MOUNT ZION ASSISTED LIVING HOME LLC

INSP-0133996

POC

Date: 6/12/2025

Type: Complaint;Compliance (Annual)

Worksheet: Assisted Living Home

SOD Sent: 2025-06-23

Summary:

The following deficiencies were found during the on-site compliance inspection and investigation of complaints 00104600 and 00104031 conducted on June 12, 2025:

Deficiencies Found: 2

Deficiency #1

Rule/Regulation Violated:

R9-10-816.F.1. Medication Services F. When medication is stored by an assisted living facility, a manager shall ensure that: 1. Medication is stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage;

Evidence/Findings:

Based on observation and interview, the manager failed to ensure medications stored by the facility were stored in a separate locked room, closet, cabinet, or self-contained unit. The deficient practice posed a risk to residents who could access the medication. Findings include: 1. During an environmental inspection of the facility with E3, the Compliance Officers observed a medication closet that contained one resident's medications, which was unlocked. The medication closet doors were equipped with locking devices, however, were not locked. 2. In an interview, E2 acknowledged a medication closet where medication is stored was unlocked and accessible to residents.

Temporary Solution:

The manager designee/ owner Gladys Rosa immediate cleared all the kitchen cabinets with medications and placed all the medications to the medication cabinet with a lock. The medications that were found inside the resident room were also organized and placed them to the medication cabinet with a lock. The said medication cabinet is locked right after taking the medication.

Permanent Solution:

The manager/ owner Gladys Rosa would also remind the caregiver to place all the medications inside the medication cabinet and should be lock at all times.

Person Responsible:

Gladys Rosa

Deficiency #2

Rule/Regulation Violated:

R9-10-819.A.11. Environmental Standards A. A manager shall ensure that: 11. Poisonous or toxic materials stored by the assisted living facility are maintained in labeled containers in a locked area separate from food preparation and storage, dining areas, and medications and are inaccessible to residents;

Evidence/Findings:

Based on observation and interview, the manager failed to ensure that poisonous or toxic materials stored by the assisted living facility were maintained in labeled containers in a locked area and were inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental tour of the facility, the Compliance Officers observed the following materials stored in an unlocked laundry room; - Kirkland Laundry Detergent- Glidden Gallon of paint- Autozone Brake Fluid 2. In an interview, E2 acknowledged the aforementioned poisonous or toxic materials were not maintained in a locked area and were accessible to residents.

Temporary Solution:

The manager designee/ owner Gladys Rosa, right after the inspection, placed all toxic/ poisonous materials in the toxic/ chemical room and locked the said room.

Permanent Solution:

The manager designee/ owner Gladys Rosa will remind the caregiver every morning to make sure that the toxic/ chemical room will be locked at all times and all the toxic/ poisonous materials should be in that room only at all times.

Person Responsible:

Gladys Rosa

INSP-0078080

Complete

Date: 6/5/2023

Type: Compliance (Annual)

Worksheet: Assisted Living Home

SOD Sent: 2023-06-21

Summary:

The following deficiencies were found during the on-site compliance inspection conducted on June 5, 2023:

Deficiencies Found: 3

Deficiency #1

Rule/Regulation Violated:

A. A manager shall ensure that:
4. A disaster drill for employees is conducted on each shift at least once every three months and documented;

Evidence/Findings:

Based on documentation review and interview, the manager failed to ensure a disaster drill for employees was conducted on each shift at least once every three months and documented.

Findings include:

1. Review of the facility's work schedule revealed the facility has two shifts per day, the day shift was 6 am to 6 pm and the night shift was 6 pm to 6 am.

2. Review of facility disaster drills provided to the surveyor revealed drills for the previous twelve months were conducted on:

January 12, 2022
June 22, 2022
January 29, 2023 at 3:30 pm

3. In an interview, E1 acknowledged the disaster drills provided were all of the drills for the facility. E1 reported E1 confused disaster drills and evacuation drills. E1 acknowledged the facilities drills documentation provided to the Department did not reveal disaster drills were documented for each shift at least once every three months.

This is a repeat deficiency from the compliance inspection conducted on January 25, 2022.

Deficiency #2

Rule/Regulation Violated:

A. A manager shall ensure that:
6. Hot water temperatures are maintained between 95º F and 120º F in areas of an assisted living facility used by residents;

Evidence/Findings:

Based on observation and interview, the manager failed to ensure hot water temperatures were maintained between 95\'b0 F and 120\'b0 F in the areas of a facility used by residents.

Findings include:

1. During the facility tour with E1, the surveyor observed the water temperature at 77 \'b0 F in a resident shared bathroom.

2. In an interview, E1 reported the hot water needed repair. E1 acknowledged the resident shared bathroom temperature was not maintained between 95\'b0 F and 120\'b0 F in the area of a facility used by residents.

Deficiency #3

Rule/Regulation Violated:

A. A manager shall ensure that:
13. Equipment used at the assisted living facility is:
a. Maintained in working order;

Evidence/Findings:

Based on observation and interview, the manager failed to ensure equipment used at the assisted living facility was maintained in working order.

Findings include:

1. The surveyor observed a hallway bathroom accessible from a common area the bathroom hot water pipe was not functional. The compliance officer observed the hot water valve did not produce any water when turned on.

2. In an interview, E1 reported the hot water pipe was in need of repair and was not working. E1 acknowledged the manager failed to ensure equipment used at the assisted living facility was maintained in working order.

MOUNT ZION ASSISTED LIVING HOME LLC

Facility Information

Inspection History

INSP-0133996

Summary:

Deficiencies Found: 2

Deficiency #1

Rule/Regulation Violated:

Evidence/Findings:

Temporary Solution:

Permanent Solution:

Person Responsible:

Deficiency #2

Rule/Regulation Violated:

Evidence/Findings:

Temporary Solution:

Permanent Solution:

Person Responsible:

INSP-0078080

Summary:

Deficiencies Found: 3

Deficiency #1

Rule/Regulation Violated:

Evidence/Findings:

Deficiency #2

Rule/Regulation Violated:

Evidence/Findings:

Deficiency #3

Rule/Regulation Violated:

Evidence/Findings: