Inspection Reports for The Gardens at Quail Springs Assisted and Memory

The complaint investigation included allegations of failure to ensure food served at preferred temperature, timely call light response, resident choice of getting out of bed time, failure to prevent elopement, and failure to follow infection control policies. The elopement allegation was substantiated with an Immediate Jeopardy situation related to two residents eloping during a fire alarm event.

Based on observations, record reviews, and interviews, the center was found in compliance with food temperature, call light response, and resident choice allegations. However, the center failed to provide adequate supervision to prevent elopement for two residents, resulting in an Immediate Jeopardy (IJ) situation that was removed after corrective actions. The center followed sufficient infection control guidelines.

The complaint alleged failure to provide care to residents dependent on staff for ADLs. The investigation included observations, interviews, and record reviews. The center was found to provide ADLs per regulations and resident needs.

The investigation found that the center provided ADLs per regulations and resident needs. However, deficiencies were cited related to failure to report substantial changes to the licensing department, specifically regarding a change in administrator.

The complaint alleged the center failed to protect residents from physical abuse. The investigation found no deficient practice related to physical abuse. The deficiencies cited were related to incident reporting and clinical record maintenance.

The investigation found no deficient practice related to physical abuse, but identified deficiencies related to failure to report incidents for two residents, incomplete clinical records including missing physician notifications, incomplete incident reports, undocumented interventions for falls, and missing hospital documentation.

The complaint investigations (#OK00060598 and #OK00060739) included allegations that the center failed to honor residents' choices, provide timely meals (specifically breakfast), provide activities and an activities director, maintain a clean environment, ensure adequate staffing, provide timely incontinent care, and provide supervision to prevent accidents.

The investigation found deficiencies including the use of unpasteurized eggs served to residents, and failure to ensure resident assessments were coordinated and signed by a registered nurse or physician. Additionally, the facility failed to maintain resident assessments for five years as required.

The complaint investigation was substantiated for failure to protect residents from physical restraints and other violations. The facility was required to submit a plan of correction and a follow-up investigation was conducted.

The investigation substantiated deficient practices related to abuse and neglect, including the use of restraints on two residents who wandered, failure to complete a thorough investigation, delayed reporting of the incident, and lack of staff training on abuse and restraint policies. The facility failed to ensure individualized care plans and interventions for wandering residents. A follow-up revisit found the facility in substantial compliance after corrective actions were implemented.