ASSURED SENIOR LIVING 25

A revisit survey was completed on 2/12/24 for all previous deficiencies cited on 11/1/23. The facility is in compliance with all deficiencies that were cited.

A revisit survey was completed on 2/12/24 for all previous deficiencies cited on 11/1/23. 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 11/1/23. A deficiency was cited.

Based on observation, record review and interview, 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 five current residents (#1-#5). Findings include:1. Chapter VII regulations governing assisted living residences, part 14.21, require the residence to be responsible for complying with authorized practitioner orders associated with medication administration except for those medications which a resident self-administers.a. Residence PolicyThe residence's written orders policy, dated 2023, read, "The residence shall be responsible for complying with authorized practitioner's orders associated with medication administration except for those medications which a resident self-administers." b. Resident #2 was admitted to the residence on 7/1/23 with diagnoses including unspecified dementia. Zolpidem A written practitioner's order, dated 6/12/23, directed the residence to administer zolpidem tart 10 mg before bed. However, the October 2023 medication administration record (MAR) read a circle with initials that the medication was not available and not administered on 10/2-10/3/23, for a total of two missed doses. GuaiFENesin DMA written practitioner's order, dated 10/2/23, directed the residence to administer GuaiFENesin DM 10 ml every four hours. However, the October 2023 MAR read X, and the medication was not administered until 10/12/23 for a total of 73 missed doses. c. Resident #1 was admitted to the residence on 9/18/23 with diagnoses including unspecified dementia. Metoprolol A written practitioner's order, dated 10/14/23, directed the residence to administer metoprolol tartrate 25 mg, 1/2 tab by mouth twice daily. However, the October 2023 medication administration record (MAR) read X, and the medication was not administered on the mornings of 10/30 and 10/31/23, and the evening doses on 10/30/23 and 10/31/23, for a total of four missed doses. Vitamin B12 A written practitioner's order, dated 10/14/23, directed the residence to administer vitamin B-12 1,000 mcg, two tablets by mouth each morning. However, the October 2023 MAR read X, and the medication was not administered on the morning of 10/30 and 10/31/23, for a total of two missed doses. c. Interviews On 10/11/23 at approximately 12:30 p.m, Staff #1 stated that medication that said pharmacy backorder, medication not available, or an X meant that the medication was not administered. On 10/11/23 at 12:45 p.m., the administrator stated that an X on the MAR meant that medications had not been started or had been discontinued. She confirmed that any X meant the medication was not administered. She could not explain why Resident #1 had missed medications after returning from the hospital on 10/29/23. Additionally, she was unable to answer as to why medications were back ordered or delayed from the pharmacy for Resident #2.2. Chapter VII regulations governing assisted living residences, part 14.38, requires that all medications shall be stored in a locked cabinet, cart, or storage area when unattended by qualified medication administration persons or other licensed staff.a. ReferenceChapter VII regulations governing assisted living residences, part 14.39, requires that controlled substances shall be kept in double lock storage.b. Observations and interviewsOn 11/1/23 at 7:35 a.m., an environmental tour of the residence revealed that the medication cart had been left unlocked with drawers open, and medications were left on top of the medication cart and on the table next to the medication cart. Residents #3 and #4 had sat at the dining room table. The medication cart had been positioned approximately 20 feet from the dining room table adjacent to the kitchen; no staff were present. On 11/1/23 at 7:35 a.m., Staff #1 opened the front door to the residence. After talking for a few minutes, Staff #1 returned to her medication cart. She stated it had been a busy morning including a resident moving out that day. She stated she had to not only get medications ready to leave with the resident but also had to make breakfast for other residents. She stated that she knew she should not have left the medications out unattended while residents had access but had only left for a minute to answer the door. On 11/1/23 at approximately 8:30 a.m., Staff #1 dropped three of Resident #1's pills onto the floor. Staff #1 picked up the pills and placed them in the garbage can beside the medication cart. She then left and entered another room to get applesauce from the fridge. She mixed crushed pills with applesauce and mixed thickener into a drink that included medication. Residents #3-#5 were sitting at the kitchen table near the medication cart. Staff #1 then left the kitchen to enter Resident #1's room, where she administered medications. Upon returning to the medication cart, Staff #1 pulled the controlled substance medication out of the garbage can and placed it in a medication disposal liquid container, leaving the other two pills in the garbage can. On 11/1/23 at approximately 8:30 a.m., Staff #1 stated that one of the pills dropped was a narcotic (controlled substance) pill, and she was taught to put the narcotic in the liquid solution and inform her supervisor. On 11/1/23 at 9:28 a.m., the medication cart was unlocked. Resident #2 was sitting at the kitchen table. Other residents were observed in the area without staff present. On 11/1/23 at 9:30 a.m., Staff #1 stated that she had forgotten to lock the cart. On 11/1/23 at 10:05 a.m., the medication cart was unlocked. Resident #5 and a visitor sat 10 feet from the medication cart in a resident common area while two individuals from an outside moving company removed Resident #5's belongings. No staff were present. On 11/1/23 at approximately 10:15 a.m., the administrator retrieved the other pills and discarded them properly. On 11/1/23 at 10:15 a.m., the administrator stated that Staff #1 had informed her that she had dropped a narcotic. She added that Staff #1 had been taught how to dispose of medications correctly. She added Staff #1 was nervous due to the onsite visit, and it was not a lack of education. The administrator stated it was Staff #1's nervousness that caused her to drop the medications. On 11/1/23 at approximately 12:33 p.m., the medication cart was unlocked. Residents were observed in the area, but no staff members were present. On 11/1/23 at approximately 12:45 p.m., the administrator observed the unlocked medication cart. She stated that it should have been locked and not left unattended.

