15
Inspections
26
Deficiencies
0
Actual Harm or Above
0
Occurrences
July 2, 2026
Last Inspection
S/S B Minimal potential

The most recent inspection of GOSHEN ASSISTED LIVING LLC on record is dated July 2, 2026. Across 15 published inspections, state surveyors cited 26 deficiencies, none of which reached the actual-harm level.

Colorado publishes inspections on a rolling window, so older surveys may no longer appear. Citation codes 0000 and 9999 are the surveyor's opening and closing comments, not deficiencies, and are excluded from the counts above. Where the state required one, the facility's own plan of correction is shown beneath the finding it answers.

Provider Information

Status
Active
Facility Type
Assisted Living Residence/Alternative Care Facility (Medicaid)
Administrator
ELSELL, ROJAI
Owner
GOSHEN ASSISTED LIVING LLC
Phone
(303) 810-8197
Payor Source
Medicaid, Private Pay
City
AURORA
ZIP
80012

Inspections & Citations

15 inspections · 26 deficiencies
7/2/2026Revisit: Licensure Complaint · ID 1YW312No deficiencies
0000Initial CommentsSurveyor note
Findings
A revisit survey was completed on 7/2/26 for all previous deficiencies cited on 4/22/26. The facility is in compliance with all regulations surveyed.
Plan of correction
The state did not require a plan of correction for this citation.
7/2/2026Revisit: Licensure Complaint · ID 2MXY12No deficiencies
0000Initial CommentsSurveyor note
Findings
A revisit survey was completed on 7/2/26 for all previous deficiencies cited on 4/22/26. The facility is in compliance with all regulations surveyed.
Plan of correction
The state did not require a plan of correction for this citation.
4/22/2026Licensure Complaint · ID 1YW3111 deficiency
0000Initial CommentsSurveyor note
Findings
A certification complaint, prompted by #CO41160 was completed on 4/22/26. A deficiency was cited.
Plan of correction
The state did not require a plan of correction for this citation.
0910PA Req-Room/Board
Findings
Based on observation, record review, and interview, the facility (residence) failed to ensure room and board included basic toiletries, affecting eleven current members (residents). Findings include:1. Record ReviewRecord review of the resident agreement revealed the residence agreed to provide a safe and sanitary environment, room and board, personal services, protective oversight, and social care. 2. ObservationOn 4/22/26 at approximately 9:00 a.m., paper towels were not available for use in the common area bathroom located on the first floor, on the left side of the hallway between three bedrooms. The bathroom was in a shared area of the residence and was accessible to residents using the common areas. The bathroom also served as the primary shower bathroom for four of eleven residents. Paper towels were not available in the bathroom at the time of observation. The residence had three resident-accessible bathrooms: two bathrooms on the first floor and one bathroom in the basement. The second first-floor bathroom was located inside the main bedroom, and no concerns were observed in that bathroom. No concerns were observed in the basement bathroom. On 4/22/26 at approximately 10:00 a.m., staff placed a new paper towel roll in the dispenser; however, the dispenser did not function properly and did not dispense paper towels. On 4/22/26 at approximately 2:00 p.m., the surveyor observed the common bathroom again did not have accessible paper towels or a functioning hand drying device available for resident use. 3. InterviewOn 4/22/26 at 3:38 p.m., Staff #1 stated a part was missing from the paper towel dispenser, which prevented the paper towels from dispensing properly, therefore the residence did not have paper towels in the bathroom. On 4/22/26 at 2:00 p.m. the Administrator stated the hallway bathroom was used by residents in the common areas, staff, visitors and by residents assigned to nearby bedrooms. On 4/22/26 at 10:00 a.m. Resident #2 stated he uses the common bathroom daily.
Plan of correction · submitted by the facility
Response to POC Tag # 0910Issue Identified:The paper towel dispenser was properly loaded and functioning as intended for resident use. During use, a resident pulled excessively hard on the paper towel, causing the paper towel roll to become tilted and disconnected from the mounting bracket. Corrective Action:A house meeting was conducted with all residents and staff to review the incident and discuss the proper use of the automatic paper towel dispenser. Residents were instructed not to pull forcefully on the paper towels and to allow the dispenser to operate through its automatic dispensing function. In addition, staff training was conducted to ensure employees routinely inspect all paper towel dispensers to verify they are properly loaded, securely mounted, and functioning correctly. Monitoring Plan:Staff will monitor all paper towel dispensers and toilet paper dispensers to ensure they are properly stocked, securely installed, and functioning appropriately. These items will be reviewed during daily and weekly staff meetings. Addendum to the Monitoring Plan:A line item was added to the cleaning schedule requiring staff to verify that all dispensers are properly loaded and functioning during each bathroom cleaning. Monitoring will occur each time bathrooms are cleaned and restocked with appropriate supplies. Compliance checks will be performed daily, and findings will be reviewed and documented by the administrator during weekly staff meetings. Monitoring began immediately following the survey conducted on April 22 and will continue as part of the facility’s ongoing daily, weekly, and monthly cleaning and staff training processes.
4/22/2026Licensure Complaint · ID 2MXY111 deficiency
0000Initial CommentsSurveyor note
Findings
A licensure complaint, prompted by #CO41158 was completed on 4/22/26. A deficiency was cited.
Plan of correction
The state did not require a plan of correction for this citation.
2680In Env-BR TP dspnsrS/S B
Findings
Based on observation and interview, the residence failed to ensure paper towels or hand drying devices were available at all times in the common bathroom affecting 11 current residents. 1. Record ReviewRecord review of the resident agreement revealed the residence (facility) agreed to provide a safe and sanitary environment, room and board, personal services, protective oversight, and social care. 2. ObservationOn 4/22/26 at approximately 9:00 a.m., paper towels were not available for use in the common area bathroom located on the first floor, on the left side of the hallway between three bedrooms. The bathroom was in a shared area of the residence and was accessible to residents using the common areas. The bathroom also served as the primary shower bathroom for four of eleven residents. Paper towels were not available in the bathroom at the time of observation. The residence had three resident-accessible bathrooms: two bathrooms on the first floor and one bathroom in the basement. The first floor bathroom near the common area did not have paper towels. On 4/22/26 at approximately 10:00 a.m., staff placed a new paper towel roll in the dispenser; however, the dispenser did not function properly and did not dispense paper towels. On 4/22/26 at approximately 2:00 p.m., the surveyor observed the common bathroom again did not have accessible paper towels or a functioning hand drying device available for resident use. 3. InterviewOn 4/22/26 at 3:38 p.m., Staff #1 stated a part was missing from the paper towel dispenser, which prevented the paper towels from dispensing properly, therefore the residence did not have paper towels in the bathroom. On 4/22/26 at 2:00 p.m. the administrator stated the hallway bathroom was used by residents in the common areas, staff, visitors and by residents assigned to nearby bedrooms. On 4/22/26 at 10:00 a.m. Resident #2 stated he uses the common bathroom daily.
Plan of correction · submitted by the facility
Response to POC Tag # 2680Issue Identified:The paper towel dispenser was properly loaded and functioning as intended for resident use. During use, a resident pulled excessively hard on the paper towel, causing the paper towel roll to become tilted and disconnected from the mounting bracket. Corrective Action:A house meeting was conducted with all residents and staff to review the incident and discuss the proper use of the automatic paper towel dispenser. Residents were instructed not to pull forcefully on the paper towels and to allow the dispenser to operate through its automatic dispensing function. In addition, staff training was conducted to ensure employees routinely inspect all paper towel dispensers to verify they are properly loaded, securely mounted, and functioning correctly. Monitoring Plan:Staff will monitor all paper towel dispensers and toilet paper dispensers to ensure they are properly stocked, securely installed, and functioning appropriately. These items will be reviewed during daily and weekly staff meetings. Addendum to the Monitoring Plan:A line item was added to the cleaning schedule requiring staff to verify that all dispensers are properly loaded and functioning during each bathroom cleaning. Monitoring will occur each time bathrooms are cleaned and restocked with appropriate supplies. Compliance checks will be performed daily, and findings will be reviewed and documented by the administrator during weekly staff meetings. Monitoring began immediately following the survey conducted on April 22 and will continue as part of the facility’s ongoing daily, weekly, and monthly cleaning and staff training processes.
12/15/2025Revisit: State Certification and State Certification Complaint (Combined) · ID MIGZ12No deficiencies
0000Initial CommentsSurveyor note
Findings
A revisit survey was completed on 12/15/25 for all previous deficiencies cited on 8/7/25. The facility is in compliance with all deficiencies that were cited.
Plan of correction
The state did not require a plan of correction for this citation.
9999Final ObservationsSurveyor note
Findings
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
Plan of correction
The state did not require a plan of correction for this citation.
12/15/2025Revisit: Licensure and Licensure Complaint (Combined) · ID TNGP12No deficiencies
0000Initial CommentsSurveyor note
Findings
A revisit survey was completed on 12/15/25 for all previous deficiencies cited on 8/7/25. The facility is in compliance with all deficiencies that were cited.
Plan of correction
The state did not require a plan of correction for this citation.
9999Final ObservationsSurveyor note
Findings
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
Plan of correction
The state did not require a plan of correction for this citation.
8/7/2025State Certification and State Certification Complaint (Combined) · ID MIGZ114 deficiencies
0000Initial CommentsSurveyor note
Findings
A recertification survey with complaint #CO40323 was completed on 8/7/25. Deficiencies were cited.
Plan of correction
The state did not require a plan of correction for this citation.
0792PA Req-P/P-Med Admin
Findings
Based on observation and interview, the facility (residence) failed to store medications under proper conditions, affecting one of one sample member (resident) on refrigerated medications (#2). Findings include:1. ObservationsOn 8/7/25 at 8:07 a.m., an environmental tour revealed a "staff only" sign was on a door that led to the garage where there was a refrigerator filled with food which was also the medication refrigerator. The refrigerated medications included as follows:A box of Lantus 100 unit injectionsA box of risperidone 200 mg injectionsA clear bag with a single dose of Humulog 100 unit and Lantus 100 unit injections. However, the clear bag was not labeled with the resident's name or prescribing information. 2. InterviewsOn 8/7/25 at 8:07 a.m., the administrator stated Resident #2 was the only resident on refrigerated medications. The administrator further stated that food was also stored in the refrigerator that was used by staff to make resident meals. On 8/7/25 at approximately 1:30 p.m., the administrator stated he believed that refrigerated medications could be stored with food as long as they were not accessible to residents. The administrator further stated the medications in the plastic bag belonged in the boxes of injectable medication that had the prescribing information and resident name. On 8/7/25 at 2:00 p.m., Staff #1 stated Resident #2's refrigerated medications had been stored with food since he was admitted to the residence in June of 2024.
