Inspection Report
Monitoring
Census: 8
Deficiencies: 2
May 23, 2025
Visit Reason
The inspection was a monitoring visit to assess compliance with applicable standards and laws at the assisted living facility.
Findings
The inspection found non-compliance with applicable standards, including deficiencies related to the disclosure statement preparation and posting of emergency telephone numbers.
Deficiencies (2)
| Description |
|---|
| The facility failed to ensure that the disclosure statement was prepared on the department form, with inconsistencies and missing sections noted in resident records. |
| The facility failed to ensure that telephone numbers for fire department, rescue squad, police, and Poison Control Center were posted by each telephone as required. |
Report Facts
Number of residents present: 8
Number of resident records reviewed: 2
Number of staff records reviewed: 1
Number of interviews conducted with residents: 1
Number of interviews conducted with staff: 2
Inspection Report
Renewal
Census: 7
Deficiencies: 0
Apr 10, 2024
Visit Reason
The inspection was conducted as a renewal inspection to evaluate the facility's compliance with applicable standards and laws for license renewal.
Findings
The inspection found no violations of applicable standards or laws. Observations included medication administration, resident activities, and a tour of the physical plant.
Report Facts
Number of resident records reviewed: 4
Number of staff records reviewed: 3
Number of interviews conducted with residents: 2
Number of interviews conducted with staff: 1
Inspection Report
Monitoring
Census: 7
Deficiencies: 3
Jan 20, 2023
Visit Reason
An unannounced monitoring inspection was conducted to review compliance with applicable standards and laws, including observation of resident care, building and grounds inspection, and record review.
Findings
The inspection found non-compliance with several standards including failure to post the name of the current on-site person in charge, unsecured cleaning supplies, and improper use of portable heating units without an emergency.
Deficiencies (3)
| Description |
|---|
| Facility failed to implement a procedure for posting the name of the current on-site person in charge. |
| Facility failed to ensure that cleaning supplies and other hazardous materials are in a locked area. |
| Facility failed to ensure that the use of portable heating units are only used to provide or supplement heat in the event of a power failure or similar emergency. |
Inspection Report
Complaint Investigation
Deficiencies: 1
Jan 20, 2023
Visit Reason
An unannounced complaint inspection was conducted regarding a complaint received about Resident Care and Related Services, specifically medication administration and physician's orders.
Findings
The inspection found that the facility failed to ensure medications were administered according to physician's instructions and standards. Resident #1 did not receive the prescribed 14-day course of Macrobid as ordered, with no documentation explaining the discrepancy.
Complaint Details
The complaint was substantiated based on evidence gathered during the inspection, supporting the allegation of improper medication administration.
Deficiencies (1)
| Description |
|---|
| Facility failed to ensure medications are administered in accordance with physician's instructions and standards of practice. |
Report Facts
Medication administration duration: 14
Inspection date: Jan 20, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alexandra Roberts | Inspector | Current inspector conducting the complaint inspection |
| Marshall Massenberg | Licensing Inspector | Contact person for questions regarding the inspection |
Inspection Report
Monitoring
Census: 7
Deficiencies: 1
Mar 21, 2022
Visit Reason
An unannounced monitoring inspection was conducted to observe meal, medication administration, an activity, inspect building and grounds, and review records.
Findings
The facility was found non-compliant for failing to ensure cleaning supplies and hazardous materials were kept in a locked area, specifically a bottle of all-purpose cleaner was observed unlocked and unattended in the laundry area.
Deficiencies (1)
| Description |
|---|
| Facility failed to ensure that cleaning supplies and other hazardous materials are kept in a locked area. |
Inspection Report
Renewal
Census: 8
Deficiencies: 0
Apr 6, 2021
Visit Reason
A renewal inspection was initiated on April 6, 2021 and concluded on April 8, 2021 to assess compliance with applicable standards and laws.
Findings
The inspection found no violations with applicable standards or law. No deficiencies were issued.
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