IOCAM ASSISTED LIVING HOME

INSP-0138237

Complete

Date: 8/5/2025

Type: Compliance (Annual)

Worksheet: Assisted Living Home

SOD Sent: 2025-09-02

Summary:

The following deficiencies were found during the on-site compliance inspection conducted on August, 5, 2025.

Deficiencies Found: 2

Deficiency #1

Rule/Regulation Violated:

R9-10-819.A.2. Emergency and Safety Standards A. A manager shall ensure that: 2. The disaster plan required in subsection (A)(1) is reviewed at least once every 12 months;

Evidence/Findings:

Based on documentation review and interview, the manager failed to ensure a disaster plan was reviewed at least once every 12 months. The deficient practice posed a risk as a disaster plan reinforces and clarifies standards expected of employees. Findings include: 1 . A review of facility documentation revealed a document titled "Disaster Plan, Relocation, Records, Medication, Food and Water." However, the last disaster plan review was conducted on May 5, 2023 and signed by E1. 2 . In an exit interview, the findings were reviewed with E2, and no additional information was added.

Temporary Solution:

Based on documentation review and interview, the manager acknowledged that the disaster plan was not reviewed (not signed on the review page) at least once every 12 months

Permanent Solution:

Owner E2 , contacted the manager E1 , manager came over and reviewed the disaster plan with the owner and employee E1, and the page was signed that it was reviewed . A copy will be attached.

Person Responsible:

CRISTINEL MATEESCU

Deficiency #2

Rule/Regulation Violated:

R9-10-819.F.3.a-b. Emergency and Safety Standards F. A manager of an assisted living home shall ensure that: 3. A rechargeable fire extinguisher: a. Is serviced at least once every 12 months, and b. Has a tag attached to the fire extinguisher that specifies the date of the last servicing and the identification of the person who serviced the fire extinguisher;

Evidence/Findings:

Based on observation and interview, a manager failed to ensure that a rechargeable fire extinguisher was serviced at least once every 12 months, and had a tag attached to the fire extinguisher that specified the date of the last servicing and the identification of the person who serviced the fire extinguisher. The deficient practice posed a risk if safety measures were not in place to protect residents in a fire. Findings include: 1 . During an environmental inspection of the facility, the Compliance Officers observed a fire extinguisher that contained no inspection tag, and the proof of purchase receipt was dated July 9, 2023. 2 . In an exit interview, the findings were reviewed with E2, and no additional information was added.

Temporary Solution:

Based on observation and interview, a manager acknowledged that a rechargeable fire extinguisher was not serviced at least once every 12 months.

Permanent Solution:

Owner E2 was able to purchase 2 new extinguishers from home depot and replaced them with the old ones, a copy of the receipt is placed on the extinguishers and a copy is attached

Person Responsible:

CRISTINEL MATEESCU

INSP-0073743

Complete

Date: 1/23/2024

Type: Compliance (Annual)

Worksheet: Assisted Living Home

SOD Sent: 2024-02-14

Summary:

The following deficiencies were found during the on-site compliance inspection conducted on January 23, 2023:

Deficiencies Found: 2

Deficiency #1

Rule/Regulation Violated:

B. If an assisted living facility provides medication administration, a manager shall ensure that:
3. A medication administered to a resident:
c. Is documented in the resident's medical record.

Evidence/Findings:

Based on documentation review, record review, 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. The deficient practice posed a risk if a resident experienced a change in condition due to improper administration of medication.

Findings include:

1. A review of facility documentation revealed a policy titled "Medications including opioids and narcotics." The policy stated "The trained caregiver will initial in the MAR (Medical Administration Record) and include the date and time the medicene was given to the resident and the medications that were taken."

2. A review of R1's and R2's medical records revealed R1 and R2 received medication administration services.

3. A review of R1's medical record revealed a MAR for January 2024. R1's January 2024 MAR did not indicate the following medications were administered on January 22, 2024 at the following times:
-"Acetaminophen" at 8:00 PM;
-"Carbidopa-Levodopa" at 12:00 PM, 6:00 PM, and 12:00 AM;
-"Famotidine" at 8:00 PM; and
-"Trazodone" at 8:00 PM.

4. A review of R2's medical record revealed a MAR. R2's January 2024 MAR did not indicate the following medications were administered on January 22, 2024 at the following times
-"Quetiapine" at 10:00 PM;
-"Trazodone" at 10:00 PM;
-"Acetaminophen" at 2:00 PM and 8:00 PM;
-"Busiprone" at 8:00 PM;
-"Ferrous Sulfate" (from January 19, 2024 through January 22, 2024) at 8:30 AM;
-"Hydroxychloroquine" at 8:00 PM;
-"Ipratropium and Albuterol" at 8:00 PM; and
-"Diclofenac" at 10:00 PM.

5. In an interview, E1 reported the medication was administered and staff must have forgotten to document in the MARs. E1 acknowledged medication administered to a resident was not documented in the resident's medical record.

Deficiency #2

Rule/Regulation Violated:

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 medication stored by the facility was stored in a locked area. The deficient practice posed a risk to the physical health and safety of residents with access to the medication.

Findings include:

1. During the environmental inspection of the facility, the Compliance Officer ovserved a glass container of "Lorazepam 2 MG" (milligrams) sitting on a tray in the refrigerator in the kitchen. The refrigerator was not locked.

2. In an interview, E1 acknowledged the aforementioned medication stored by the facility was not stored in a locked area.

Facility Information

Inspection History

INSP-0138237

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-0073743

Summary:

Deficiencies Found: 2

Deficiency #1

Rule/Regulation Violated:

Evidence/Findings:

Deficiency #2

Rule/Regulation Violated:

Evidence/Findings: