COUNTRYSIDE SENIOR LIVING

36-420.04. Emergency responders; patient information; hospitals; discharge planning; patient screenings; discharge document A. An assisted living center or assisted living home that contacts an emergency responder on behalf of a resident shall provide to the emergency responder a written document that includes all of the following: 1. The reason or reasons the emergency responder was requested on behalf of the resident. 2. Whether the resident receives medication services and, if the resident has provided this information to the assisted living center or assisted living home, a list of all the resident's prescription and over-the-counter medications, their dosages and how frequently they are administered. 3. The name, address and telephone number of the resident's current pharmacy. 4. A list of any known allergies to any medications, additives, preservatives or materials like latex or adhesive. 5. The name and contact information for the resident's primary care physician and power of attorney or authorized representative. 6. Basic information about the resident's physical and mental conditions and basic medical history, such as having diabetes or a pacemaker or experiencing frequent falls or cardiovascular and cerebrovascular events, as well as dates of recent episodes, if known. 7. The point-of-contact information for the assisted living center or assisted living home, including the telephone number, if available, cell phone number and email address. A point of contact must be available to respond to questions regarding the information provided twenty-four hours a day, seven days a week. 8. A copy of the resident's health insurance portability and accountability act release authorizing a receiving hospital to communicate with the assisted living center or assisted living home to plan for the resident's discharge. This paragraph does not preclude a resident from revoking the resident's health insurance portability and accountability act r

Based on documentation review, record review, and interview, the assisted living facility failed to provide the required documentation to an emergency responder, for one of one sampled resident for whom an emergency responder had been contacted. Findings include: 1. A review of facility documentation revealed an incident report dated May 6, 2024 for an unwitnessed fall. The documentation stated 911 was called. The incident report indicated R2 had been transported to the hospital after being found on the floor. 2. In an interview, E1 was asked for documentation of the required documentation given to the responders. E1 reported it was not done.

Based on record review, documentation review, and interview, the manager failed to ensure when a resident had an accident, emergency, or injury resulting in the resident needing medical services, a caregiver or assistant caregiver documented the action taken to prevent the accident, emergency, or injury from occurring in the future which posted a health and safety risk. Findings include: 1. A review of the facility's documentation revealed a report dated May 6, 2024 regarding R2's fall. The report stated R2 had an unwitnessed fall. However, the documentation of any action taken to prevent the accident, emergency, or injury from occurring in the future was not available for review. Documentation stated that 911 was called. 2. Review of R2's medical record revealed that R2 required directed care and medication administration services and was ambulatory. 3. In an interview, E1 acknowledged the facility failed to document action taken to prevent the injury from reoccurring in the future