Plan of correction · submitted by the facility
Response to POC Tag # 0792We acknowledge the deficiency. Historically a secure medication box was in place and was being used until one of the staff members changed the code and locked the box and could not open it again. Corrective Action: a new and secure medication lock box has been put in place for refrigerated medications storage. Monitoring plan: review the med storage policy with the staff during the weekly staff meeting. Addendum to the Monitoring Plan: Added a line item / note to the MAR (Medication Administration Record) for all refrigerated medication must be stored in a secure box and isolated from the food and will be checked during the daily medication administration.monitoring will be conducted when each refrigerated meds are administered by the QMAP and recorded in the MAR. This will be checked daily and documented by the administrator during the weekly staff meeting. Monitoring started after the survey was conducted on August 7th and will continue as part of the MAR daily, weekly and monthly reconciliation process and QAPI process.
1710Ben/Svc Req-ACF-Inclusions
Findings
Based on interviews and record review, the facility (residence) failed to ensure an assessment was conducted prior to admission and at least annually, and documented the member (resident's) behavioral and social needs, affecting three of three residents who had a history of behaviors (#1-#3). (Cross reference B1770)Findings include:1. Resident #2 was admitted to the residence on 6/15/24 with diagnoses including paranoid schizophrenia, bi-polar disorder and post traumatic stress disorder (PTSD). An intake assessment dated 6/15/24, which was the residence's pre-admission assessment, was completed by the assistant administrator. The intake assessment read the resident was an elopement risk. An admission assessment dated 6/15/24, read on a scale of one to ten, the resident rated a four in combativeness toward others, and a five in wandering. However, there was no evidence the assessments addressed Resident #2's physical, behavioral or social needs. Moreover, there were no other assessments in the resident's record. On 8/7/25 at 7:50 a.m., Resident #2 stated approximately two days prior to the onsite investigation, he had left the residence and was unable to find his way back. Resident #3 stated "strangers" took him back to the residence. On 8/7/25 at 8:07 a.m., the administrator stated that Resident #2 would elope from the residence and be unable to find his way back home, and would also frequently refuse his medications. He further stated Resident #2 had engaged in a previous verbal altercation with Resident #5 and felt the residence was unable to meet his needs. On 8/7/25 at approximately 1:01 p.m., the administrator, who was also the administrator at Resident #2's former residence, stated Resident #2 was discharged from the residence since he had engaged in verbal altercations with other residents, wandered out of the residence and was unable to find his way back home, and was "out of control." The administrator stated he felt the resident required a secure environment. On 8/7/25 at approximately 1:30 p.m., acknowledged the residence's assessments did not include all the requirements. 2. Additionally, the residence failed to ensure a comprehensive pre-admission assessment was completed to include information on resident physical, behavioral and social needs for Residents #1 and #3.
Plan of correction · submitted by the facility
Response to POC 1710We acknowledge the deficiency..An assessment was conducted and placed in resident #2 folder. however, this resident has been refusing medications and any additional assessments or treatments. All the issues that were mentioned by surveyor have documents and were added to the resident file for review. Also, this resident has major drinking and drugs problems that will affect his behavior and the facility have not been able to transfer this resident to an alternative facility. Corrective Action: all records for resident #1, #2 and #3 were reviewed for completeness and proper location. Monitoring plan:all residence supporting documents have been reviewed and will be reviewed with the staff during the weekly staff meeting. Addendum to the Monitoring Plan: A checklist and an interval schedule has been developed for all/each resident to: re-create, review, ensure and sign off on all required documents: Assessment prior to admission for behavioral and social needs. Annually schedule, conduct and document the re-assessment and care plan for behavioral, social needs and daily living. All residence records, supporting documents have been reviewed and will be scheduled to be reviewed with the staff during the weekly, monthly, quarterly staff meetings to determine the list of residents requiring a re-assessment and signed off by the administrator during the weekly staff meeting. Monitoring and corrective action started after the survey was conducted on August 7th and will continue as part of the daily, weekly and monthly audit process and QAPI process.
1770Ben/Svc Req-ACF-PA-PCSP
Findings
Based on interview and record review, the facility (residence) failed to ensure that each resident care plan included special health or behavioral management needs that support the member (resident) affecting affecting three of four sample residents (#1-#3). (Cross reference B1710)Findings include:1. Resident #2 was admitted to the residence on 6/15/24 with diagnoses including paranoid schizophrenia, bi-polar disorder and post traumatic stress disorder (PTSD). An intake assessment dated 6/15/24, completed by the assistant administrator (AA). The intake assessment read the resident was an elopement risk. An admission assessment dated 6/15/24, completed by the AA, The assessment read on a scale of one to ten, the resident rated a four in combativeness toward others, and a five in wandering. However, the most recent care plan dated 6/15/24, did not include any behavioral interventions related to the resident's combative behavior and elopement risk. On 8/7/25 at 7:50 a.m., Resident #2 stated approximately two days prior to the onsite investigation, he had left the residence and was unable to find his way back. Resident #3 stated "strangers" took him back to the residence. On 8/7/25 at 8:07 a.m., the administrator stated that Resident #2 would elope from the residence and be unable to find his way back home, and would also frequently refuse his medications. He further stated Resident #2 had engaged in a previous verbal altercation with Resident #5. On 8/7/25 at 8:39 a.m., Resident #5 stated Resident #2 yelled expletives toward him "a lot," with a more severe expletive verbalized two weeks prior to the onsite investigation. On 8/7/25 at 12:29 p.m., Staff #1 stated Resident #2 engaged in verbal altercations with other residents and would leave the residence without telling staff where he was going. Staff #1 stated Resident #2 yelled at Resident #5 on 7/30/25. Staff #1 further stated there were no behavioral interventions in place in the residence's care plan. On 8/7/25 at approximately 1:30 p.m., the administrator acknowledged Resident #2 had behaviors that required staff intervention. The administrator stated he was aware of the requirement for care plans to include specific personal services needs and staff tasks necessary to meet those needs; however, he was unaware the care plan did not include that information. 2. There was similar deficient practice for Residents #1 and #3.
Plan of correction · submitted by the facility
Response to POC 1770We acknowledge the deficiency. An assessment was conducted and placed in resident #2 folder. however, this resident has been refusing medications and any additional assessments or treatments. All the issues that were mentioned by surveyor have documents and were added to the resident file for review. Also, this resident has major drinking and drugs problems that will affect his behavior and the facility have not been able to transfer this resident to an alternative facility. Corrective Action: all records for resident #1, #2 and #3 were reviewed for completeness and proper location. Addendum to the Monitoring Plan:A checklist and an interval schedule has been developed for all/each resident to: re-create, review, ensure and sign off on all required documents: Assessment prior to admission for behavioral and social needs. Annually schedule, conduct and document the re-assessment and care plan for behavioral, social needs and daily living. All residence records, supporting documents have been reviewed and will be scheduled to be reviewed with the staff during the weekly, monthly, quarterly staff meetings to determine the list of residents requiring a re-assessment and signed off by the administrator during the weekly staff meeting. Monitoring and corrective action started after the survey was conducted on August 7th and will continue as part of the daily, weekly and monthly audit process and QAPI process.
1780Ben/Svc Req-ACF-PA-Env Standards
Findings
Based on observations, record review and interview, the facility (residence) failed to maintain a home-like quality and feel for members (residents) at all times, affecting 12 current residents. Findings include:The residence's undated resident agreement read in part: "(The residence) agrees to make available... a physically safe and sanitary environment."On 8/7/25 from approximately 7:30 a.m. to 2:00 p.m., an environmental tour of the residence revealed the following:The residence grounds were covered in cigarette butts. The downstairs common area bathroom had a hole of approximately one foot, in the drywall above the shower. Additionally, the shower wall had six missing tiles that exposed concrete underneath, making it difficult to clean and sanitize. On 8/7/25 at 1:30 p.m., the administrator acknowledged the requirement to maintain a safe and sanitary environment. The administrator stated he had been having a difficult time finding someone to make repairs and residents continued to throw cigarette butts in the yard despite previous meetings about it.
Plan of correction · submitted by the facility
Response to POC Tag # 1780We acknowledge the deficiency. We have repeatedly notified all the residents and specifically the smokers in the house not to throw cigaret buts on the ground between the rocks and they did not listen. Signs were posted on the walls and have spoken to each individual and they promised not throw cigarette butts and they still did so! Smoking policy was reviewed and discussed during the house meeting in addition the smoking policy clearly states that smoking is only allowed in the designated smoking area and cigarettes butts to be disposed in the special containers. This issue has been a challenge to all of us and will be discussed during the house meeting. As for the missing tiles in the shower that was caused by one of the residents that punched the tiles and also waiting for the contractor to return and replace the tiles. As far as the hole in the bathroom ceiling we had a water leak the contractor opened the ceiling to repair the leak and stated that he need to repair another part before he closed the ceiling. Corrective action: all mentioned issues have been addressed and were repaired (Pictures will be provided for a desk revisit)Addendum to the Monitoring Plan:Smoking agreement was presented and signed by all smokers to ensure that they will not smoke and jeopardize or put the facility at risk.smoking area signed have been posted and house meeting is being held to discuss and address all house rules and smoking issues. A maintenance checklist and a maintenance schedule have been developed to review, ensure and sign off on all required maintenance and preventive maintenance schedule and needs. All facility maintenance records documents have been reviewed and will be reviewed with the staff during the weekly, monthly, quarterly staff meetings to determine the list of maintenance items / issues requiring immediate attention. Monitoring, corrective action and repairs started after the survey was conducted on August 7th and will continue as part of the daily, weekly and monthly review and audit process and QAPI process.
9999Final ObservationsSurveyor note
Findings
THIS PORTION OF THE REPORT IS FOR INFORMATIONAL PURPOSES ONLY. No response is necessary. The facility was advised it must review and maintain the following processes in accordance with existing program regulations found at 10 CCR 2505-10 8.7000.8.7414 Medication AdministrationA. Provider Agencies shall provide sufficient support to Members in the use of prescription and non- prescription medications. Members shall be presumed capable of self-administration unless they are determined otherwise. The type and level of medication administration support provided shall be determined by the results of an assessment performed by a qualified person. Medications shall be administered only by persons authorized in accordance with 6 C.C.R. 1011-1, Chapter VII and XXIV.8.7001B Resident Agreementa. Provider-Owned or -Controlled Residential Settings must have all of the following qualities and protect all of the following individual rights, based on the needs of the individual as indicated in their Person-Centered Support Plan, subject to the Rights Modification process in Section 8.7001. B.4: i. The unit or dwelling is a specific physical place that can be owned, rented, or occupied under a legally enforceable agreement by the individual, and the individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord/tenant law of the State, county, city, or other designated entity. For settings in which landlord/tenant laws do not apply, a lease, residency agreement, or other form of written agreement must be in place for each individual, and the document must provide protections that address eviction processes and appeals comparable to those provided under the jurisdiction's landlord/tenant law.
