BROOKDALE EAST ARBOR

B. A manager shall ensure that before or at the time of acceptance of an individual, the individual submits documentation that is dated within 90 calendar days before the individual is accepted by an assisted living facility and: 1. If an individual is requesting or is expected to receive supervisory care services, personal care services, or directed care services: a. Includes whether the individual requires: i. Continuous medical services, ii. Continuous or intermittent nursing services, or iii. Restraints; and b. Is dated and signed by a: i. Physician, ii. Registered nurse practitioner, iii. Registered nurse, or iv. Physician assistant; and 2. If an individual is requesting or is expected to receive behavioral health services, other than behavioral care, in addition to supervisory care services, personal care services, or directed care services from an assisted living facility: a. Includes whether the individual requires continuous behavioral health services, and b. Is signed and dated by a behavioral health professional.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance of an individual, the individual submitted documentation dated within 90 calendar days before the individual was accepted by the assisted living facility; signed and dated by a physician, registered nurse practitioner, registered nurse or physician assistant, for two of four residents sampled. The deficient practice posed a risk if a resident was not assessed and determined to be within the scope of an assisted living facility prior to receiving services. Findings include: 1. A review of R1's medical record revealed a document titled, "Physician/Healthcare Provider Plan of Care," dated May 3, 2023, and signed by a physician and documenting R1's level of care and needs. However, the document was not dated within 90 calendar days before R1's date of admission. 2. A review of R3's medical record revealed a document titled, "Physician/Healthcare Provider Plan of Care," dated April 29, 2022, and signed by a physician and documenting R3's level of care and needs. However, the document was not dated within 90 calendar days before R3's date of admission. 3. In an interview, E1 acknowledged R1's and R3's medical records did not contain documentation that was dated within 90 days before the individual was accepted by the assisted living facility and was signed and dated by a physician, registered nurse practitioner, registered nurse or physician assistant.

Based on record review and interview, the manager failed to ensure a resident had a written service plan reviewed and updated at least once every three months for a resident receiving directed care services, for one of one resident sampled who received directed care services. The deficient practice posed a risk if the service plan did not reinforce and clarify services to be provided to a resident. Findings include: 1. A review of R1's medical record revealed a service plan dated February 24, 2023, indicating R1 received directed care services. However, a subsequent reviewed or updated service plan was not available for review. 2. In an interview, E1 acknowledged R1's service plan was not reviewed and updated at least once every three months as required.