OBERON HOUSE, THE

Citation coded "0000" or "9999" are initial and final comments of an inspection for informational purposes, this field may also have been left blank intentionally

A licensure complaint, prompted by #CO37888, was completed on 5/6/25. No deficiencies were cited.

A revisit survey was completed on 9/30/24 for all previous deficiencies cited on 7/1/24. The facility is in compliance with all deficiencies that were cited.

A revisit survey was completed on 9/30/24 for all previous deficiencies cited on 7/1/24. The facility is in compliance with all deficiencies that were cited.

A certification complaint, prompted by #CO35089 and #CO35209, was completed on 7/1/24. Deficiencies were cited.

Based on observation, record, review, and interview, the facility (residence) failed to provide personal care services as a benefit to the participant (resident), affecting one current sample resident (#1). Findings include:1. Residence PolicyThe residence's undated resident agreement read in part that the residence provided services as required by all applicable state laws and regulations. 2. Record ReviewResident #1 was admitted to the residence on 12/4/22 with diagnoses that included early-onset dementia. A care plan, dated 4/11/24, read in part that the resident required staff assistance to be toileted every two hours during awake hours the following times: 7:00 a.m., 9:00 a.m., 11:00 a.m., 1:00 p.m., 3:00 p.m., 5:00 p.m., 7:00 p.m., and 9:00 p.m. Staff was required to notify the resident's family if the resident refused assistance two times in a row. A review of electronic activities of daily life revealed that staff failed to document toileting during the following times:6/1/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/2/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/3/24 at 7:00 a.m., 11:00 a.m., and 1:00 p.m. 6/4/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., 1:00 p.m. , 3:00 p.m., 5:00 p.m., 7:00 p.m., and 9:00 p.m. 6/5/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/6/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., 1:00 p.m. 6/7/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., 1:00 p.m. , 3:00 p.m., 5:00 p.m., 7:00 p.m., and 9:00 p.m. 6/8/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/9/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/10/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., 1:00 p.m. , 3:00 p.m., 5:00 p.m., 7:00 p.m., and 9:00 p.m. 6/11/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/12/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/13/24 at 7:00 a.m., 11:00 a.m., and 1:00 p.m. 6/14/24 at 9:00 a.m., 11:00 a.m., 1:00 p.m. , 3:00 p.m., 5:00 p.m., 7:00 p.m., and 9:00 p.m. 6/15/24 at 7:00 a.m., 11:00 a.m., 3:00 p.m., 5:00 p.m., 7:00 p.m., and 9:00 p.m. 6/17/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/16/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., 3:00 p.m., 5:00 p.m., 7:00 p.m., and 9:00 p.m. 6/17/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/18/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/19/24 at 11:00 a.m. and 1:00 p.m. 6/20/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., 1:00 p.m. , 3:00 p.m., 7:00 p.m., and 9:00 p.m. 6/21/24 at 7:00 a.m., 9:00 a.m., and 11:00 a.m. 6/22/24 at 7:00 a.m., 9:00 a.m., and 11:00 a.m. 6/23/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/24/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/25/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/26/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., 1:00 p.m. , 3:00 p.m., 5:00 p.m., 7:00 p.m., and 9:00 p.m. 6/27/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. On 7/1/24, photos provided by the family member of Resident #1, revealed saturated and soiled incontinence products. 3. InterviewsOn 6/27/24 at 5:39 p.m., an external service provider hired by the family of Resident #1 in January 2024 stated she visited the resident three times a week for approximately four hours each time. She further stated staff failed to provide toileting assistance on several occasions. She confirmed that nearly every time she visited the resident from 4:00 p.m. to 8:00 p.m. three times a week, the resident's incontinence product was soiled. On 6/27/24 at 7:00 p.m., a family member of Resident #1 said that when she visited Resident #1 three or four times a week and the resident's incontinence product was saturated with urine. Additionally, she stated the resident's incontinence product was often wet and that on one occasion the couch was saturated with urine as well. The family member said when the resident refused assistance to the bathroom, the staff was required to notify the family member, but they did not do so. The family member stated she took at least seven photos of Resident #1's soiled incontinence products that included 6/23/24 to show management that the staff failed to assist Resident #1 with toileting. On 7/1/24 at 11:30 a.m., the director of operations acknowledged that staff did not document that they assisted Resident #1 with toileting every two hours. She added that she knew it was a concern that she needed to address with the staff.

Based on interview and record review, the facility (residence) failed to maintain and follow written policies and procedures for the administration of medication in accordance with 6 CCR 1011-1, Chapter VII Medication Administration Regulations, affecting one of three sample participants (residents) (#1). Findings include:1. Chapter VII regulations governing assisted living residences, part 14.21 requires the residence to comply with authorized practitioner orders associated with medication administration except for those medications which a resident self-administers. a. Record ReviewResident #1 was admitted to the residence on 12/4/22 with diagnoses that included early-onset dementia. A written practitioner's order, dated 2/16/24, directed the residence to administer 5 mg of melatonin before bed. The June 2024 medication administration record (MAR) read that staff administered 5 mg of melatonin from 6/1 to 6/26/24, for a total of 26 doses. On 6/27/24, the label on the bottle of Resident #1's melatonin read that one gummy was a 2.5 mg dose.b. InterviewsOn 6/27/24 at 7:00 p.m., Resident #1's family member said that on 6/26/24, she had stopped Staff #2 from administering the medications to ensure Staff #2 had dispensed the medications as ordered. She stated the staff had only dispensed half the ordered dose of melatonin (one melatonin gummy at 2.5 mg). The family member said Staff #2 informed her that she had given half of the ordered dose for "the entire time" of the written practitioner's order (on 2/16/24). On 6/27/24 at 7:45 p.m., Staff #2 acknowledged that she had administered the wrong dose of melatonin and administered half the ordered dose. She stated that the front of the label on the bottle was "misleading" because it read that the doses were 5 mg. Staff #2 stated she did not know that she was administering only half of the ordered dose of melatonin until the family member of Resident 1# informed her. She acknowledged that she and the other staff members had consistently only administered one gummy. On 6/27/24, at 7:55 p.m., the director of operations stated that she was also confused by the melatonin labeling and thought it was misleading that the label on the supplement bottle read that the melatonin doses were 5 mg; however, she acknowledged the staff failed to confirm that two gummies at 2.5 mg each equaled the 5 mg ordered by the practitioner.