Plan of correction
The state did not require a plan of correction for this citation.
8/7/2025Licensure and Licensure Complaint (Combined) · ID TNGP119 deficiencies
0000Initial CommentsSurveyor note
Findings
A relicensure survey with complaint #CO40322 was completed on 8/7/25. Deficiencies were cited.
Plan of correction
The state did not require a plan of correction for this citation.
1010Res Ad/D/C-MoveIn CritS/S B
Findings
Based on record review and interview, the residence failed to complete a comprehensive pre-admission assessment of residents and ensure those persons' needs can be met fully by the existing staff, affecting three of three residents who had a history of behaviors (#1-#3). (Cross reference U1150, U1142 and U2230)Findings include: 1. Resident #2 was admitted to the residence on 6/15/24 with diagnoses including paranoid schizophrenia, bi-polar disorder and post traumatic stress disorder (PTSD). An intake assessment dated 6/15/24, which was the residence's pre-admission assessment, was completed by the assistant administrator. The intake assessment read the resident was an elopement risk. However, there was no evidence the assessment included the resident's mental and social needs. On 8/7/25 at 7:50 a.m., Resident #2 stated approximately two days prior to the onsite investigation, he had left the residence and was unable to find his way back. Resident #3 stated "strangers" took him back to the residence. On 8/7/25 at 8:07 a.m., the administrator stated that Resident #2 would elope from the residence and be unable to find his way back home, and would also frequently refuse his medications. He further stated Resident #2 had engaged in a previous verbal altercation with Resident #5 and felt the residence was unable to meet his needs. On 8/7/25 at approximately 1:01 p.m., the administrator, who was also the administrator at Resident #2's former residence, stated Resident #2 was discharged from the residence since he had engaged in verbal altercations with other residents, wandered out of the residence and was unable to find his way back home, and was "out of control." The administrator stated he felt the resident required a secure environment. 2. Additionally, the residence failed to ensure a comprehensive pre-admission assessment was completed to include information on resident mental and social needs for Residents #1 and #3.
Plan of correction · submitted by the facility
Response to POC 1010We acknowledge the deficiency. An assessment was conducted and placed in resident #2 folder. however, this resident has been refusing medications and any additional assessments or treatments. All the issues that were mentioned by surveyor have documents and were added to the resident file for review. Also, this resident has major drinking and drugs problems that will affect his behavior and the facility have not been able to transfer this resident to an alternative facility. Corrective Action: all records for resident #1, #2 and #3 were reviewed for completeness and proper location. Monitoring plan:all residence supporting documents have been reviewed and will be reviewed with the staff during the weekly staff meeting. Addendum to the Monitoring Plan: A checklist and an interval schedule has been developed for all/each resident to: re-create, review, ensure and sign off on all required documents: Assessment prior to admission for behavioral and social needs. Annually schedule, conduct and document the re-assessment and care plan for behavioral, social needs and daily living. All residence records, supporting documents have been reviewed and will be scheduled to be reviewed with the staff during the weekly, monthly, quarterly staff meetings to determine the list of residents requiring a re-assessment and signed off by the administrator during the weekly staff meeting. Monitoring and corrective action started after the survey was conducted on August 7th and will continue as part of the daily, weekly and monthly audit process and QAPI process.
1110Res Care Srvs-Min Srvs Res AgrS/S B
Findings
Based on observation, record review and interview, the residence failed to provide a physically safe environment, including measures to reduce the risk of potential hazards in the physical environment related to the unique characteristics of the population, affecting 12 current residents. Findings include:The residence's undated resident agreement read in part: "(The residence) agrees to make available... a physically safe and sanitary environment."On 8/7/25 from approximately 7:30 a.m. to 2:00 p.m., an environmental tour of the residence revealed the following:The residence grounds were covered in cigarette butts. The downstairs common area bathroom had a hole of approximately one foot, in the drywall above the shower. Additionally, the shower wall had six missing tiles that exposed concrete underneath, making it difficult to clean and sanitize. On 8/7/25 at 1:30 p.m., the administrator acknowledged the requirement to maintain a safe and sanitary environment. The administrator stated he had been having a difficult time finding someone to make repairs and residents continued to throw cigarette butts in the yard despite previous meetings about it.
Plan of correction · submitted by the facility
Response to POC Tag # 1110We acknowledge the deficiency. We have repeatedly notified all the smokers residents in the house not to throw cigarette buts on ground and between the rocks and they did not listen. Signs were posted on the walls and have spoken to each individual and they promised not throw cigarette butts and they still did so! Smoking policy clearly states that smoking is only allowed in the designated smoking area and cigarettes butts to be disposed in the special containers. As far as the hole in the bathroom ceiling we had a water leak the contractor opened the ceiling to repair the leak and stated that he need to repair another part before he closed the ceiling. As for the missing tiles in the shower that was caused by one of the residents that punched the tiles and also waiting for the contractor to return and replace the tiles. Corrective action: Writes ups were given to all violators and they agreed not to smoke outside the designated area again.all mentioned issues have been addressed and are being repaired as we speak (Pictures will be provided for a desk revisit) This issue has been a challenge to all and will be discussed during the house meeting. Monitoring plan: review all the above topics with the staff during the weekly staff meeting. We have repeatedly notified all the residents and specifically the smokers in the house not to throw cigaret buts on the ground between the rocks and they did not listen. Signs were posted on the walls and have spoken to each individual and they promised not throw cigarette butts and they still did so! Smoking policy was reviewed and discussed during the house meeting in addition the smoking policy clearly states that smoking is only allowed in the designated smoking area and cigarettes butts to be disposed in the special containers. This issue has been a challenge to all of us and will be discussed during the house meeting. As for the missing tiles in the shower that was caused by one of the residents that punched the tiles and also waiting for the contractor to return and replace the tiles. As far as the hole in the bathroom ceiling we had a water leak the contractor opened the ceiling to repair the leak and stated that he need to repair another part before he closed the ceiling. Corrective action: all mentioned issues have been addressed and were repaired (Pictures will be provided for a desk revisit)Addendum to the Monitoring Plan:Smoking agreement was presented and signed by all smokers to ensure that they will not smoke and jeopardize or put the facility at risk.smoking area signed have been posted and house meeting is being held to discuss and address all house rules and smoking issues. A maintenance checklist and a maintenance schedule have been developed to review, ensure and sign off on all required maintenance and preventive maintenance schedule and needs. All facility maintenance records documents have been reviewed and will be reviewed with the staff during the weekly, monthly, quarterly staff meetings to determine the list of maintenance items / issues requiring immediate attention. Monitoring, corrective action and repairs started after the survey was conducted on August 7th and will continue as part of the daily, weekly and monthly review and audit process and QAPI process.
1142Res Care Srvs-Comp Res Asmnt IncldS/S B
Findings
Based on interview and record reviews the residence failed to complete a comprehensive assessment that included all required information, affecting three of four sample residents (#1-#3). (Cross reference U1110, U1150 and U2230)Findings include:Resident #2 was admitted to the residence on 6/15/24 with diagnoses including paranoid schizophrenia, bi-polar disorder and post traumatic stress disorder (PTSD). An admission assessment dated 6/15/24, read on a scale of one to ten, the resident rated a four in combativeness toward others, and a five in wandering. However, the assessment did not include the types of physical, mental, or social support required, routines and interests, food and dining preferences and reactions to the environment and others that may occur at certain times or in certain circumstances. There were no other assessments in the resident's record. There was similar deficient practice for Residents #1 and #3. On 8/7/25 at approximately 1:30 p.m., the administrator stated he was aware of the requirement of what needed to be included in the comprehensive assessment and would make updates.
Plan of correction · submitted by the facility
Response to POC 1142We acknowledge the deficiencyAn assessment was conducted and placed in resident #2 folder. however, this resident has been refusing medications and any additional assessments or treatments. All the issues that were mentioned by surveyor have documents and were added to the resident file for review. Also, this resident has major drinking and drugs problems that will affect his behavior and the facility have not been able to transfer this resident to an alternative facility. Corrective Action: all records for resident #1, #2 and #3 were reviewed for completeness and proper location. Monitoring plan:all residence supporting documents have been reviewed and will be reviewed with the staff during the weekly staff meeting. Addendum to the Monitoring Plan:A checklist and an interval schedule has been developed for all/each resident to: re-create, review, ensure and sign off on all required documents: Assessment prior to admission for behavioral and social needs. Annually schedule, conduct and document the re-assessment and care plan for behavioral, social needs and daily living. All residence records, supporting documents have been reviewed and will be scheduled to be reviewed with the staff during the weekly, monthly, quarterly staff meetings to determine the list of residents requiring a re-assessment and signed off by the administrator during the weekly staff meeting. Monitoring and corrective action started after the survey was conducted on August 7th and will continue as part of the daily, weekly and monthly audit process and QAPI process.
1150Res Care Srvs-Res CPS/S B
Findings
Based on interviews and record review, the residence failed to ensure each resident care plan promoted resident safety and detailed specific personal service needs and preferences along with the staff tasks necessary to meet those needs, affecting three of four sample residents (#1-#3). (Cross reference U1010, U1142 and U2230)Findings include:1. Resident #2 was admitted to the residence on 6/15/24 with diagnoses including paranoid schizophrenia, bi-polar disorder and post traumatic stress disorder (PTSD). An intake assessment dated 6/15/24 was completed by the assistant administrator (AA). The intake assessment read the resident was an elopement risk. An admission assessment dated 6/15/24, completed by the AA, The assessment read on a scale of one to ten, the resident rated a four in combativeness toward others, and a five in wandering. However, the most recent care plan, dated 6/15/24, did not include any behavioral interventions related to the resident's combative behavior and elopement risk. On 8/7/25 at 7:50 a.m., Resident #2 stated approximately two days prior to the onsite investigation, he had left the residence and was unable to find his way back. Resident #3 stated "strangers" took him back to the residence. On 8/7/25 at 8:07 a.m., the administrator stated that Resident #2 would elope from the residence and be unable to find his way back home, and would also frequently refuse his medications. He further stated Resident #2 had engaged in a previous verbal altercation with Resident #5. On 8/7/25 at 8:39 a.m., Resident #5 stated Resident #2 yelled expletives toward him "a lot," with a more severe expletive verbalized two weeks prior to the onsite investigation. On 8/7/25 at 12:29 p.m., Staff #1 stated Resident #2 engaged in verbal altercations with other residents and would leave the residence without telling staff where he was going. Staff #1 stated Resident #2 yelled at Resident #5 on 7/30/25. Staff #1 further stated there were no behavioral interventions in place in the residence's care plan. On 8/7/25 at approximately 1:30 p.m., the administrator acknowledged Resident #2 had behaviors that required staff intervention. The administrator stated he was aware of the requirement for care plans to include specific personal services needs and staff tasks necessary to meet those needs; however, he was unaware the care plan did not include that information. 2. There was similar deficient practice for Residents #1 and #3.