A relicensure survey was completed on 11/1/23. Deficiencies were cited. A change of ownership occurred on 8/3/23.

Based on record review and interview, the residence failed to comply with authorized practitioner orders associated with medication administration except for those medications which a resident self-administers, affecting two of three sample residents (#1, #2). Findings include:1. Residence PolicyThe residence's written orders policy, dated 2023, read, "The residence shall be responsible for complying with authorized practitioner's orders associated with medication administration except for those medications which a resident self-administers." 2. Resident #2 was admitted to the residence on 7/1/23 with diagnoses including unspecified dementia.a. Zolpidem A written practitioner's order, dated 6/12/23, directed the residence to administer zolpidem tart 10 mg before bed. However, the October 2023 medication administration record (MAR) read a circle with initials that the medication was not available and not administered on 10/2-10/3/23, for a total of two missed doses. b. GuaiFENesin DMA written practitioner's order, dated 10/2/23, directed the residence to administer GuaiFENesin DM 10 ml every four hours. However, the October 2023 MAR read X, and the medication was not administered until 10/12/23 for a total of 73 missed doses. 2. Resident #1 was admitted to the residence on 9/18/23 with diagnoses including unspecified dementia.a. Metoprolol A written practitioner's order, dated 10/14/23, directed the residence to administer metoprolol tartrate 25 mg, 1/2 tab by mouth twice daily. However, the October 2023 medication administration record (MAR) read X, and the medication was not administered on the mornings of 10/30 and 10/31/23, and the evening doses on 10/30/23 and 10/31/23, for a total of four missed doses. a. Vitamin B12 A written practitioner's order, dated 10/14/23, directed the residence to administer vitamin B-12 1,000 mcg, two tablets by mouth each morning. However, the October 2023 MAR read X, and the medication was not administered on the morning of 10/30 and 10/31/23, for a total of two missed doses. 3. Interviews On 10/11/23 at approximately 12:30 p.m, Staff #1 stated that medication that said pharmacy backorder, medication not available, or an X meant that the medication was not administered. On 10/11/23 at 12:45 p.m., the administrator stated that an X on the MAR meant that medications had not been started or had been discontinued. She confirmed that any X meant the medication was not administered. She could not explain why Resident #1 had missed medications after returning from the hospital on 10/29/23. Additionally, she was unable to answer as to why medications were back ordered or delayed from the pharmacy for Resident #2.

Based on observation and interview, the residence failed to ensure all medications, including controlled substances, were stored in a locked cabinet, cart, or storage area when unattended by qualified medication administration persons or other licensed staff, affecting four current residents (#2-#5). Findings include:1. ReferenceChapter VII regulations governing assisted living residences, part 14.39, requires that controlled substances shall be kept in double lock storage. 2. Observations and interviewsOn 11/1/23 at 7:35 a.m., an environmental tour of the residence revealed that the medication cart had been left unlocked with drawers open, and medications were left on top of the medication cart and on the table next to the medication cart. Residents #3 and #4 had sat at the dining room table. The medication cart had been positioned approximately 20 feet from the dining room table adjacent to the kitchen; no staff were present. On 11/1/23 at 7:35 a.m., Staff #1 opened the front door to the residence. After talking for a few minutes, Staff #1 returned to her medication cart. She stated it had been a busy morning including a resident moving out that day. She stated she had to not only get medications ready to leave with the resident but also had to make breakfast for other residents. She stated that she knew she should not have left the medications out unattended while residents had access but had only left for a minute to answer the door. On 11/1/23 at approximately 8:30 a.m., Staff #1 dropped three of Resident #1's pills onto the floor. Staff #1 picked up the pills and placed them in the garbage can beside the medication cart. She then left and entered another room to get applesauce from the fridge. She mixed crushed pills with applesauce and mixed thickener into a drink that included medication. Residents #3-#5 were sitting at the kitchen table near the medication cart. Staff #1 then left the kitchen to enter Resident #1's room, where she administered medications. Upon returning to the medication cart, Staff #1 pulled the controlled substance medication out of the garbage can and placed it in a medication disposal liquid container, leaving the other two pills in the garbage can. On 11/1/23 at approximately 8:30 a.m., Staff #1 stated that one of the pills dropped was a narcotic (controlled substance) pill, and she was taught to put the narcotic in the liquid solution and inform her supervisor. On 11/1/23 at 9:28 a.m., the medication cart was unlocked. Resident #2 was sitting at the kitchen table. Other residents were observed in the area without staff present. On 11/1/23 at 9:30 a.m., Staff #1 stated that she had forgotten to lock the cart. On 11/1/23 at 10:05 a.m., the medication cart was unlocked. Resident #5 and a visitor sat 10 feet from the medication cart in a resident common area while two individuals from an outside moving company removed Resident #5's belongings. No staff were present. On 11/1/23 at approximately 10:15 a.m., the administrator retrieved the other pills and discarded them properly. On 11/1/23 at 10:15 a.m., the administrator stated that Staff #1 had informed her that she had dropped a narcotic. She added that Staff #1 had been taught how to dispose of medications correctly. She added Staff #1 was nervous due to the onsite visit, and it was not a lack of education. The administrator stated it was Staff #1's nervousness that caused her to drop the medications. On 11/1/23 at approximately 12:33 p.m., the medication cart was unlocked. Residents were observed in the area, but no staff members were present. On 11/1/23 at approximately 12:45 p.m., the administrator observed the unlocked medication cart. She stated that it should have been locked and not left unattended.

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. 21.4 Porches, stairs, handrails, and ramps shall be maintained in good repair.