A licensure complaint, prompted by #CO35088 and #CO35207, was completed on 7/1/24. Deficiencies were cited.

Based on record review, observation, and interview, the residence failed to make a sanitary environment available, either directly or indirectly through a resident agreement, affecting one of three sample residents. (#1) Findings include:Residence PolicyThe residence's undated resident agreement read in part that the residence provided services as required by all applicable state laws and regulations. Record ReviewResident #1 was admitted to the residence on 12/4/22 with diagnoses that included early-onset dementia. A care plan, dated 4/11/24, read in part that the resident required staff assistance to be toileted every two hours during awake hours the following times: 7:00 a.m., 9:00 a.m., 11:00 a.m., 1:00 p.m., 3:00 p.m., 5:00 p.m., 7:00 p.m., and 9:00 p.m. Staff was required to notify the resident's family if the resident refused assistance two times in a row. A review of electronic activities of daily life revealed that staff failed to document toileting during the following times:6/1/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/2/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/3/24 at 7:00 a.m., 11:00 a.m., and 1:00 p.m. 6/4/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., 1:00 p.m. , 3:00 p.m., 5:00 p.m., 7:00 p.m., and 9:00 p.m. 6/5/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/6/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., 1:00 p.m. 6/7/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., 1:00 p.m. , 3:00 p.m., 5:00 p.m., 7:00 p.m., and 9:00 p.m. 6/8/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/9/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/10/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., 1:00 p.m. , 3:00 p.m., 5:00 p.m., 7:00 p.m., and 9:00 p.m. 6/11/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/12/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/13/24 at 7:00 a.m., 11:00 a.m., and 1:00 p.m. 6/14/24 at 9:00 a.m., 11:00 a.m., 1:00 p.m. , 3:00 p.m., 5:00 p.m., 7:00 p.m., and 9:00 p.m. 6/15/24 at 7:00 a.m., 11:00 a.m., 3:00 p.m., 5:00 p.m., 7:00 p.m., and 9:00 p.m. 6/17/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/16/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., 3:00 p.m., 5:00 p.m., 7:00 p.m., and 9:00 p.m. 6/17/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/18/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/19/24 at 11:00 a.m. and 1:00 p.m. 6/20/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., 1:00 p.m. , 3:00 p.m., 7:00 p.m., and 9:00 p.m. 6/21/24 at 7:00 a.m., 9:00 a.m., and 11:00 a.m. 6/22/24 at 7:00 a.m., 9:00 a.m., and 11:00 a.m. 6/23/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/24/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/25/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. 6/26/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., 1:00 p.m. , 3:00 p.m., 5:00 p.m., 7:00 p.m., and 9:00 p.m. 6/27/24 at 7:00 a.m., 9:00 a.m., 11:00 a.m., and 1:00 p.m. On 7/1/24, photos provided by the family member of Resident #1, revealed saturated and soiled incontinence products. 3. InterviewsOn 6/27/24 at 5:39 p.m., an external service provider hired by the family of Resident #1 in January 2024 stated she visited the resident three times a week for approximately four hours each time. She further stated staff failed to provide toileting assistance on several occasions. She confirmed that nearly every time she visited the resident from 4:00 p.m. to 8:00 p.m. three times a week, the resident's incontinence product was soiled. On 6/27/24 at 7:00 p.m., a family member of Resident #1 said that when she visited Resident #1 three or four times a week and the resident's incontinence product was saturated with urine. Additionally, she stated the resident's incontinence product was often wet and that on one occasion the couch was saturated with urine as well. The family member said when the resident refused assistance to the bathroom, the staff was required to notify the family member, but they did not do so. The family member stated she took at least seven photos of Resident #1's soiledincontinence products that included 6/23/24 to show management that the staff failed to assist Resident #1 with toileting. On 7/1/24 at 11:30 a.m., the director of operations acknowledged that staff did not document that they assisted Resident #1 with toileting every two hours. She added that she knew it was a concern that she needed to address with the staff.

Based on record review and interview, the residence failed to be responsible for complying with authorized practitioner orders associated with medication administration except for those medications which a resident self-administers, affecting one of three sample residents (#1). Findings include:1. Record Review Resident #1 was admitted to the residence on 12/4/22 with diagnoses that included early-onset dementia. A written practitioner's order, dated 2/16/24, directed the residence to administer 5 mg of melatonin before bed. The June 2024 medication administration record (MAR) read that staff administered 5 mg of melatonin from 6/1 to 6/26/24, for a total of 26 doses. On 6/27/24,the label on the bottle of Resident #1's melatonin read that one gummy was a 2.5 mg dose. 2. InterviewsOn 6/27/24 at 7:00 p.m., Resident #1's family member said that on 6/26/24, she had stopped Staff #2 from administering the medications to ensure Staff #2 had dispensed the medications as ordered. She stated the staff had only dispensed half the ordered dose of melatonin (one melatonin gummy at 2.5 mg). The family member said Staff #2 informed her that she had given half of the ordered dose for "the entire time" of the written practitioner's order (on 2/16/24). On 6/27/24 at 7:45 p.m., Staff #2 acknowledged that she had administered the wrong dose of melatonin and administered half the ordered dose. She stated that the front of the label on the bottle was "misleading" because it read that the doses were 5 mg. Staff #2 stated she did not know that she was administering only half of the ordered dose of melatonin until the family member of Resident 1# informed her. She acknowledged that she and the other staff members had consistently only administered one gummy. On 6/27/24, at 7:55 p.m., the director of operations stated that she was also confused by the melatonin labeling and thought it was misleading that the label on the supplement bottle read that the melatonin doses were 5 mg; however, she acknowledged the staff failed to confirm that two gummies at 2.5 mg each equaled the 5 mg ordered by the practitioner.

A revisit survey was completed on 4/23/24 for all previous deficiencies cited on 11/20/23. The facility is in compliance with all deficiencies that were cited.

A revisit survey was completed on 4/23/24 for all previous deficiencies cited on 11/20/23. The facility is in compliance with all deficiencies that were cited.

Citation coded "0000" or "9999" are initial and final comments of an inspection for informational purposes, this field may also have been left blank intentionally

A recertification survey was completed on 11/20/23. Deficiencies were cited.

Based on observation and interview, the facility (residence) failed to ensure individuals' right to privacy and right to be free of cameras in the interior areas of residential settings including common areas and residential hallways, affecting 53 current participants (residents). Findings include:The residence's Resident Rights policy dated January 2023, read in part; "To every consideration of privacy concerning your personal needs and security personal property."On 11/20/23 at approximately 8:58 a.m., there was a sign that read "Smile, you're on camera" located on the door leading towards the kitchen. The residence had 11 video surveillance cameras as follows: On the first floor, there was a camera facing the entrance, one camera at the end of each hallway facing towards resident rooms, there are two hallways, and one camera facing another exit door but far enough to have a common area in its view, the common area had a television chairs for viewing. On the second floor, there was a camera on the ends of the hallways facing towards resident rooms, two hallways, also a camera facing the window in the common area. On the third floor, there was a camera facing the exit across from the check in desk. One camera was located in the group meeting area, parallel to the chapel and a camera at the end of each hallway, facing resident rooms, there were two hallways. On 11/20/23 at 9:02 a.m., Staff #6 stated the video surveillance cameras were placed on the ends of the hallways and confirmed they were on. On 11/20/23 at approximately 9:09 a.m., Staff #4 stated the cameras were on and placed for security reasons. On 11/20/23 at 4:02 p.m., the director of operations stated someone had stolen money from her office and the cameras are inside for security reasons due to the increased homeless population that resides around the residence. On 11/20/23 at 4:41 p.m., the co-owner stated the cameras were installed to let families know if residents have left or not when they ' ve asked and to provide documentation for law enforcement when requested.

Based on interview and record review the facility (residence) failed to follow written policies and procedures for the administration of medication in accordance with 6 CCR 1011-1, Chapter VII, Medication Administration Regulations, affecting six of six sample participants (residents) (#1-#6). Findings Include 1. Chapter VII regulations governing assisted living residences, requires in part 14.9, that no medication shall be administered by a qualified medication administration person on a pro re nata (PRN) or "as needed" basis except: (B) Where the resident understands the purpose of the medication, is capable of voluntarily requesting the medication, and the assisted living residence has documentation from an authorized practitioner that the use of such medication in this manner is appropriate.a. Resident #6 was admitted to the residence on 12/19/22 with diagnoses of dementia, muscle weakness and cognitive communication deficit. An assessment, dated 6/20/23, read Resident #6 had diminished communication skills, was on external hospice and required assistance with medication administration. A written practitioner's order, dated 10/30/23, directed the residence to administer dilaudid 1 mg every six hours as needed for pain. The November 2023 medication administration record (MAR) read the medication was administered by a qualified medication administration person on 11/14/23. The MAR further read the resident had spit out the routine dose and the qualified medication adinistration person (QMAP) administered the PRN dose for pain. On 11/20/23 at 9:02 a.m., the co-owner stated Resident #6 no longer able to speak english. She stated the resident had experienced a change in condition and only spoke Japanese. The co-owner stated the responsible party for Resident #6 visited the residence daily and could assist in translating when needed. On 11/20/23 at 12:45 p.m., the responsible party for Resident #6 stated Resident #6 used to speak and understand english; however, as her condition changed she was only able to communicate in Japanese. On 11/20/23 at 4:15 p.m., Staff #7 stated when QMAPs thought Resident #6 needed her PRN medication, she stated they would call the responsible party to obtain permission for administering the medication since Resident #6 was unable to request the medication. b. Resident #5 was admitted to the residence on 12/4/22 with a diagnosis of dementia. A written practitioner's order, dated 11/5/23, directed the residence to administer tramadol every eight hours as needed. A second written practitioner's order, dated 11/6/23, directed the residence to administer tramadol every eight hours scheduled for seven days. However, the November 2023 MAR read the medication was administered as needed on 11/6/23. During a medication cart audit, tramadol HCL 50 as needed was located in the cart and revealed one medication missing. On 11/20/23 at 1:51 p.m., the resident services director (RSD) stated Resident #5 was not fully able to request PRN medications. She stated the tramadol that was administered on 11/6/23, the QMAP notified external hospice and requested to administer the medication. On 11/20/23 at 4:02 p.m., the director of operations stated practitioner's ordered PRN medications and if the residents were cognitive, they needed to ask for the medications. She stated for Residents #5 and #6, the residence called their external hospice nurse and asked if they could administer the medications. The director of operations also stated, Residents #5 and #6 could not verbalize their desire for PRN medications, they were unable to say they were in pain. On 11/20/23 at 4:15 p.m., Staff #7 stated Resident #5 was not able to request PRN medications. She stated the residence was in the process of obtaining a discontinue order for all of the resident's PRN medications. 2. Chapter VII regulations governing assisted living residences, requires in part 14.21, that the assisted living residence shall be responsible for complying with authorized practitioner orders associated with medication administration except for those medications which a resident self-administers.a. Resident #4 was admitted to the residence on 12/4/22 with diagnoses of dementia, muscle weakness and cognitive communication deficit. A written practitioner's order, dated 10/12/23, directed the residence to administer vitamin B12 1000 mcg once daily. However, the November 2023 MAR read the medication was not administered on 11/2, 11/4, 11/5, 11/7, 11/9, 11/12, 11/14, 11/16, 11/18 and 11/19/23 for a total of 10 missed doses. A written practitioner's order, dared 10/12/23, directed the residence to administer vitamin D2 1.25 mg twice weekly. However, the November 2023 MAR read the medication was administered once weekly from 11/1/23 to 11/19/23 for a total of three doses administered. A written practitioner's order, dated 10/12/23, directed the residence to administer loratadine 10 mg once daily. A second written practitioner's order, dated 11/14/23, directed the residence to administer Zyrtec 10 mg once daily. However, the November 2023 MAR read neither medication was administered on 11/14/23 for a total of one missed dose. On 11/20/23, at 1:20 p.m., the RSD stated once the medication orders were received from the practitioners the QMAP would send the order to the pharmacy and enter the medication on the MAR. She stated her duty was to make sure the medication was entered correctly on the MAR and audit medications. The RSD stated some families purchased the over the counter medications and did not go through the pharmacy. She stated QMAPs were responsible for notifying the families the medication was running out of stock and would make a notation. However, she stated it depended on the importance of the medication if their residence would purchase the over the counter and subsequently bill the family. The RSD subsequently stated that a vitamin was an over the counter medication that would not be considered important. She further stated she was unaware of the error with Zyrtec. b. Resident #5 was admitted to the residence on 12/4/22 with a diagnosis of dementia. A written practitioner's order, dated 11/6/23, directed the residence to administer tramadol 50 mg every eight hours for seven days. However, the November 2023 MAR read the medication was not administered on 11/7 at 2:00 a.m. and 10:00 a.m. due to the medication not being entered on the MAR. Additionally, the medication was not administered as order on 11/11-11/13/23 all three doses due to the medication being held, for a total of 11 missed doses. The residence was unable to provide a hold order for Resident #5's tramadol. On 11/20/23, at 1:20 p.m., the RSD stated she was not aware of the error with the tramadol. On 11/20/23, at 4:21 p.m., the co-owner stated she was not aware of the residence's failure to comply with medications regarding Resident #4 and #5. 3. Chapter VII regulations governing assisted living residence, requires in part 14.27, that no stock medications shall be stored or administered by qualified medication administration persons. A) All over-the-counter medication prescribed for administration shall be labeled or marked with the individual resident's full name.a. Resident #1During a medication cart audit the following three medications were not labeled with Resident #1's full name:Tylenol 500 mgCalcium 600 mgVitamin B-12 1000 mcgb. Resident #3During a medication cart audit the following two medications were not labeled with Resident #3's full name:OmeprazoleCalcium Citrate plus D3c. Resident #4During a medication cart audit the following three medications were not labeled with Resident #4's full name:Vitamin B-12 2,500 mcgZyrtec 10 mgPolyethylene Glycold. Resident #6During a medication cart audit the following two medications were not labeled with Resident #6's full name:Vicks VapoRubOcusoft lid ScrubOn 11/20/23, at 4:41 p.m., the co-owner stated she was aware of the regulation which required full resident names on over the counter medications; however, the co-owner stated she thought the medication bottles has resident initials and thought that was okay. 4. Chapter VII regulations governing assisted living residences, requires in part 14.31, that the administrator and the QMAP supervisor shall, on a quarterly basis, audit the accuracy and completeness of the medication administration records, controlled substance list, medication error reports, and medication disposal records. Any irregularities shall be investigated and resolved. The results of the audits shall be documented and routinely included as part of the assisted living residence ' s Quality Management Program assessment and review. On 11/20/23 at 11:10 a.m., the residence's last three medication audits were requested from the co-owner. The medication audit book was provided and revealed no evidence of medication audits completed by the qualified medication administration person supervisor and the administrator since 2021. On 11/20/23 at approximately 1:20 p.m., the RSD stated the residence sent copies of the medication administration records to an external service provider who completed monthly audits of their residents. She stated that she completed medication audits along with the administrator and the director of operations. She stated the residence looked at controlled substances, checked refusals, spoke to practitioners and looked at the medication carts. She stated she was in the process of learning her position as she had only been at the residence for ten months and was not aware of everything that needed to be done for the required quarterly audits. On 11/20/23 at 4:04 p.m., the director of operations stated she was aware of the regulation about medication audits but did not guide or check in with the RSD to ensure medication audits were being completed. On 11/20/23 at 4:20 p.m., the co-owner stated she was aware of the regulation regarding medication audits.

A relicensure survey was completed on 11/20/23. Deficiencies were cited.

Based on record review and interview, the residence failed to request, prior to staff hire, a name-based criminal history record check conducted by the Colorado Bureau of Investigation (CBI) for each prospective staff member, for two of two sample staff (#2-#3) affecting 53 current residents. (Cross-reference Q664). Findings include: The residence's Personnel Files policy, dated October 2021, read in part: "Personnel files include, but are not limited to, written documentation regarding the following items: Result of background checks and CAPS (Colorado Adult Protective Services) checks and follow up, as applicable." The policy did not include information regarding a CBI as part of the background check process. Staff #2 and #3's personnel files read they were hired on 7/20/23 and 10/5/23 respectively. Staff #2's personnel file did not include a CBI criminal history report completed prior to hire. The co-owner provided a CBI for Staff #2 completed during the onsite visit, 11/20/23. Staff #3's personnel file included a CBI criminal history report dated on 10/13/23, eight days after the staff 's hire date. Staff #2 and #3 were listed on the residence's current staff list and the co-owner confirmed both staff currently worked at the residence. On 11/20/23 at approximately 4:02 p.m., the director of operations acknowledged a criminal history records check conducted through the CBI was not routinely included in the residence's national background checks. On 11/20/23 at 4:41 p.m., the co-owner stated background checks were required to be completed prior to an employee starting work at the residence. She stated the residence utilized a third party agency to complete nation background checks and she was unsure if a CBI was included in the national background check. The co-owner stated it was her understanding the residence was completing CBI criminal history checks.

Based on observation, record review and interview, the residence failed to ensure residents were provided with, and acknowledged receipt of, information regarding whether or not the assisted living residence had video surveillance monitoring throughout the residence, affecting 53 current residents. Findings include:On 11/20/23 at approximately 9:00 a.m., the residence had 11 video surveillance cameras. On the first floor, there was a camera facing the entrance, one camera at the end of each hallway facing towards resident rooms, there were two hallways, and one camera facing another exit door with the common area in its view, the common area contained a television and chairs that residents were seated in. On the second floor, there were cameras on the ends of the hallways facing towards resident rooms, two hallways, also a camera facing the window in the common area. On the third floor, there was a camera facing the exit across from the check in desk. One camera was located in the group meeting area, parallel to the chapel and a camera at the end of each hallway, facing resident rooms, there were two hallways. The residence's Resident Agreement, dated October 2021, revealed no evidence the assisted living had a disclosure for monitoring devices such as video surveillance. On 11/20/23 at 9:02 a.m., Staff #6 stated the video surveillance cameras were placed on the ends of the hallways and confirmed they were on and in working condition. On 11/20/23 at 9:45 a.m., Resident #1 stated she was unaware of the cameras and surveillance. On 11/20/23 at approximately 2:30 p.m., Resident #7 stated that she was unaware of the cameras located inside of the residence. On 11/20/23 at approximately 4:02 p.m., the director of operations stated the cameras were installed for safety reasons due to the ongoing homeless population around the residence and was unaware the residence agreement did not include the cameras. On 11/20/23 at 4:41 p.m., the co-owner stated she was aware the residence had cameras; however, the co-owner stated she was not aware if the residence cameras were disclosed in the resident agreement.

Based on observation, interview and record review the residence failed to either directly or indirectly through a resident agreement provide personal services affecting two of two sample residents that required assistance with eating (#5, #6). (Cross-reference Q1146, Q1150)Findings include:1. References and Residence Policiesa. The residence's Resident Agreement, dated January 2023, read in part: Through its staff the residence would make assistance available to the resident as needed, with dressing, grooming, bathing and other activities of daily living. If the residence determined that the services could not be provided because of applicable state law or otherwise, transfer to a higher level of care outside of the residence would be required. b. The residence's Procedure to Assist with Eating, dated October 2021, read in part: Assistance with eating, defined as an activity of daily living, included ingestion, chewing, swallowing, and digestion of food. Only personal care workers trained by a licensed professional may assist with feeding participants. The residence would have staff observe resident food consumption on a regular basis in order to detect unplanned changes such as weight loss and dehydration. Changes in consumption that may indicate the need for assistance with eating was reported to the resident's practitioner and case manager. c. Chapter VII regulations governing assisted living residences, part 2.3, defines activities of daily living as those personal functional activities required by an individual for continued well-being, health and safety and include, but are not limited to, eating.d. Chapter VII regulations governing assisted living residences, part 2.34, defines personal services as those services that an assisted living residence and its staff provide for each resident including, but not limited to activities of daily living. 2. Resident #6 was admitted to the residence on 12/19/22 with diagnoses of dementia, muscle weakness and cognitive communication deficit. a. ObservationsOn 11/20/23 at 7:54 a.m. through 8:07 a.m., Resident #6 was seated at the dining room table with a bowl of oatmeal, milk and juice. Resident #6 was hunched over in her wheelchair not eating and had her head resting on the bowl of oatmeal. On 11/20/23 at 8:08 a.m., an unknown staff approached Resident #6 pulled her hand from her lap and tried to place a utensil in her hand. Resident #6 was unable to grab the utensil and put her hand back into her lap. The staff subsequently provided the resident with a drink of milk. On 11/20/23 at 9:08 a.m., Resident #6 was moved from the dining room to her room. Her breakfast plate was not eaten. On 11/20/23 at approximately 12:45 p.m., Resident #6 was seated in her room and her family member was providing assistance with eating rice.b. Record ReviewAn assessment, dated 6/20/23, read in part: Resident #6 required reminders to eat and drink, required her food cut up and required monitoring when eating as she was at risk for choking. The undated care plan for Resident #6 read in part: Resident #6 required staff monitoring, verbal prompts and cues for eating three times a day. Additionally, the care plan further read that the resident required her food cut into small pieces. c. InterviewsOn 11/20/23 at 9:08 a.m., Staff #6 stated Resident #6 could usually eat by herself; however, she stated the resident was tired on the day of the onsite visit. On 11/20/23 at approximately 12:45 p.m., the responsible party for Resident #6 stated she visited the resident daily. She stated that Resident #6 had a decline in the past several months and had days where she was unable to feed herself. The responsible party stated she arrived at the residence to provide Resident #6 with assistance with eating. The responsible party stated on the resident's good days she was able to drink and use utensils to eat; however, she acknowledged on her bad days she was unable to eat independently. The responsible party further stated on the bad days, the residence was unable to meet the personal service needs of Resident #6. On 11/20/23 at 1:51 p.m., the resident services director (RSD) stated Resident #6's last assessment and care plan were completed on 6/20/23. She stated Resident #6 required her food cut into small pieces. She stated staff at the residence did not provide Resident #6 with assistance with eating. The RSD stated that because the residence did not employ certified nursing assistants, they were not allowed to provide assistance with eating. She stated staff did their best to encourage Resident #6 to eat. However, she confirmed if a resident did not eat, staff were not allowed to assist the resident other than handing the utensil to them. On 11/20/23 at 2:24 p.m., Staff #5 stated that staff cut up Resident #6's food; however, the staff stated the resident was independent with eating and did not need to be monitored. On 11/20/23 at 3:24 and 3:34 p.m., Staff #7 stated the responsible party for Resident #6 sat with her daily from 11:00 a.m. to 6:00 p.m. She stated when responsible party was not present for breakfast, the resident would sip on her drinks. Staff #7 further stated the responsible party for Resident #6 hired private care staff to assist the resident with eating. On 11/20/23 at 4:02 p.m., the director of operations stated Resident #5 and #6 were on hospice and to her knowledge, the residence was not allowed to feed residents on hospice. Additionally, she stated staff had been feeding Resident #6, staff occasionally took Resident #6 with them on breaks and fed her then. On 11/20/23 at 4:41 p.m., the co-owner stated assistance with eating was prohibited and as the resident declined external hospice would assist the resident with eating. She stated Resident #6 could eat independently; however, she confirmed that the family member for Resident #6 when at the residence did provide the resident assistance with eating. 3. Resident #5 was admitted to the residence on 12/4/22 with a diagnosis of dementia.a. ObservationsOn 11/20/23 during morning and lunch meal times Resident #5 was observed in bed laying down asleep.b. Record ReviewAn assessment, dated 8/2/23, read in part: Resident #5 required staff monitoring, verbal prompts and cues while eating. The undated care plan for Resident #5 read in part: Resident #5 required monitoring and verbal prompts when eating. c. InterviewsOn 11/20/23 at 1:51 p.m., the RSD stated staff did not provide assistance with eating for Resident #5. She stated historically Resident #5 was a "pretty hardy eater"; however, she stated Resident #5 was not eating much food anymore and even was struggling to take his medications. On 11/20/23 at 2:24 p.m., Staff #5 stated Resident #5 had a recent change in condition. She stated the resident was no longer attending activities and ate in his room. Staff #5 stated Resident #5 had not eaten in the dining room for a week. Additionally, Staff #5 stated the resident did not need assistance with eating, he was not asking for food; however, she stated that if he did need assistance staff could put the food on a fork for him. On 11/20/23 at 3:34 p.m., Staff #7 stated Resident #5 had experienced a rapid decline as a result of a fall earlier in the month and only drank nutritional supplements. On 11/20/23 at 4:41 p.m., the co-owner stated Resident #5 was in the late stages of hospice and staff should have been providing assistance with eating.

Based on observation, interview and record review, the residence failed to update the comprehensive assessment whenever a resident's condition changed from baseline status affecting two of two sample residents who experienced a change in condition (#5, #6). (Cross reference Q1110, Q1150)Findings include:1. ReferenceChapter VII regulations governing assisted living residences, part 12.7, requires that the comprehensive assessment shall include all the following items: (B) Information regarding the resident's overall health and physical functioning ability; (D) Communication ability and any specific needs to facilitate effective communication;(E) Current diagnoses and any known or anticipated need or impact related to the diagnoses and (F) Food and dining preferences, unique needs and restrictions; (G) Individual bathroom routines, sleep and awake patterns. 2. Resident #6 was admitted to the residence on 12/19/22 with diagnoses of dementia, muscle weakness and cognitive communication deficit. Observations on 11/20/23 from 7:54 a.m. to 12:45 p.m. revealed Resident #6 was unable to eat independently and unable to communicate with staff. Resident #6 was observed to only understand and speak japanese. On 11/20/23 at 12:45 p.m., the responsible party for Resident #6 stated she visited the resident on a daily basis. She stated that Resident #6 had experienced a significant change in condition within the last two months. The responsible party stated Resident #6 used to speak and understand english; however, as her condition changed she was only able to communicate in Japanese. She stated Resident #6 "gets really frustrated when she cannot communicate." The responsible party further stated she came to the residence daily to assist with communication and provide assistance with eating. She further stated Resident #6 had good days and bad days and confirmed the day of the onsite visit the resident had experienced a bad day. The responsible party stated on her bad days she was not able to eat independently and required two staff members for transfer assistance. On 11/20/23 at 1:51 p.m., the resident services director (RSD) stated she completed comprehensive assessments for all residents. The RSD stated she last completed the assessment for Resident #6 was completed on 6/20/23 (five months prior to the onsite visit). On 11/20/23 at 2:24 p.m., Staff #5 stated Resident #6 was independent with eating. She stated staff would cut up her food into smaller pieces; however, she did not require any monitoring with eating. On 11/20/23 at 4:41 p.m., the co-owner stated comprehensive assessments were completed 30 days after a move-in, every six months and if the change in condition was a dramatic decline. An assessment, dated 6/20/23, read in part: Resident #6 required reminders to eat and drink, required her food cut up, required monitoring when eating as she was a choking risk, required one person transfer assistance for toileting and ambulation, was on external hospice services and had diminished verbal skills, staff were required to assist the resident in sounding out words and expressing herself. However, the comprehensive assessment failed to address the resident was only able to understand and speak Japanese, and required more than one person transfer assistance on her bad days and physical assistance with eating. 3. Resident #5 was admitted to the residence on 12/4/22 with a diagnosis of dementia. On 11/20/23 during morning and lunch meal times Resident #5 was observed in bed laying down asleep. On 11/20/23 at 1:51 p.m., the RSD stated Resident #5 was not eating much food anymore and even was struggling to take his medications. On 11/20/23 at 2:24 p.m., Staff #5 stated Resident #5 had a recent change in condition. She stated the resident was no longer attending activities and ate in his room. Staff #5 stated Resident #5 had not eaten in the dining room for a week. Additionally, Staff #5 stated the resident did not need assistance with eating, he was not asking for food; however, she stated that if he did need assistance staff could put the food on a fork for him. On 11/20/23 at 3:34 p.m., Staff #7 stated Resident #5 had experienced a rapid decline as a result of a fall earlier in the month and only drank nutritional supplements. On 11/20/23 at 4:02 p.m., the director of operations stated, Resident #5 had been declining and was unsure why his assessment had not been updated. On 11/20/23 at 4:41 p.m., the co-owner confirmed Resident #5 had a dramatic change in condition caused by a fall and should have had a comprehensive assessment completed. An assessment, dated 8/2/23, read in part: Resident #5 required staff monitoring, verbal prompts and cues while eating, assistance with toileting to include dressing, undressing and cleaning up, one person assistance with transfers, was able to assist with transfers and required a wheelchair for mobility. Additionally, the assessment read the resident was on external hospice services. However, the assessment failed to address the resident needed assistance with eating and drinking and was unable to assist with transfers.