Plan of correction · submitted by the facility
Response to POC 1150We acknowledge the deficiency. Resident #3 was brought in as a respite for couple of day. All the issues that were mentioned by surveyor have documents and were added to the resident file for review. An assessment was conducted and placed in resident #2 folder. however, this resident has been refusing medications and any additional assessments or treatments. All the issues that were mentioned by surveyor have documents and were added to the resident file for review. Also, this resident has major problems that will affect his behavior and the facility have not been able to transfer this resident to an alternative facility. Corrective Action: all records for resident #1, #2, #3 and #5 were reviewed for completeness and proper location. Monitoring plan:all residence supporting documents have been reviewed and will be reviewed with the staff during the weekly staff meeting. Addendum to the Monitoring Plan: A checklist and an interval schedule has been developed for all/each resident to: re-create, review, ensure and sign off on all required documents: Assessment prior to admission for behavioral and social needs. Annually schedule, conduct and document the re-assessment and care plan for behavioral, social needs and daily living. All residence records, supporting documents have been reviewed and will be scheduled to be reviewed with the staff during the weekly, monthly, quarterly staff meetings to determine the list of residents requiring a re-assessment and signed off by the administrator during the weekly staff meeting. Monitoring and corrective action started after the survey was conducted on August 7th and will continue as part of the daily, weekly and monthly audit process and QAPI process.
1394Res Rghts-Res Mtgs Wrt MinS/S B
Findings
Based on interview and record review the residence failed to ensure written minutes of resident meetings were maintained and readily available for review, affecting 12 current residents. Findings include:On 8/7/25 at 7:57 a.m., meeting minutes for the last three resident council meetings were requested. Meeting minutes were requested again at 12:37 p.m. As of 2:00 p.m., the time of exit, no resident meeting minutes were provided. On 8/7/25 at 11:21 a.m., the administrator stated he would be unable to provide resident meetings until after the onsite investigation, since they were written on his phone. The administrator had his phone on his person at the time of the survey. On 8/7/25 at 1:30 p.m., the administrator stated he was aware resident meetings were required to be readily available; however, he believed the notes on his phone were sufficient.
Plan of correction · submitted by the facility
Response to POC 1394Meeting minutes were provided to the state surveyor via email and she acknowledged receipt. I have an email response from the surveyor dated August 7th 2025 stating that she will review the documents. Corrective Action: all house meeting will be printed and posted at the facility on monthly basis. Monitoring plan:all house meeting records will be printed and posted and will be reviewed with the staff during the weekly staff meeting. Addendum to the Monitoring Plan: House meetings were being held and will continue to be held on monthly basis and will be posted on the bulletin board in the common area. Additional house meeting will be scheduled at time if we feel there has been issue or topics or urgent announcement to be discussed. An interval house meeting schedule and an agenda have been developed to discuss: announcements, events, celebrations, Birthdays, new residents, holidays, parties, activities issues, review open issues from the last house meeting, challenges for the month and Q&A.Meeting notes were provided electronically to the surveyor before departing from the facility in August 7th. Monitoring and corrective all house meeting records will be printed and posted and will be reviewed with the staff during the weekly staff meeting and will continue as part of the monthly meetings process and QAPI process.
1636Med/Med Adm-Med Strge RefridgeS/S B
Findings
Based on observations and interviews, the residence failed to ensure all refrigerated medications were clearly labeled with the resident's name and prescribing information, and were stored in a refrigerator that did not contain food, affecting one of one sample residents on refrigerated medications (#2). Findings include:1. ObservationsOn 8/7/25 at 8:07 a.m., an environmental tour revealed a "staff only" sign was on a door that led to the garage, where there was a refrigerator filled with food which was also the medication refrigerator. The refrigerated medications included as follows:A box of Lantus 100 unit injectionsA box of risperidone 200 mg injectionsA clear bag with a single dose of Humulog 100 unit and Lantus 100 unit injections. However, the clear bag was not labeled with the resident's name or prescribing information. 2. InterviewsOn 8/7/25 at 8:07 a.m., the administrator stated Resident #2 was the only resident on refrigerated medications. The administrator further stated that food was also stored in the refrigerator that was used by staff to make resident meals. On 8/7/25 at approximately 1:30 p.m., the administrator stated he believed that refrigerated medications could be stored with food as long as they were not accessible to residents. The administrator further stated the medications in the plastic bag belonged in the boxes of injectable medication that had the prescribing information and the resident's name. On 8/7/25 at 2:00 p.m., Staff #1 stated Resident #2's refrigerated medications had been stored with food since he was admitted to the residence in June of 2024.
Plan of correction · submitted by the facility
Response to POC Tag # 1636We acknowledge the deficiency. Historically a secure medication box was in place and was being used until one of the staff members changed the code and locked the box and could not open it again. Corrective Action: a new and secure medication lock box has been put in place for refrigerated medications storage. Monitoring plan: review the med storage policy with the staff during the weekly staff meeting. Addendum to the Monitoring Plan: Added a note to the MAR (Medication Administration Record) that all refrigerated medication must be stored in a secure box and isolated from the food and will be checked during the medication administration.monitoring will be conducted each refrigerated meds are administered by the QMAP and recorded in the MAR. This will be checked and documented by the administrator during the weekly staff meeting. Monitoring started after the survey was conducted on August 7th and will continue as part of the MAR daily, weekly and monthly reconciliation process and QAPI process.
2230HIR-Cntnt IncldS/S B
Findings
Based on interviews and record review, the residence failed to require staff members to document, before the end of their shift, any out of the ordinary event or issues affecting three of four sample residents (#1-#3). (Cross reference U1010, U1142 and U1150). Findings include:1. Resident #2 was admitted to the residence on 6/15/24 with diagnoses including paranoid schizophrenia, bi-polar disorder and post traumatic stress disorder (PTSD). Progress notes of all out of the ordinary events affecting Resident #2 were requested; however, there was no documentation in progress notes of the following:On 8/7/25 at 7:50 a.m., Resident #2 stated approximately two days prior to the onsite investigation, he had left the residence and was unable to find his way back. Resident #3 stated "strangers" took him back to the residence. On 8/7/25 at 8:07 a.m., the administrator stated that Resident #2 would elope from the residence and be unable to find his way back home. He further stated Resident #2 had engaged in a previous verbal altercation with Resident #5 over the television. On 8/7/25 at 8:39 a.m., Resident #5 stated Resident #2 yelled expletives toward him "a lot," with a more severe expletive verbalized two weeks prior to the onsite investigation. On 8/7/25 at 11:21 a.m., the administrator stated he documented through pictures and notes on his phone incidents he was made aware of. The assistant administrator added that the documentation of out of the ordinary behaviors is "eviction notices."On 8/7/25 at 12:29 p.m., Staff #1 stated Resident #2 had verbal altercations with other residents and would leave the residence without telling staff where he was going. Staff #1 stated Resident #2 yelled at Resident #5 on 7/30/25. Staff #1 further stated she was trained to inform the administrator of out of the ordinary events and did not document them unless related to medication refusals. On 8/7/25 at approximately 1:30 p.m., the administrator stated he thought making notes on his phone and pictures of incidents were sufficient. He was unaware residence staff needed to document in the progress notes in the resident record out of the ordinary events. 2. There was similar deficient practice for Residents #1 and #3.
Plan of correction · submitted by the facility
Response to POC 2230We acknowledge the deficiency. Resident #3 was brought in as a respite for couple of day. All the issues that were mentioned by surveyor have documents and were added to the resident file for review. An assessment was conducted and placed in resident #2 folder. however, this resident has been refusing medications and any additional assessments or treatments. All the issues that were mentioned by surveyor have documents and were added to the resident file for review. Also, this resident has major problems that will affect his behavior and the facility have not been able to transfer this resident to an alternative facility. Corrective Action: all records for resident #1, #2 and #3 were reviewed for completeness and proper location. Monitoring plan:all residence supporting documents have been reviewed and will be reviewed with the staff during the weekly staff meeting. Addendum to the Monitoring Plan: A checklist and an interval schedule has been developed for all/each resident to: re-create, review, ensure and sign off on all required documents: Assessment prior to admission for behavioral and social needs. Annually schedule, conduct and document the re-assessment and care plan for behavioral, social needs and daily living. All residence records, supporting documents have been reviewed and will be scheduled to be reviewed with the staff during the weekly, monthly, quarterly staff meetings to determine the list of residents requiring a re-assessment and signed off by the administrator during the weekly staff meeting. Monitoring and corrective action started after the survey was conducted on August 7th and will continue as part of the daily, weekly and monthly audit process and QAPI process.
2516Ex Env MntnedS/S B
Findings
Based on observation and interview, the residence failed to keep the residence handrails in good repair, affecting 12 current residents. Findings include:On 8/7/25 from approximately 7:30 a.m. to 2:00 p.m., an environmental tour of the residence revealed the handrails on the ramp at the front of the residence had peeling paint and splintering wood. On 8/7/25 at approximately 1:30 p.m., the administrator acknowledged the requirement to keep handrails in good repair. The administrator stated he had been having a difficult time finding someone to make repairs.
Plan of correction · submitted by the facility
Response to POC Tag # 2516We acknowledge the deficiency. The handrails has been maintained/painted repeatedly throughout the year. We have spoken to the contractor to repaint it and they suggested different type of paint. Corrective action: all mentioned issues have been addressed and are being repaired as we speak (Pictures will be provided for a desk revisit). Monitoring plan: review all the above topics with the staff during the weekly staff meeting. Addendum to the Monitoring Plan:A maintenance checklist and a maintenance schedule have been developed to review, ensure and sign off on all required maintenance and preventive maintenance schedule and needs. All facility maintenance records documents have been reviewed and will be reviewed with the staff during the weekly, monthly, quarterly staff meetings to determine the list of maintenance items / issues requiring immediate attention. Monitoring, corrective action and repairs started after the survey was conducted on August 7th and will continue as part of the daily, weekly and monthly review and audit process and QAPI process.
