SUNNY DAYS SENIOR LIVING

Based on observation and interview, the manager failed to designate a caregiver who was present on the facility's premises and accountable for the facility when the manager was not present, as the manager's designee.

Findings include:

1. Upon arrival at approximately 10:30 AM, the Compliance Officer observed E2 and E3 on the premises with eight residents. E2 reported E2 was the manager's designee.

2. During a tour of the facility, the Compliance Officer observed a posting that identified E2 as the manager's designee.

3. During a tour of the facility, the Compliance Officer noted it felt warm on the west side of the home. The Compliance Officer observed the thermostat on the west side of the home appeared to be set at 85\'b0F. Using a Department issued infrared thermometer, the Compliance Officer measured the resident rooms on the west side of the home to be at or above 84\'b0F.

4. The Compliance Officer requested E2 to adjust the thermostat to bring the resident rooms into compliance. However, the thermostat was locked and required a code to unlock and adjust.

5. In an interview, E2 reported E2 did not have the code. E2 was unable to adjust the temperature. E2 reported E1 had the code. However, E1 was traveling and unavailable. E2 reported E1 was due to return at 6:30 PM the night of the inspection.

6. In an interview, E2 acknowledged E2 was not accountable for the facility as E2 was unable to adjust the temperature in the home and as the manager's designee, E2 should have been able to adjust the temperature.

7. In a follow-up interview conducted on August 1, 2023, E1 acknowledged E2 was not left with the ability to adjust the temperature in the home when E1 was traveling. E1 acknowledged E2 was unable to be accountable for the facility in the absence of E1.

Based on documentation review, record review, and interview, the manager failed to ensure a medication administered to a resident was administered in compliance with a medication order, for one of two residents sampled. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication.

Findings include:

1. A review of R1's medical record revealed a service plan dated April 3, 2023. The service plan revealed R1 received medication administration.

2. A review of R1's medical record revealed a signed medication list dated April 3, 2023 for Oxycodone-Acetaminophen 10-325 milligrams (mg), one tablet every four to six hours as needed (PRN).

3. A review of R1's medications revealed Oxycodone-Acetaminophen 10-325 mg was available for use.

4. A review of R1's medication organizer revealed Oxycodone-Acetaminophen 10-325 mg was in the organizer, in four separate time slots, four times a day for each day that remained to be administered (Tuesday through Saturday).

5. In an interview, E2 and E3 acknowledged the Oxycodone-Acetaminophen 10-325 mg was not administered in compliance with a medication order. The medication was prescribed as a PRN medication but was administered as a scheduled medication.

Based on record review, observation, and interview, the manager failed to ensure a medication administered to a resident was documented in the resident's medical record for two of two residents sampled.

Findings include:

1. A review of R1's medical record revealed a service plan dated April 3, 2023. The service plan revealed R1 received medication administration.

2. A review of R1's medical record revealed a signed medication list dated April 3, 2023 that included Oxycodone-Acetaminophen 10-325 milligrams (mg), one tablet every four to six hours as needed (PRN).

3. A review of R1's medications revealed Oxycodone-Acetaminophen 10-325 mg was available for use.

4. A review of R1's medication organizer revealed Oxycodone-Acetaminophen 10-325 mg was in the organizer, in four separate time slots, four times a day for each day that remained to be administered (Tuesday through Saturday).

5. A review of R1's medication administration record (MAR) revealed the Oxycodone-Acetaminophen 10-325 mg had not been documented as administered for the entire month of July as evidenced by no initials on the MAR that indicated the caregiver that administered the medication.

6. Further review of R1's medical record revealed a Narcotics Administration Record dated July 12, 2023-August 1, 2023. The Narcotics Administration Record revealed the Oxycodone-Acetaminophen 10-325 mg had been administered on July 12, 2023 at 8:00 AM, 12:00 PM, 5:00 PM, and 10:00 PM; July 13, 2023 at 8:00 AM; and July 14, 2023. The Narcotics Administration Record also revealed the slot for "Doses Given" was prefilled with the number "1" for the remainder of the month. The remainder of the Narcotics Administration Record was blank, indicating the medication was not administered.

7. In an interview, E2 and E3 acknowledged the Oxycodone-Acetaminophen 10-325 mg did not get documented accurately in R1's medical record when administered.

8. A review of R2's medical record revealed a service plan dated July 3, 2023. The service plan revealed R2 received medication administration.

9. A review of R2's medical record revealed a verbal order dated July 17, 2023 that included Memantine 10 mg, take one tablet every other day for seven days, then discontinue.

10. A review of R2's medical revealed R2's MAR included Memantine 10 mg. The MAR documented that R2 received Memantine 10 mg the following days:
-July 17, 2023;
-July 19, 2023;
-July 21, 2023;
-July 23, 2023;
-July 25, 2023;
-July 27, 2023;
-July 29, 2023; and
-July 31, 2023.

11. According to the verbal order, R2 should have received the aforementioned medication only on July 17, 2023; July 19, 2023; July 21, 2023; and July 23, 2023, and then discontinued. However, the MAR documented that the medication was administered every other day until July 31, 2023.

12. In an interview, E2 and E3 acknowledged the medication administered to R2 was not documented accurately in R2's MAR. E2 and E3 reported R2 received the medication on the correct days and then the medication was discontinued. However, the documentation of the medication in R2's MAR did not indicate the medication was discontinued as ordered.

Based on observation and interview, the manager failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed a risk to the health and safety of the residents.

Findings include:

1. In an interview, E2 reported the facility had recently received a delivery from the pharmacy. The Compliance Officer requested to see the medications.

2. The Compliance Officer observed E2 enter an unlocked caregiver room. E2 returned with a brown bag of medication from the pharmacy.

3. In an interview, E2 acknowledged the medications were not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage.

Based on documentation review, record review, observation, and interview, the manager failed to ensure policies and procedures were implemented for storing medication.

Findings include:

1. A review of the facilities policies and procedures revealed a policy titled, "Safe Storage of Medication." Under the title "Procedures" the document stated, "Each resident's medication must be stored in the container in which it was received. That is, staff cannot transfer medication from one container to another."

2. A review of R1's medical record revealed a service plan dated April 23, 2023. The service plan indicated R1 received medication administration.

3. A review of R1's medical record revealed a signed medication list dated April 3, 2023. The medication list included Losartan 100 milligrams (mg), one tablet every day.

4. A review of R1's medication administration record (MAR) revealed R1 received medication administration of Losartan 100 mg at 8:00 AM every day.

5. A review of R1's medications revealed a full bottle of Losartan 100 mg. However, upon closer review, the compliance officer observed three different shaped pills in the bottle.

6. A review of https://www.webmd.com/pill-identification/default.htm identified each pill as Losartan 100 mg, each with a different manufacturer.

7. Further review of R1's medical record revealed a signed medication list dated April 3, 2023. The medication list included Metoprolol Succinate ER 25 mg, one tablet two times a day.

8. A review of R1's medication administration record revealed R1 received medication administration of Metoprolol 25 mg at 8:00 AM and 8:00 PM every day.

9. A review of R1's medications revealed a bottle of Metoprolol 25 mg. However, upon closer review, the Compliance Officer observed two different shaped pills in the bottle.

10. A review of https://www.webmd.com/pill-identification/default.htm identified each pill as Metoprolol 25 mg, each with a different manufacturer.

11. In an interview, E2 acknowledged the facility's policies and procedures were not implemented for storing medication. E2 reported not knowing mixing different bottles of medications together was contrary to the facility's medication storage policies and procedures.

12. In a follow-up interview conducted August 1, 2023, E1 reported not knowing mixing different bottles of medications together was contrary to the facility's medication storage policies and procedures.

Based on documentation review and interview, the manager failed to ensure the facility had a disaster plan that was developed, documented, maintained in a location accessible to caregivers and assistant caregivers, and, if necessary, implemented that included when, how, and where residents would be relocated, how a resident's medical record would be available to individuals providing services to the resident during a disaster, a plan to ensure each resident's medication would be available to administer to the resident during a disaster, and a plan for obtaining food and water for individuals present in the assisted living facility or the assisted living facility's relocation site during a disaster. The deficient practice posed a risk as there was no plan to ensure the health and safety of residents in an emergency.

Findings include:

1. During the facility inspection, the Compliance Officer requested the facility's disaster plan. E2 and E3 reviewed the facility's documentation and were unable to locate the disaster plan.

2. In an interview, E2 and E3 acknowledged the facility did not have a disaster plan maintained in a location accessible to caregivers.

Based on documentation review and interview, the manager failed to ensure the facility's disaster plan was reviewed at least once every 12 months.

Findings include:

1. A review of facility documentation revealed no documentation to indicate the facility's disaster plan was reviewed at least once within the past 12 months that included the date and time of the disaster plan review, the name of each employee participating in the disaster plan review, a critique of the disaster plan review and any recommendations for improvement.

2. In an interview, E2 acknowledged the facility's disaster plan was not reviewed every 12 months as required.