Based on observation, record review and interview, the residence failed to ensure care plans reflected the most current assessment information and detailed specific personal service needs and preferences along with the staff tasks necessary to meet those needs, affecting two of two sample residents (#5, #6) who had a change from baseline status. (Cross-reference Q1110, Q1146) Findings include: 1. Resident #6 was admitted to the residence on 12/19/22 with diagnoses of dementia, muscle weakness and cognitive communication deficit. Observations on 11/20/23 from 7:54 a.m. to 12:45 p.m. revealed Resident #6 was unable to eat independently and unable to communicate with staff. Resident #6 was observed to only understand and speak japanese. On 11/20/23 at 9:01 a.m., Staff #1 stated Resident #6 had a recent change of condition. On 11/20/23 at 12:45 p.m., the responsible party for Resident #6 stated she visited the resident on a daily basis. She stated that Resident #6 had experienced a significant change in condition within the last two months. The responsible party stated Resident #6 used to speak and understand english; however, as her condition changed she was only able to communicate in japanese. She stated Resident #6 "gets really frustrated when she cannot communicate." The responsible party further stated she came to the residence daily to assist with communication and provide assistance with eating. She further stated Resident #6 had good days and bad days and confirmed the day of the onsite visit the resident had experienced a bad day. The responsible party stated on her bad days Resident #6 was not able to eat independently and required two staff members for transfer assistance. On 11/20/23 at 1:51 p.m., the resident services director (RSD) stated she completed care plans for all residents. The RSD stated the care plan for Resident #6 was completed on 6/20/23 (five months prior to the onsite visit). The undated care plan for Resident #6 read the resident required monitoring, verbal prompts and cues while eating, was independent with personal hygiene, required full assistance with transfers, used a wheelchair, had diminished verbal skills needed assistance sounding out words and expressing herself. However, the care plan failed to detail specific personal service needs and preferences along with the staff tasks necessary to meet those needs. 2. Resident #5 was admitted to the residence on 12/19/22 with diagnoses of dementia, muscle weakness and cognitive communication deficit. On 11/20/23 during morning and lunch meal times Resident #5 was observed in bed laying down asleep. On 11/20/23 at 1:51 p.m., the RSD stated a change in a resident care plan would alert the care staff that a task for the resident needed completed. The RSD confirmed that the residence used contracted staff and they did not have access to the resident care plans. On 11/20/23 at 2:24 p.m., Staff #5 stated Resident #5 had a recent change in condition. She stated the resident was no longer attending activities and ate in his room. Staff #5 stated Resident #5 had not eaten in the dining room for a week. Additionally, Staff #5 stated the resident did not need assistance with eating, he was not asking for food; however, she stated that if he did need assistance staff could put the food on a fork for him. On 11/20/23 at 3:34 p.m., Staff #7 stated Resident #5 had experienced a rapid decline as a result of a fall earlier in the month and only drank nutritional supplements. On 11/20/23 at 4:02 p.m., the director of operations stated, Resident #5 had been declining and was unsure why his care plan had not been updated. On 11/20/23 at 4:41 p.m., the co-owner stated care plans were updated with a drastic change in condition. She confirmed Resident #5 experienced a fall which resulted in his rapid decline and agreed his care plan should have been updated. The undated care plan for Resident #5 read the resident required monitoring, verbal prompts and cues while eating, was independent with personal hygiene, required full assistance with transfers but could assist, used a wheelchair, had diminished verbal skills needed assistance sounding out words and expressing himself. However, the care plan failed to detail specific personal service needs and preferences along with the staff tasks necessary to meet those needs after the resident fell and had a change in condition.

Based on record review and interview, the residence failed to ensure that qualified medication administration persons (QMAPs) did not administer as-needed (PRN) medications to residents who could not request the medication or understand the purpose of the medication, affecting two of two sample residents (#5, #6) whose PRN medications were reviewed. (Cross-reference Q1146) Findings include:1. ReferencesChapter VII regulations governing assisted living residences, part 14.10, requires that unless otherwise allowed by statute, the assisted living residence shall not permit a qualified medication administration person to perform any of the following tasks: Decision making regarding PRN medication administration. 2. Resident #6 was admitted to the residence on 12/19/22 with diagnoses of dementia, muscle weakness and cognitive communication deficit. An assessment, dated 6/20/23, read Resident #6 had diminished communication skills, was on external hospice and required assistance with medication administration. A written practitioner's order, dated 10/30/23, directed the residence to administer dilaudid 1 mg every six hours as needed for pain. The November 2023 medication administration record (MAR) read the medication was administered by a qualified medication administration person on 11/14/23. The MAR further read the resident had spit out the routine dose and the QMAP administered the PRN dose for pain. On 11/20/23 at 9:02 a.m., the co-owner stated Resident #6 no longer able to speak english. She stated the resident had experienced a change in condition and only spoke Japanese. The co-owner stated the responsible party for Resident #6 visited the residence daily and could assist in translating when needed. On 11/20/23 at 12:45 p.m., the responsible party for Resident #6 stated Resident #6 used to speak and understand english; however, as her condition changed she was only able to communicate in Japanese. On 11/20/23 at 4:15 p.m., Staff #7 stated when QMAPs thought Resident #6 needed her PRN medication, she stated they would call the responsible party to obtain permission for administering the medication since Resident #6 was unable to request the medication. 3. Resident #5 was admitted to the residence on 12/4/22 with a diagnosis of dementia. A written practitioner's order, dated 11/5/23, directed the residence to administer tramadol every eight hours as needed. A second written practitioner's order, dated 11/6/23, directed the residence to administer tramadol every eight hours scheduled for seven days. However, the November 2023 MAR read the medication was administered as needed on 11/6/23. During a medication cart audit, tramadol HCL 50 as needed was located in the cart and revealed one medication missing. On 11/20/23 at 1:51 p.m., the resident services director (RSD) stated Resident #5 was not fully able to request PRN medications. She stated the tramadol that was administered on 11/6/23, the QMAP notified external hospice and requested to administer the medication. On 11/20/23 at 4:02 p.m., the director of operations stated practitioner's ordered PRN medications and if the residents were cognitive, they needed to ask for the medications. She stated for Residents #5 and #6, the residence called their external hospice nurse and asked if they could administer the medications. The director of operations also stated, Residents #5 and #6 could not verbalize their desire for PRN medications, they were unable to say they were in pain. On 11/20/23 at 4:15 p.m., Staff #7 stated Resident #5 was not able to request PRN medications. She stated the residence was in the process of obtaining a discontinue order for all of the resident's PRN medications.