2680In Env-BR TP dspnsrS/S B
Findings
Based on observation and interviews, the residence failed to provide paper towels or hand drying devices in each common bathroom, affecting 12 current residents. Findings include:On 8/7/25 from approximately 7:30 a.m. to 2:00 p.m., an environmental tour revealed all three common area bathrooms at the residence failed to make available paper towels or any other hand drying devices. On 8/7/25 at 7:33 a.m., Resident #4 stated there was a hand towel in the bathrooms; however, it had been gone for about a week prior to the onsite investigation. Resident #4 stated he had been drying his hands on his clothes. On 8/7/25 at 8:39 a.m., Resident #5 stated he believed there were no paper towels or other hand drying devices for approximately a month prior to the onsite investigation. Resident #5 stated he dried his hands by "shaking them off."On 8/7/25 at 8:52 a.m., Resident #1 stated there had been no hand drying devices or paper towels for as long as he could remember. He further stated he dried his hands on his clothes. On 8/7/25 at 11:16 a.m., Staff #1 stated the residence did not use paper towels. She stated she provided fabric towels for handwashing; however, she was washing them. On 8/7/25 at approximately 1:30 p.m., the administrator acknowledged he was aware of the requirement for there to be paper towels or hand drying devices in each common bathroom. The administrator stated if there weren't paper towels, it was because residents took them.
Plan of correction · submitted by the facility
Response to POC Tag # 2680We acknowledge the deficiency. Corrective action: Paper towel dispensers have been installed to prevent the residents from taking the full roles of paper towels and hide it their roomMonitoring plan: paper towels dispensers will be checked daily by the staff! also, discussed with the residence during the house meeting to remind the staff to refill the dispensers when they are out. Addendum to the Monitoring Plan: Added line items/notes to the cleaning schedule to check and initial that paper towels, toilet papers and other cleaning supplies are sufficient for the entire day at each of the bathrooms in the house.monitoring will be conducted during the cleaning process each day and at the change of each shift. administered will check and sign off that each bathroom has been cleaned and supplies are replenished every day. This will be checked and documented by the administrator during the weekly, monthly and quarterly staff meeting. Monitoring started after the survey was conducted on August 7th and will continue as part of the daily cleaning process and QAPI process.
9999Final ObservationsSurveyor note
Findings
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 7.7.13 Each personnel file shall include, but not be limited to, written documentation regarding the following items: (C) Orientation and training, including, but not limited to the following, as applicable: (1) First aid and CPR certification. 11.3 At the time the resident moves in, the assisted living residence shall ensure that the resident and/or the resident ' s legal representative has received a copy of the written resident agreement and agreed to the terms set forth therein. The assisted living residence shall ensure that the agreement is signed and dated by both parties. 14.11 Only medication that has been ordered by an authorized practitioner shall be prepared for or administered to residents. 14.21 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.
Plan of correction
The state did not require a plan of correction for this citation.
1/30/2024Revisit: CHOW and Licensure (Re-licensure) (Combined) · ID 9RMS12No deficiencies
0000Initial CommentsSurveyor note
Findings
A revisit survey was completed on 1/30/24 for all previous deficiencies cited on 2/15/23. The facility is in compliance with all deficiencies that were cited.
Plan of correction
The state did not require a plan of correction for this citation.
1/30/2024Revisit: State Certification (Re-certification) · ID OQ5K12No deficiencies
0000Initial CommentsSurveyor note
Findings
A revisit survey was completed on 1/30/24 for all previous deficiencies cited on 2/15/23. The facility is in compliance with all deficiencies that were cited.
Plan of correction
The state did not require a plan of correction for this citation.
1/30/2024Revisit: Licensure Complaint · ID TF9K14No deficiencies
0000Initial CommentsSurveyor note
Findings
A revisit survey was completed on 1/30/24 for all previous deficiencies cited on 2/15/23. The facility is in compliance with all deficiencies that were cited.
Plan of correction
The state did not require a plan of correction for this citation.
2/14/2023CHOW and Licensure (Re-licensure) (Combined) · ID 9RMS119 deficiencies
0000Initial CommentsSurveyor note
Findings
A relicensure survey was completed on 2/15/23. Deficiencies were cited.
Plan of correction
The state did not require a plan of correction for this citation.
0172LicProc-IntlApp CAPSS/S B
Findings
Based on observation, record review and interview, the residence failed to ensure applicants complied with Colorado Adult Protective Service Data System (CAPS) requirements prior to hiring staff who provided care to the residents, affecting two of three sample staff (#3, #5). 1. Findings include:a. According to Colorado Revised Statutes (2020) Title 26 Human Services Code," ... individuals receiving care and services from persons employed in programs or facilities ... are vulnerable to mistreatment, including abuse, neglect, and exploitation. It is the intent of the general assembly to minimize the potential for employment of persons with a history of mistreatment of at-risk adults in positions that would allow those persons unsupervised access to these adults. As a result, the general assembly finds it necessary to strengthen protections for vulnerable adults by requiring certain employers to request a CAPS check by the state department to determine if a person who will provide direct care to an at-risk adult has been substantiated in a case of mistreatment of an at-risk adult."b. C.R.S. 26-3.1-101 (1.8) reads a "CAPS check" means a check of the Colorado adult protective services data system pursuant to section 26-3.1-111.c. Chapter VII regulations governing assisted living residences, part 2.7, defines an "At-risk person" as any person who is 70 years of age or older, or any person who is 18 years of age or older and meets one or more of the following criteria: (D) Is a person with an intellectual and developmental disability as defined in Section 25.5-10-202, C.R.S.; (E) Is a person with a mental health disorder as defined in Section 27-65-102(11.5), C.R.S.2. ObservationThroughout the on-site visit on 2/14/23 from 7:30 a.m. to 4:30 p.m., Staff #3 was providing care and services to all the residents. 3. Record ReviewOn 2/14/23, a review of Staff #3's record revealed a hire date of 5/23/22. There was no documentation that a CAPS check was requested or completed for Staff #3. On 2/14/23, a review of Staff #4's record revealed a hire date of 3/1/22. There was no documentation that a CAPS check was requested or completed for Staff #4.4. InterviewOn 2/14/23 at 9:50 a.m., Staff #3 stated she worked at the residence for approximately eight months providing direct care to the residents. On 2/14/23 at 3:45 p.m., the administrator stated he was aware CAPS checks were required to be completed for staff and stated he was responsible for completing CAPS for the staff at the residence. The administrator stated it was important to have them prior to hire to make sure the new hires did not have a criminal background and so the facility could rule out hiring individuals who had been charged with abuse. The administrator acknowledged the staff files for Staff #3, #4 and #5 did not contain documentation of a request for a CAPS check. He stated CAPS checks had been completed for all staff and were maintained offsite at his home computer.
Plan of correction · submitted by the facility
Response to POC Tag # 0172Staff # 3 had all the required documents including CAPS document. However, this employee works at multiple locations. We had to retrieve the documents from another location as well as some of the employees' files were located at the home office. In addition, this facility has only 3 employees including the administrator. However, tag #0172 indicates that we have 5 employees. I think the surveyor got mixed with the fact that the administrator was showing examples of all the employees folders that works at our sister facilities. Corrective Action: CAPS document was and has been included in the employee folder which currently located at the facility. Monitoring plan: No person Staff/Employee/Volunteer will be allowed to perform a job at the facility without having all the training documents and certification at the facility at all times. Going forward, A copy of the CAPS documents has been added to the employee file and a duplicate full employees files will be available at each location the employee(s) will be working at. Completion date: Feb 24th 2023
0662Prsnnl-Prsnnl Files Dept RvwS/S B
Findings
Based on observation, interview and record review, the residence failed to have personnel files for current employees available on site for Department review, affecting three of three sample staff (#3, #4, #5). Findings include:1. Referencesa. Chapter VII regulations governing assisted living residences, part 2.45, defines "Staff" as employees and contracted individuals intended to substitute for or supplement employees who provide personal services. "Staff' does not include individuals providing external services, as defined herein.b. Chapter VII regulations governing assisted living residences, part 7.12, requires each personnel file shall include, but not be limited to, written documentation regarding the following items:(B) Date of hire or acceptance of volunteer service and date duties commenced;(C) Orientation and training, including first aid and CPR certification, if applicable;(F) Tuberculin test results, if applicable. 2. ObservationThroughout the on-site visit on 2/14/23 from 7:30 a.m. to 4:30 p.m., Staff #3 was observed providing care and services to all the residents. 3. Record ReviewOn 2/14/23 at 8:25 a.m., personnel files for Staff #3-#5 were requested from the administrator. However, the complete personnel filed for Staff #3, #4 and #5 were not provided at all. On 2/14/23 at 8:40 a.m., Staff #3's personnel file was provided by the administrator, however the staff file did not contain the documentation of description of the employee or volunteer duties, date of hire or acceptance, and results of background checks and follow up. On 2/14/23 at 8:40 a.m., Staff #4's personnel file was provided by the administrator, however the staff file did not contain a description on employee or volunteer duties, orientation and training including first aid and cardiopulmonary resuscitation (CPR) certification, tuberculin test results. On 2/14/23 at 8:40 a.m., Staff #5's personnel file was provided by the administrator, however the staff file did not contain the documentation of first aid and cardiopulmonary resuscitation (CPR) certification. On 2/14/23 at 9:30 a.m., the administrator provided electronic copies of the requested Staff #3 training and orientation and hire date. However, the tuberculin test results for Staff #3 was not provided. 4. InterviewOn 2/14/23 at approximately 3:15 p.m., the administrator stated the residence did not maintain personnel files onsite at the residence. He stated personnel files for all the staff were maintained offsite at his home computer, approximately 30 minutes. He stated he did not have access to all the staff files electronically. The administrator stated he was not aware of the requirement to have personal files on site and readily available. The administrator added the personal files should have been accessible and were readily available for department review and added he took all the staff files to his home office to do staff files audit.
Plan of correction
The state did not require a plan of correction for this citation.
