Deficiencies per Year
8
6
4
2
0
Severe
High
Moderate
Inspection Report
Follow-Up
Census: 51
Deficiencies: 5
Jun 14, 2023
Visit Reason
Follow-up survey conducted to determine if orders from the April 28, 2023 survey were corrected.
Findings
The follow-up survey verified that the facility is in substantial compliance with previous correction orders.
Severity Breakdown
Level 1: 1
Level 2: 3
Level 3: 1
Deficiencies (5)
| Description | Severity |
|---|---|
| Failed to develop a written emergency preparedness plan with all required content including annual review, missing resident quarterly review, and policy for facility role under a waiver. | Level 2 |
| Failed to provide required employee training on fire safety and evacuation, including required evacuation drills. | Level 2 |
| Failed to ensure a background study was submitted and clearance received for one employee affiliated with the current license. | Level 3 |
| Failed to ensure registered nurse developed training and competencies for unlicensed personnel providing medications during unplanned time away. | Level 2 |
| Assisted living contract included language requiring residents to obtain renters' insurance at management's request, which is non-compliant. | Level 1 |
Report Facts
Residents present: 51
Fine amount: 3000
Time period for correction: 21
Time period for correction: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jessica Chenze | Supervisor, State Evaluation Team | Signed follow-up survey letter |
| Jess Schoenecker | Supervisor, State Evaluation Team | Signed correction order letter |
| CNS-B | Clinical Nurse Supervisor | Employee with background study deficiency |
| ULP-C | Unlicensed Personnel | Employee lacking documented training and competency for medication administration during unplanned time away |
| LALD-A | Licensed Assisted Living Director | Interviewed regarding deficiencies and contract issues |
| Environmental Services Manager-F | Interviewed regarding fire safety and evacuation drills | |
| Regional Health and Well-Being Director-E | Interviewed regarding fire safety and evacuation drills |
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