GARDENS CARE HOMES - MEADOW HILLS, THE

A revisit survey was completed on 3/22/24 for all previous deficiencies cited on 3/8/23. The facility is in compliance with all deficiencies that were cited.

A licensure complaint, prompted by #CO31117 was completed on 3/8/23. Deficiencies were cited.

Based on record review and interviews, the residence failed to comply with authorized practitioner orders associated with medication administration, affecting one of four sample residents (#2). Findings include: 1. ReferencesAccording to WebMD, Zofran is used alone or with other medications to prevent nausea and vomiting. If you stop taking the drug suddenly or don't take it at all: You could have nausea and vomiting that's not controlled. WebMD (2005-2023) Zofran, retrieved from:https://www.webmd.com/drugs/2/drug-30/zofran-oral/details/list-sideeffects 2. Resident #2 was admitted to the residence on 2/15/23 with the diagnoses including vomiting, diarrhea. A written practitioner's order, dated 2/26/23, directed the residence to administer Zofran 4 mg two times a day for two days. However, the February 2023 electronic medication administration record (eMAR) read the residence did not administer the medication for both doses from 2/27-2/28/23, for a total of four missed doses due to the medication being out of stock. On 3/8/23 at 1:42 p.m., the administrator designee (AD) stated the medication for Resident #2 was not in stock and not administered because the medication was not delivered by the pharmacy. She added she reached out to the practitioner to notify that the medication for Resident #2 was not given. However, no proof or documentation was provided. On 3/8/23 at 2:30 p.m., the practitioner for Resident #2 stated she prescribed Zofran for two days to control and stop Resident #2's vomiting. She stated she was not aware that Resident #2 did not receive the medication. She added she did not receive any notification from the residence stating the resident did not receive Zofran. The practitioner stated she expected the residence to administer the medication to Resident #2 to control the vomiting. On 3/8/23 at 4:30 p.m., the administrator stated she was not aware that Resident #2 did not receive the prescribed medication. The administrator stated the assistant manager (AM) and AD were responsible for ordering medications. She stated residents should not miss doses of prescribed medications.