0910Em Pr-P/P Res InfoS/S B
Findings
Based on record review and interview, the residence failed to include residents full name and emergency contact information on the roster of current residents along with a diagram that showed room locations, affecting eight current residents. Findings include:On 2/14/23 at approximately 7:30 a.m., a current resident roster was requested from Staff #3, however, she was unable to provide a resident roster. Staff #3 asked the surveyor to wait until the administrator arrived so that the administrator could provide the resident roster. On 2/14/23 at 8:15 a.m., a current resident roster was requested from the administrator. On 2/14/23 at 8:20 a.m., the administrator provided a handwritten list of resident names. The handwritten list of residents did not include residents' full names and emergency contact information for the eight current residents. Additionally, the resident roster did not include a diagram that showed room locations. On 2/14/23 at approximately 3:50 p.m., the administrator stated he was aware the requirements for the resident roster; however, he stated he was not aware that the resident roster should contain the diagram that showed the room locations. The administrator stated he did not have a current resident roster that included the required information and added the handwritten list was the only resident roster the residence had.
Plan of correction · submitted by the facility
Tag Number 0910: we acknowledge the deficient practice. Plan of correction: resident roster has been updated and with a new diagram and names, room number and emergency contact information. Monitoring plan: Admin to ensure that the resident roster is updated at the same time when the monthly fire drill is conducted. Completion date: feb 20th 2023
1332Res Rghts-House Rules ViolationS/S B
Findings
Based on record review and interview, the residence failed to ensure the house rules listed all possible actions which may be taken by the residence if any rule was knowingly violated by a resident, affecting eight current residents. Findings include: On 2/14/23 at 8:30 a.m., the residences House Rules were provided and revealed the house rules did not list all possible actions which may have been taken by the residence if a resident had knowingly violated the house rules. On 2/14/23 at 9:44 a.m., Resident #3 stated residents were not allowed to consume marijuana or smoke in their rooms. She stated if a resident were to smoke cigarettes in their rooms she believed they would be issued a 30 day discharge notice. Resident #3 stated her room mate (former resident) used to smoke cigarettes in her room but she failed to answer what actions were taken against the former resident. On 2/14/23 at approximately 3:45 p.m., the administrator stated if a resident violated the house rules they were issued a behavioral contract or verbal warning and if there was continued violation the resident would be evicted from the residence. He stated he was not aware the house rules were required to list the possible actions for knowingly violating the rules. The administrator stated he thought the house rules were not allowed to violate the resident rights and including the possible action would be close to violating the residents rights.
Plan of correction · submitted by the facility
Tag # 1332 The house rules that were posted on the wall did not have the full document due to frame size limitation which was accepted by the FINAL riule setting inspector during her inspection of the final rules setting that was performed on the same day! please find the rules: Here is what the rules read: If any rule is knowingly violated by a resident, a care conference will be scheduled with the resident, the resident’s representative, the Community Staff, the Case Manager, and the Ombudsman, if necessary. The severity of the violation will be discussed to determine the course of action, and efforts will be made by all parties to correct and mitigate the situation. However, if the resident continues to knowingly violate a House Rule, a Rights Modification may occur, or the Community may need to follow the Discharge Policy. A house meeting was conducted on Feb 20th 2023 and all residents were re-informed the house rules and violation of the rules. Correction date: Feb 21/2023
1430Med/Med Adm-Gen Rq Pract OrdrS/S B
Findings
Based on record review and interview, the residence failed to ensure only medication ordered by an authorized practitioner were administered to residents, affecting two of three sample residents (#4 and #7). Findings include: 1. Reference a. Chapter VII regulations governing assisted living residences, part 2.26, defines medication administration as assisting a person in the ingestion, application, inhalation, or, using universal precautions, rectal or vaginal insertion of medication, including prescription drugs, according to the legibly written or printed directions of the attending physician or other authorized practitioner, or as written on the prescription label, and making a written record thereof with regard to each medication administered, including the time and the amount taken. b. The Medication and Medication Administration policy, dated 10/19 read in part, "an employee or volunteer is not permitted to administer or assist with administering medication to a resident unless such individual is a practitioner, a nurse, a qualified medication administration person (QMAP), or a certified nurse medication aide (CNA-Med) acting within his or her scope of practice. 2. Resident #4 was admitted to the residence on 4/10/17 with diagnoses including hypertension, depression, gastro esophageal reflux disease. The January and February 2023 medication administration record (MAR) for Resident #4 documented the administration of five medications in which no practitioner's order could be located. 1. Aspirin 81 mg tablet once daily on 1/1-1/31, 2/1 to 2/14/232. Glucosamine complex capsule one tablet once daily on 1/1-1/31, 2/1 to 2/14/233. Pioglitazone 15 mg once daily from 1/1-1/31, 2/1-2/13/234. Venlafaxine ER 150 mg every morning on 1/1-1/31, 2/1-2/14/23The record for Resident #4 revealed no evidence of signed practitioner's orders for the above four medications. 3. Resident #7 was admitted to the residence on 9/1/22 with unknown diagnoses. The January and February 2023 MAR for Resident #7 documented the administration of Lamotrigine 200 mg daily in the morning in which no practitioner's order could be located from 1/1-31, 2/1-2/14/23. On 2/14/23 at approximately 12:25 p.m., the administrator stated he did not receive an order for Lamotrigine. On 2/14/23 at 12:30 p.m., the administrator stated Resident #4 telephoned and/or visited his practitioner every single day to complain about his health. The administrator stated Resident #4's external service providers prescribed medications to Resident #4 and send the list to the pharmacy. He stated the new signed medication order list was not sent to the residence and stated as a result the residence was missing orders for Resident #4. He stated he audited all the medication orders for the residents on 12/14/22 and failed to locate all the practitioner orders for Resident #4 and #7. He acknowledged that the residence did not have all the signed orders for Resident #4 and #7.
Plan of correction · submitted by the facility
Response to POC Tag # 1430 : We acknowledge the deficient practice. Plan of correction: all existing and new medication will have a signed order before they are administered. 4 way meeting was conducted between: the facility staff, the PCP and the pharmacy to ensure that all medication orders for all residents are reconciled and 100% accurate. also, residents were asked to involve the staff when requesting a change of medications in order to keep track of any changes in his situation or medications. Also, the facility, the PCP and pharmacy agreed to exchange and reconcile the MAR on monthly basis. In addition, QMAP staff were retrained via refresher on medication administration topics surrounding MAR recordkeeping, charting, audit review, medication storage, controlled substance perpetual count keeping, expiration management, cycle medication/meds on hands policy. Trainer was able to review the MARs and observe sample medication passes and made corrective actions and teachings on MAR completeness and signatures, reviewing expiration dates, ensuring corresponding signed doctor orders were retrievable. A daily, weekly and monthly audit of the medication administration will be conducted by the administrator and 3rd party QMAP person will be conducted to ensure accuracy. All process improvements will be documented and added to the Quality manual. Completion date of the initial corrective action Feb 24th 2023 and will continue on daily and weekly basis for ever.
1468Med/Med Adm-Ordrs Cmpy w/OrdrsS/S B
Findings
Based on observation, interview and record review, the residence failed to comply with authorized practitioner orders, affecting two of four sample residents (#7, #8). Findings include:1. Residence policyThe residence's Medication Administration policy, read in part, "This community complies with all applicable federal and state statutes and regulations, including but not limited to Chapter 7 and Chapter 24 ... This community complies with all federal and state laws and regulations relating to procurement, storage, administration, and disposal of controlled substances."2. Resident #8 was admitted to the residence on 5/12/22 with diagnoses including schizophrenia, major depressive disorder. a. MelatoninA written practitioner's order, dated 6/14/22, directed the residence to administer Melatonin five mg once daily every evening at bed time. However, the January and February 2023 medication administration record (MAR) read the residence did not administer the medication from 1/1-1/31, 2/1-2/13/23 as the medication was not available for a total of 45 missed doses b. FluticasoneA written practitioner's order, dated 5/23/22, directed the residence to instill fluticasone 50 mcg one spray in each nostril daily. However, the January and February 2023 MAR read the medication was not administered as the medication was not available 1/1-1/31, 2/1-2/13/23 for a total of 45 missed doses. On 2/14/23 at approximately 12:20 p.m., Staff #3 stated Resident #8's fluticasone and melatonin were not available. On 2/14/23 at 12:30 p.m., the administrator stated Resident #8 did not receive the above medications because they were not available. He sated Staff #3 did not document on the MARs that the medication was out of stock. He stated Resident #8 was responsible for ordering his own medications and the resident did not order because he did not want the medication. However, he confirmed the medication for Resident #8 was not administered as ordered. 3. Resident #7 was admitted to the residence on 9/1/22 with an unknown diagnosis.a. HydroxyzineA written practitioner's order, dated 10/3/22, directed the residence to administer hydroxyzine HCL 50 mg once daily. However, the February 2023 MAR read the residence did not administer the medication from 2/7-2/14/23, for a total of eight missed doses. On 2/14/23 at 12:20 p.m., Staff #3 stated she administered medications according to the instructions on the MARs. She stated if there was a discrepancy from the medication list to the MARs, she followed instructions to administer the medication per the MAR. Staff #3 confirmed Resident #7 did not receive his medication. On 2/14/23 at 12:30 p.m., the administrator stated he and Staff #3 were responsible for ensuring medication orders were input into the resident files. The administrator stated Resident #7 telephoned and/or visited his practitioner every single day to complain about his health. The administrator stated Resident #7's external service providers discontinued (DC'd) medications for Resident #7 and send the list directly to the pharmacy. He stated the new signed DC'd order list was not sent to the residence and stated as a result the residence was missing new orders for Resident #7. He stated he audited all the resident's medication orders on 12/14/22 and failed to locate all the practitioner orders for Resident #7. However, he confirmed the resident was not administered medications as ordered.
Plan of correction · submitted by the facility
Response to POC Tag # 1468 : We acknowledge the deficient practice. However, this tag seems to have the same verbiage as Tag # 0623 and tag # 1430Plan of correction: all existing and new medication will have a signed order before they are administered. 4 way meeting was conducted between: the facility staff, the PCP and the pharmacy to ensure that all medication orders for all residents are reconciled and 100% accurate. also, all residents were asked to involve the staff when requesting a change of medications in order to keep track of any changes in his situation or medications. Also, the facility, the PCP and the pharmacy agreed to exchange and reconcile the MAR on monthly basis. In addition, QMAP staff were retrained via refresher on medication administration topics surrounding MAR recordkeeping, charting, audit review, medication storage, controlled substance perpetual count keeping, expiration management, cycle medication/meds on hands policy. Trainer was able to review the MARs and observe sample medication passes and made corrective actions and teachings on MAR completeness and signatures, reviewing expiration dates, ensuring corresponding signed doctor orders were retrievable. Daily / weekly audit of the MAR and PCP orders will be checked by the administrator and a 3rd party QMAP to ensure that all MARs are matching the orders and medications administered and signed off correctly. Completion date: Feb 25th 2023 Daily / weekly Monitoring will be conducted by the administrator on daily / weekly basis and by the PCP and pharmacy on monthly basis.
