensing rules, referring to multiple other citations. |
| Z0163 - Nutrition and Hydration: Failed to ensure individualized nutrition and hydration plans were developed and included in service plans for sampled residents. |
| Z0164 - Activities: Failed to evaluate and develop individualized activity plans for sampled residents. |
| C0000 - Comment: Documented findings of kitchen inspections and re-licensure surveys indicating substantial compliance or comments. |
Report Facts
Inspections on page: 4
Total deficiencies: 14
Total licensing violations: 10
Total notices: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff 1 | Administrator | Named in multiple findings related to administration compliance, medication errors, infection control, and staff training |
| Staff 2 | Corporate Administrator | Named in multiple findings related to administration compliance, medication errors, infection control, and staff training |
| Staff 16 | Caregiver (CG) | Named in change of condition and monitoring deficiency |
| Staff 11 | Caregiver (CG) | Named in staff training deficiency |
| Staff 21 | Caregiver (CG) | Named in staff training deficiency |
| Staff 17 | Medication Aide (MA) | Named in staff training deficiency |
| Staff 5 | Medication Aide (MA) | Named in staff training deficiency |
| Staff 7 | Medication Aide (MA) | Named in staff training deficiency |
| Staff 1 | Administrator | Named in medication administration deficiency |
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