Based on observation, interview and record review, the residence failed to comply with authorized practitioner's orders associated with medication administration affecting two of four sample residents (#4, #5). Findings include:1. Resident #4 was admitted to the residence on 12/4/22 with diagnoses of dementia, muscle weakness and cognitive communication deficit. A written practitioner's order, dated 10/12/23, directed the residence to administer vitamin B12 1000 mcg once daily. However, the November 2023 medication administration record (MAR) read the medication was not administered on 11/2, 11/4, 11/5, 11/7, 11/9, 11/12, 11/14, 11/16, 11/18 and 11/19/23 for a total of 10 missed doses. A written practitioner's order, dared 10/12/23, directed the residence to administer vitamin D2 1.25 mg twice weekly. However, the November 2023 MAR read the medication was administered once weekly from 11/1/23 to 11/19/23 for a total of three doses administered. A written practitioner's order, dated 10/12/23, directed the residence to administer loratadine 10 mg once daily. A second written practitioner's order, dated 11/14/23, directed the residence to administer Zyrtec 10 mg once daily. However, the November 2023 MAR read neither medication was administered on 11/14/23 for a total of one missed dose. On 11/20/23, at 1:20 p.m., the resident services director (RSD) stated once the medication orders were received from the practitioners the qualified medication administration person (QMAP) would send the order to the pharmacy and enter the medication on the MAR. She stated her duty was to make sure the medication was entered correctly on the MAR and audit medications. The RSD stated some families purchased the over the counter medications and did not go through the pharmacy. She stated QMAPs were responsible for notifying the families the medication was running out of stock and would make a notation. However, she stated it depended on the importance of the medication if their residence would purchase the over the counter and subsequently bill the family. The RSD subsequently stated that a vitamin was an over the counter medication that would not be considered important. She further stated she was unaware of the error with Zyrtec. 2. Resident #5 was admitted to the residence on 12/4/22 with a diagnosis of dementia. A written practitioner's order, dated 11/6/23, directed the residence to administer tramadol 50 mg every eight hours for seven days. However, the November 2023 MAR read the medication was not administered on 11/7 at 2:00 a.m. and 10:00 a.m. due to the medication not being entered on the MAR. Additionally, the medication was not administered as order on 11/11-11/13/23 all three doses due to the medication being held, for a total of 11 missed doses. The residence was unable to provide a hold order for Resident #5's tramadol. On 11/20/23, at 1:20 p.m., the RSD stated she was not aware of the error with the tramadol. On 11/20/23, at 4:21 p.m., the co-owner stated she was not aware of the residence's failure to comply with medications regarding Resident #4 and #5.

Based on observation and interview, the residence failed to ensure all over-the-counter medications prescribed for administration were labeled or marked with the individual resident's full name, affecting four of six sample residents (#1, #3, #4, #6). Findings include:1. Resident #1During a medication cart audit the following three medications were not labeled with Resident #1's full name:Tylenol 500 mgCalcium 600 mgVitamin B-12 1000 mcg 2. Resident #3During a medication cart audit the following two medications were not labeled with Resident #3's full name:OmeprazoleCalcium Citrate plus D33. Resident #4During a medication cart audit the following three medications were not labeled with Resident #4's full name:Vitamin B-12 2,500 mcgZyrtec 10 mgPolyethylene Glycol 4. Resident #6During a medication cart audit the following two medications were not labeled with Resident #6's full name:Vicks VapoRubOcusoft lid ScrubOn 11/20/23, at 4:41 p.m., the co-owner stated she was aware of the regulation which required full resident names on over the counter medications; however, the co-owner stated she thought the medication bottles has resident initials and thought that was okay.

Based on record review and interview, the administrator and the qualified medication administration supervisor (QMAP) failed to conduct and document quarterly audits of medication administration records' completeness and accuracy, affecting six of six sample residents (#1- #6). (Cross- reference Q1426, Q1468, Q1494)Findings include: On 11/20/23 at 11:10 a.m., the residence's last three medication audits were requested from the co-owner. The medication audit book was provided and revealed no evidence of medication audits completed by the qualified medication administration person supervisor and the administrator since 2021. On 11/20/23 at approximately 1:20 p.m., the resident service director (RSD) stated the residence sent copies of the medication administration records to an external service provider who completed monthly audits of their residents. She stated that she completed medication audits along with the administrator and the director of operations. She stated the residence looked at controlled substances, checked refusals, spoke to practitioners and looked at the medication carts. She stated she was in the process of learning her position as she had only been at the residence for ten months and was not aware of everything that needed to be done for the required quarterly audits. On 11/20/23 at 4:04 p.m., the director of operations stated she was aware of the regulation about medication audits but did not guide or check in with the RSD to ensure medication audits were being completed. On 11/20/23 at 4:20 p.m., the co-owner stated she was aware of the regulation regarding medication audits.

THIS PORTION OF THE REPORT IS FOR INFORMATIONAL PURPOSES ONLY.No response is necessary. The residence was advised it must review and maintain the following processes in accordance with existing program regulations found at 6 CCR 1011-1, Chapter 7.10.1 The assisted living residence shall have readily available a roster of current residents, their room assignments and emergency contact information, along with a facility diagram showing room locations. 17.14 Staff who assist feeding a resident shall be trained in the proper techniques for supporting nutrition and hydration by a licensed or registered professional qualified by education and training to assess choking risks, such as a registered nurse, speech language pathologist, or registered dietitian.