2312Phy Pl Stnd ExcptnsS/S B
Findings
Based on observation, record review and interview, the residence failed to comply with the rules pertaining to Facilities Guidelines Institute (FGI) review, affecting eight current residents. Findings include:1. ReferencesChapter II regulations, general licensure standards governing health facilities, contains the following definitions and rules: Part 1.25, defines "FGI Guidelines" as the Guidelines for Design and Construction of Hospitals, Guidelines for Design and Construction of Outpatient Facilities, and Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, published by the Facilities Guidelines Institute. Part 1.43, defines "Minor alterations" as building construction projects which are not additions, which do not affect the structural integrity of the building, which do not change functional operation, and/or which do not add beds or capacity above what the facility (residence) is limited to under the existing license. Part 1.52, defines "Renovation" as the moving of walls and reconfiguring of existing floor plans. It includes the rebuilding or upgrading of major systems, including but not limited to: heating, ventilation, and electrical systems. It also means the changing of the functional operation of the space. Renovations do not include "minor alterations," as defined herein. Part 3.2.1, requires each facility (residence) or agency shall be in compliance with all applicable local zoning, housing, fire, and sanitary codes and ordinances of the city, city and county, or county where it is situated, to the extent that such codes and ordinances are consistent with federal law. Part 3.2.3 requires that, for any construction or renovations of a facility (residence) or agency initiated on or after July 1, 2020, the following requirements of the 2018 Editions, Facilities Guidelines Institute including any errata and guideline interpretations adopted as of November 1, 2019, are incorporated by reference, as applicable to facility (residence) or agency license type:(C) for residential facilities, including but not limited to Assisted Living Residences. Part 3.2.4 requires facilities to maintain the facility (residence) to the FGI Guidelines under which the Department approved the facility's (residence) or agency's initial license until such time as a new guideline compliance review occurs as required by this Part 3. Part 3.3.1, requires that a guideline compliance review is required by the following:(A) Addition to a facility (residence) or agency, as defined in Part 1.2 of these rules.(B) New construction of a facility (residence) or agency, as defined at Part 1.46 of these rules.(C) A renovation of a licensed facility (residence) or agency, as defined at Part 1.52 of these rules.(D) A guideline compliance review is not needed for minor alterations, as defined at Part 1.43of these rules. Part 3.3.2 requires that design documents for guideline compliance review by the Department, are to be submitted at the time the facility (residence) or agency applies for the building permits from the local authority.(A) In the event that a building permit is not required, the design documents shall be submitted to the Department for guideline compliance review prior to the start of construction or renovation.(B) Submittal of the design documents shall be made by the guideline compliance review representative.(C) Design documents submitted to the Department for review shall be signed by the responsible design professional.(D) Design documents shall be coordinated and the scale of drawings submitted shall be consistent for all disciplines.(1) In the event that the design documents previously submitted to the Department for guideline compliance review cease to be current, the responsible design professional shall submit updated design documents to the Department.(2) Phased submittals of design documents may be submitted for approval upon the discretion of the Department. Part 3.3.3, requires that thecompliance guideline review is completed at the time the initial license is issued or when the department has notified the responsible design professional that there are no outstanding issues.(A) The compliance guideline review shall be completed by the Department prior to renovations to an existing facility (residence) or agency are undertaken. Part 3.4.1 requires requests for waivers of FGI Guidelines shall be submitted to the Department on the form and inthe manner required by the Department.(A) The Department will accept and review waiver requests related to FGI Guidelines prior to the submission of a license application.(B) Any consideration of a waiver from the FGI Guidelines will be based on design documents submitted at the time of the waiver request. If the design documents are changed, a new waiver request must be submitted.(C) In the event that the FGI Guidelines are in conflict with Centers for Medicare and Medicaid Services (CMS) requirements for facilities or agencies that are seeking or are subject to certification, the CMS requirements will apply and no waiver is necessary. Part 3.6 reads that, no approval of, or failure to review design documents by the Department shall relieve the owner, developer, designing architect, or engineer of their respective responsibilities for compliance with applicable laws, rules, or codes respecting fire prevention, fire protection, building construction safety, and the FGI Guidelines. Part 5.1.3, requires that nothing contained in these provisions abrogates the applicant's obligation to meet minimum requirements under local safety, fire, electrical, building, zoning, and similar codes. 2. ObservationsOn 2/14/23 at approximately 7:45 a.m., the environmental tour of the residence revealed the following:There were two rooms in the basement of the residence that had a wall that was not constructed to reach the ceiling. There was approximately a 12-inch gap from the top of the wall to the ceiling. Resident #1 and #2 resided in one room and the other room was an unused staff room. The wall separated the residence's common area and the resident room. 3. Record reviewReview of the department's records revealed the residence had not applied for an FGI review prior to the start of renovations. 4. InterviewOn 2/14/23 at 9:00 a.m., the administrator stated that a wall had been added in the basement by the former administrator to create one new room. He stated it was built before December of 2019, however he failed to give an exact timeline on when the wall was built in the basement. During an interview on 2/14/23 at 9:13 a.m., an FGI representative stated there was no project regarding an addition of walls in the basement in their files from the residence. The FGI team member stated the residence would be required to undergo an FGI review for the addition of walls in the basement. On 2/14/23 at approximately 9:25 a.m., an FGI representative stated the partially constructed wall in the basement required FGI review and approval before the residents could occupy the space. He stated the residence was in violation of Chapter 2, Parts 3.2.3(C) and 3.3.1(A). He stated the residence was required to submit architectural drawings and a plan review request form to the FGI team as soon as possible. On 2/14/23 at 9:32 a.m., an FGI representative stated that the department licensing representative approved bed increases for the residence if they did not involve any construction. He stated this residence involved the construction of the wall in the basement, which meant it would be required to undergo FGI review. On 2/14/23 at 9:45 a.m., an FGI representative stated that regardless of which owner completed the construction, the residence was required to submit the space for FGI review. On 2/14/23 at 9:48 a.m., the department licensing representative stated the residence completed a change of capacity on 10/21/21. She stated it was approved and the license was issued. She stated she asked the administrator if there was construction for the change and she stated the administrator replied there were existing bedrooms that were not currently being used. The representative stated there was a change of ownership around the same time. On 2/14/23 at 10:41 a.m., the member of Colorado Division of Fire Prevention and Control (DFPC) stated he completed an inspection of the residence on 10/6/21 with deficiencies cited and no plan of correction (POC) submitted. He stated during the inspection the administrator asked about adding rooms to the basement, to which he stated he replied that the residence would be required to perform an FGI review. On 2/14/23 at 11:22 a.m., an FGI representative stated he spoke with a DFPC representative regarding the wall. The FGI representative stated he sent pictures of the walls that were provided to him by surveyors to the DFPC representative. The DFPC representative stated the wall in the basement appeared new since his last inspection on 10/6/21. The FGI representative stated the residence was required to undergo both an FGI and life safety code (LSC) review and the residence had not reached out to him until the day of the onsite visit. On 2/15/23 at 4:20 p.m., the administrator stated he thought a plan was submitted to an FGI representative before he took over. The administrator stated the residence had the capacity for eight residents and added he contacted the department's licensing section and increased the license from 10 to 12 residents. The administrator stated that an FGI representative asked to submit the plan, and added he submitted a plan for the basement of 1500 sq. ft. Contrary to what the FGI representative stated the administrator stated the information was provided to an FGI representative in October of 2021 about the wall that was built partially to section off the room. He added DFPC completed their inspection in October 2021 and approved the residence. He stated he spoke with an FGI representative on 2/14/23 and the FGI representative told him the residence was required to go through an FGI review.
Plan of correction
The state did not require a plan of correction for this citation.
2516In Env-Gen SmkngS/S B
Findings
Based on observation and interview, the residence failed to ensure resident rooms occupied by smokers had fire resistant wastebaskets, affecting two of two smokers (#3, #9). Findings include: a. ObservationsOn 2/14/23 at 7:40 a.m., Resident #3 was smoking in the outdoor designated smoking area. Resident #3 extinguished her cigarette in an ashtray. On 2/14/23 at 11:50 a.m., Resident #9 was smoking in the outdoor designated smoking area. b. InterviewsOn 2/14/23 at 8:30 a.m., Staff #3 stated Resident #3 smoked cigarettes. On 2/14/23 at 9:45 a.m., the administrator stated Resident #3 was a smoker. He stated the residence had more smokers who were discharged recently. On 2/14/23 at 10:30 a.m., Resident #3 stated herself and Resident #9 were smokers. She stated they usually smoked together. On 2/14/23 at 11:35 a.m., the administrator confirmed that Resident #3 and #9 were smokers. He thought Resident #5 was an occasional smoker. On 2/14/23 at 11:30 a.m., an environmental tour was conducted with Staff #3 in the room of resident's who smoked (#3 and #9). Resident #3's room contained plastic a wastebasket, which was not fire resistant. Resident #9's room did not have any fire resistant wastebasket. On 2/14/23 at 3:30 p.m., the administrator stated he was not aware the residence was required to have fire resistant wastebaskets in the resident rooms who smoked since the residents were not permitted to smoke in their rooms. Further, he stated Resident #3's room had a metal trash wastebasket and it might have gotten misplaced. The administrator stated he was not aware that Resident #9's room did not have any kind of trash can.
Plan of correction · submitted by the facility
Response to POC Tag # 2516 : We acknowledge the deficient practice. Plan of correction: Fire resistance containers/waste baskets were placed smoking area and placed in all smokers rooms. Monitoring plan:All fire-resistant waste baskets have been placed and labeled with room numbers and designated smoking area to prevent mix up when emptying the trash and placed in the smokers' rooms. All staff and residents have been notified of the specific fire-resistant waste baskets. This information will be reviewed during the daily/weekly standup staff meeting. Training will be conducted and documented accordingly. A daily audit check list has been created for the Administrator and staff to perform daily walks throughout the facility to ensure that all items (including smoke resistance waste baskets) are placed in the proper locations including the designated smoking area in the back of the building. Completion date: 2/22/2023
2624In Env-Smkng Fire DspslS/S B
Findings
Based on observation and interview, the residence failed to have a fire resistant waste disposal container in the designated outdoor smoking area, affecting eight current residents. Findings include:1. ObservationsOn 2/14/23 at 7:40 a.m., Resident #3 was smoking in the outdoor designated smoking area. Resident #3 extinguished her cigarette in an ashtray. On 2/14/23 at 7:45 a.m., an environmental tour of the residence's outdoor smoking area revealed a plastic wastebasket and a sliced Jalapeno metal can. The wastebasket was not fire resistant. Cigarette butts and an empty cigarette box were inside the wastebasket. Additionally, cigarette butts were in the Jalapeno can. On 2/14/23 at 11:50 a.m., Resident #9 was smoking in the outdoor designated smoking area. 2. InterviewOn 2/14/23 at 3:50 p.m., the administrator stated he expected residents to empty the ashtray into a fire resistant container in the outdoor smoking area. However, the administrator acknowledged residents were not constantly doing so. He stated he was not aware that the outdoor smoking area had the plastic wastebasket and jalapeno can as trash can. The administrator stated he was responsible to ensure the outdoor designated areas had fire resistant trash can, however he could not explain why he failed to monitor that.