Based on interview and record review, the residence failed to follow the written policies and procedures that address the transmission of communicable diseases with significant risk of transmission to other persons, affecting 15 current residents. Findings include: a. References and residence policies 1. The residence's Infection Control / Infection Prevention policy read in part, "Assisted living residences must also develop, implement, and follow written policies and procedures that address the transmission of communicable diseases with a significant risk of transmission to other persons and for reporting diseases to the state and/or local health department, pursuant to 6 CCR 1009-1 Epidemic and Communicable Disease Control. The policies and procedures include at a minimum, all of the following criteria; the method for monitoring and encouraging employee wellness, the method for tracking infection patterns and trends and initiating a response, the method for determining when to seek assistance from a medical professional and/or local health department, isolation techniques, and appropriate handling of linen and clothing of residents with communicable infections." 2. 6-CCR 1009-1 Epidemic and Communicable Disease Control, Regulation 1, Reportable Diseases, read in part: "The Board of Health also requires the reporting of any unusual illness, or outbreak, or epidemic of illnesses, which may be of public concern whether or not known to be, or suspected of being, communicable. Such illnesses, outbreaks, or epidemics include, but are not limited to: 1) those which may be a risk to the public and which may affect large numbers of persons such as illnesses transmitted through food, water, animal to person, or from person to person; 2) cases of a newly recognized entity, including novel influenza; 3) those related to a healthcare setting or contaminated medical devices or products; and 4) those related to environmental contamination by any infectious agent or toxic product of such an agent."b. ObservationsOn 3/8/23 from 7:30 a.m. to 5:15 p.m., there was no sign of an outbreak posted anywhere in the residence. On 3/8/23 at 8:45 a.m., Resident #4, #7 and #8 were eating breakfast seated side by side. On 3/8/23 at 11:45 p.m., all the residents were communal dining for lunch. On 3/8/23 at 1:15 p.m., all the residents were seated in the living room and entertainment room for activities. On 3/8/23 at 5:00 p.m., all the residents were communal dining for dinner.c. Record reviewOn 3/8/23 at 3:22 p.m., a member of the local health department provided documentation that she provided to the residence on 3/3/23 that read in part, "we request that you display an outbreak sign, and please alert all residents, families and visitors of the current illness circulating in the residence prior to entering. Lastly, fill in the attached log template or you can use your own if you prefer. I will check in throughout the week to obtain updates until we are able to resolve the outbreak. Please send us an encrypted illness log one-two times a week."An email from the local health department was sent to the administrator designee on 3/3/23 that read in part, "Please see attached for the documentation we discussed over the phone for the illness log template and additional useful resources. Please review the disease control measures to ensure that you are implementing proper protocols to prevent additional spread of illness in your facility. In addition, we request that you display an outbreak sign. I attached one that you may use, or you may use your own signage, but we ask that you alert all residents, families and visitors of the current illness circulating in the facility prior to entering. Lastly, I have attached an illness log template or you can use your own if you prefer. I will check in throughout the week to obtain updates until we are able to resolve the outbreak. Please send an encrypted illness log 1-2 times a week by responding to this email or fax."One of the attached documents read in part, "Restrict symptomatic staff from work for at least 48 hours after cessation of symptoms and place them on contact precautions ... Immediately launder contaminated linens and clothing separately from uncontaminated items ... post signs throughout the facility about the increase in gastrointestinal illness ... Restrict visits from elderly persons, young children, and persons with underlying medical conditions until the outbreak is over ... Request all persons to wash their hands upon entry and exit of the facility ... Suspend group activities such as bingo, card games, communal dining, etc ... Enhanced infection control precautions should remain in place for at least 2 weeks following the last case of illness." d. InterviewsOn 3/8/23 at 8:30 a.m., Resident #7 stated she was sick and had severe diarrhea. Resident #7 stated most of the residents had "terrible vomiting". Resident #7 stated she still had diarrhea and added it comes and goes. Resident #7 additionally stated Resident #8 was sick. On 3/8/23 at 8:38 a.m., Resident #8 stated he had been vomiting and had diarrhea for the last 10 days. He stated he thought residents got sick because one staff member on duty was sick and was cooking, cleaning and distributing medications to the residents. On 3/8/23 at 1:37 p.m., the member from the local health department stated that she received a report on 3/2/23 from a member of the state health department stating there was an outbreak at the residence. She stated she reached out to the administrator on 3/3/23 and the administrator responded that they were in outbreak. The member from the local health department stated it looked like person to person transmission. She stated she contacted the residence on 3/3/23 to provide standard disease control measures such as restrictions of any new admissions and restrictions of activities; environmental protection agency (EPA) cleaner list and asked the residence to make sure that the cleaners they were using were norovirus sensitive. On 3/8/23 at approximately 2:00 p.m., the administrator designee (AD) stated the virus started on the week of 2/22/23. She stated Resident #3 first got sick, which she was not aware of until three days later. The AD stated Staff #1 got sick after Resident #3, which spread to her and the assistant manager (AM). The AD stated Reside #5 and #6 had reported diarrhea on 2/25/23, and she further added she made Resident #5's bed and changed her sheets because they were soiled from diarrhea. The AD stated on 2/26/23, she received notification from AM stating all the residents were sick and were not feeling well. On 3/8/23 at 2:30 p.m., the AD stated the member from the local health department reached out to the residence and asked if they had any questions about viral illness onsite, symptoms and duration. The AD stated the member from the local health department stated it was a virus and sent a list of protocols to follow on 3/3/23. The AD stated the protocols included to post an outbreak sign and use environmental protection agency (EPA) approved cleaning supplies. She stated there were no postings of outbreak signs in the residence and further added "we think the virus is gone now". The AD stated the diarrhea was first reported by Resident #3 and added "it's hard to trust Resident #3 because she has dementia."On 3/8/23 at 3:42 p.m., the activities assistant (AA) stated the viral outbreak started the week of 2/20/23. She stated as an activities assistant her main focus was to complete the activities and added she did not pay attention to the illness. She stated on 2/20/23 the activities the residents did included reading daily chronicles, coloring in the group setting. She added on 3/4/23 a resident was sick and added she did not remember who the resident was; however, activities were still provided. She stated the residence did not ask residents to quarantine after 3/1/23. The AA stated an outbreak sign was posted on the front door on 2/25/23 to 2/28/23 and added she printed the sign out. The AA further stated she was not aware of why the posting was removed and added the residents were still sick. On 3/8/23 at 4:30 p.m., the administrator stated she did not classify the illness as a virus outbreak. She stated the local health department was not sure of what the illness was. She stated the member from the local health department reached out to her and added she cannot recall the date of when she received the call. The administrator stated the member from the local health department asked some questions on what cleaners the residence used and when did the illness start. The administrator stated it was not unusual for residents to have diarrhea at all. She stated the local health department was most concerned about the proper infection and sanitation. The administrator stated she did not know why the outbreak postings were not posted and added the AD was responsible for it. Moreover, the administrator acknowledged that the protocols issued by the local health department were not followed.

A relicensure survey was completed on 2/8/23. No deficiencies were cited.

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 7.14.29 All prescribed and PRN (as needed) medications shall be listed and recorded on a medication administration record (MAR) which contains the name and date of birth of the resident, the resident's room location, any known allergies, and the name and telephone number of theresident's authorized practitioner.(A) The medication administration record shall reflect the name, strength, dosage, and mode of administration of each medication, the date the order was received, the date and time of administration, any special considerations related to administration, and the signature or initial of the person administering the medication.