Plan of correction · submitted by the facility
Response to POC Tag # 2624 : We acknowledge the deficient practice. Plan of correction: Fire resistance cigarettes waste baskets were placed in the smokers rooms and outdoors designated smoking area. Monitoring plan:All fire-resistant waste baskets have been placed and labeled with room numbers and designated smoking area to prevent mix up when emptying the trash and placed in the smokers' rooms. All staff and residents have been notified of the specific fire-resistant waste baskets. this information will be reviewed during the daily/weekly standup staff meeting. Training will be conducted and documented accordingly. A daily audit check list has been created for the Administrator and staff to perform daily walks throughout the facility to ensure that all items (including smoke resistance waste baskets are placed in the proper locations including the designated smoking area in the back of the building. Completion date: 2/20/2023
2/14/2023State Certification (Re-certification) · ID OQ5K111 deficiency
0000Initial CommentsSurveyor note
Findings
A recertification survey was completed on 2/15/23. A deficiency was cited.
Plan of correction
The state did not require a plan of correction for this citation.
0630Acf-Prov Role/Resp-Svc Req Med admn Pol/PrS/S B
Findings
Based on record review and interview, the facility (residence) failed to comply with written policies and procedures for the administration of medication in accordance with 6 CCR 1011-1, Chapter VII, affecting three of four sample residents (participants) (#4, #7, #8). Findings include:1. Chapter VII regulations governing assisted living residences, part 14.21, requires 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. Residence policyThe residence's Medication Administration policy, read in part, "This community complies with all applicable federal and state statutes and regulations, including but not limited to Chapter 7 and Chapter 24 ... This community complies with all federal and state laws and regulations relating to procurement, storage, administration, and disposal of controlled substances."b. Resident #8 was admitted to the residence on 5/12/22 with diagnoses including schizophrenia, major depressive disorder. MelatoninA written practitioner's order, dated 6/14/22, directed the residence to administer Melatonin five mg once daily every evening at bed time. However, the January and February 2023 medication administration record (MAR) read the residence did not administer the medication from 1/1-1/31, 2/1-2/13/23 as the medication was not available for a total of 45 missed doses FluticasoneA written practitioner's order, dated 5/23/22, directed the residence to instill fluticasone 50 mcg one spray in each nostril daily. However, the January and February 2023 MAR read the medication was not administered as the medication was not available 1/1-1/31, 2/1-2/13/23 for a total of 45 missed doses. On 2/14/23 at approximately 12:20 p.m., Staff #3 stated Resident #8's fluticasone and melatonin were not available. On 2/14/23 at 12:30 p.m., the administrator stated Resident #8 did not receive the above medications because they were not available. He sated Staff #3 did not document on the MARs that the medication was out of stock. He stated Resident #8 was responsible for ordering his own medications and the resident did not order because he did not want the medication. However, he confirmed the medication for Resident #8 was not administered as ordered. c. Resident #7 was admitted to the residence on 9/1/22 with an unknown diagnosis. HydroxyzineA written practitioner's order, dated 10/3/22, directed the residence to administer hydroxyzine HCL 50 mg once daily. However, the February 2023 MAR read the residence did not administer the medication from 2/7-2/14/23, for a total of eight missed doses. On 2/14/23 at 12:20 p.m., Staff #3 stated she administered medications according to the instructions on the MARs. She stated if there was a discrepancy from the medication list to the MARs, she followed instructions to administer the medication per the MAR. Staff #3 confirmed Resident #7 did not receive his medication. On 2/14/23 at 12:30 p.m., the administrator stated he and Staff #3 were responsible for ensuring medication orders were input into the resident files. The administrator stated Resident #7 telephoned and/or visited his practitioner every single day to complain about his health. The administrator stated Resident #7's external service providers discontinued (DC'd) medications for Resident #7 and send the list directly to the pharmacy. He stated the new signed DC'd order list was not sent to the residence and stated as a result the residence was missing new orders for Resident #7. He stated he audited all the resident's medication orders on 12/14/22 and failed to locate all the practitioner orders for Resident #7. However, he confirmed the resident was not administered medications as ordered. 2. Chapter VII regulations governing assisted living residences, part 14.11, requires that only medication that has been ordered by an authorized practitioner shall be preparedfor or administered to residents.a. Reference Chapter VII regulations governing assisted living residences, part 2.26, defines medication administration as assisting a person in the ingestion, application, inhalation, or, using universal precautions, rectal or vaginal insertion of medication, including prescription drugs, according to the legibly written or printed directions of the attending physician or other authorized practitioner, or as written on the prescription label, and making a written record thereof with regard to each medication administered, including the time and the amount taken. The Medication and Medication Administration policy, dated 10/19 read in part, "an employee or volunteer is not permitted to administer or assist with administering medication to a resident unless such individual is a practitioner, a nurse, a qualified medication administration person (QMAP), or a certified nurse medication aide (CNA-Med) acting within his or her scope of practice.b. Resident #4 was admitted to the residence on 4/10/17 with diagnoses including hypertension, depression, gastro esophageal reflux disease. The January and February 2023 medication administration record (MAR) for Resident #4 documented the administration of five medications in which no practitioner's order could be located. 1. Aspirin 81 mg tablet once daily on 1/1-1/31, 2/1 to 2/14/232. Glucosamine complex capsule one tablet once daily on 1/1-1/31, 2/1 to 2/14/233. Pioglitazone 15 mg once daily from 1/1-1/31, 2/1-2/13/234. Venlafaxine ER 150 mg every morning on 1/1-1/31, 2/1-2/14/23The record for Resident #4 revealed no evidence of signed practitioner's orders for the above four medications. c. Resident #7 was admitted to the residence on 9/1/22 with unknown diagnoses. The January and February 2023 MAR for Resident #7 documented the administration of Lamotrigine 200 mg daily in the morning in which no practitioner's order could be located from 1/1-31, 2/1-2/14/23. On 2/14/23 at approximately 12:25 p.m., the administrator stated he did not receive an order for Lamotrigine. On 2/14/23 at 12:30 p.m., the administrator stated Resident #4 telephoned and/or visited his practitioner every single day to complain about his health. The administrator stated Resident #4's external service providers prescribed medications to Resident #4 and send the list to the pharmacy. He stated the new signed medication order list was not sent to the residence and stated as a result the residence was missing orders for Resident #4. He stated he audited all the medication orders for the residents on 12/14/22 and failed to locate all the practitioner orders for Resident #4 and #7. He acknowledged that the residence did not have all the signed orders for Resident #4 and #7.
Plan of correction · submitted by the facility
Response to POC Tag # 0630 : We acknowledge the deficient practice. Plan of correction: all existing and new medication will have a signed order before they are administered. 4 way meeting was conducted between: the facility staff, Innovage and Grane pharmacy to ensure that all medication orders for WW are reconciled and 100% accurate. also, WW was asked not to involve the staff when requesting a change of medications inorder to keep track of any changes in his situation or medications. Also, the facility and Innovage agreed to exchange and reconcile the MAR on monthly basis. Plan of correction: MAR for resident number 8 was reconciled and determined that the melatonin was DC'd by the doctor however the pharmacy did not remove the meds from the list. In addition, QMAP staff were re-trained via refresher on medication administration topics surrounding MAP record keeping, charting, audit review, medication storage, controlled substance perpetual count keeping, expiration management, cycle medication/meds on hand policy. Trainer was able to review the MARs and observe sample medication passes and made corrective actions and teaching on MAR completeness and signatures, reviewing expirations dates, ensuring corresponding signed doctors orders were retrievable. Monitoring plan:Daily/nightly monitoring with the staff will be conducted and documented accordingly until all staff members, administrator and owners are confident and able to perform their duties without close supervision. A daily /weekly review of the MAR and PCP orders will be reviewed with the staff will be held to ensure that all the meds are being administered according to the MAR. Also, the MAR will be signed off by the administrator upon review and acceptance. Completion date: Ferb 24th 2023 and on going
2/14/2023Revisit: Licensure Complaint · ID TF9K131 deficiency
0000Initial CommentsSurveyor note
Findings
A certification revisit was completed on 2/14/23 for the previous deficiency cited on 10/19/2020. A deficiency was cited.
Plan of correction
The state did not require a plan of correction for this citation.
0630Acf-Prov Role/Resp-Svc Req Med admn Pol/PrS/S B
Findings
Based on record review and interview, the facility (residence) failed to comply with written policies and procedures for the administration of medication in accordance with 6 CCR 1011-1, Chapter VII, affecting three of four sample residents (participants) (#1-#3). Findings include:1. Chapter VII regulations governing assisted living residences, part 14.21, requires 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. Residence policyThe residence's Medication Administration policy, read in part, "a practitioner is "authorized" if state law allows the practitioner to prescribe treatment, medication. If a practitioner are administering medication in this community, there is documentation that their credentials have been reviewed and validated."b. Resident #2 was admitted to the residence on 5/12/22 with diagnoses including schizophrenia, major depressive disorder. MelatoninA written practitioner's order, dated 6/14/22, directed the residence to administer Melatonin 5 mg once daily every evening at bed time. However, the January and February 2023 medication administration record (MAR) read the residence did not administer the medication from 1/1-1/31, 2/1- 2/13/23 as the medication was not available for a total of 45 missed doses FluticasoneA written practitioner's order, dated 5/23/22, directed the residence to instill fluticasone 50 mcg one spray in each nostril daily. However, the January and February 2023 MAR read the medication was not administered as the medication was not available 1/1-1/31, 2/1-2/13/23 for a total of 45 missed doses. On 2/14/23 at approximately 12:20 p.m., Staff #1 stated Resident #2's fluticasone and melatonin were not available. On 2/14/23 at 12:30 p.m., the administrator stated Resident #2 did not receive the above medications because they were not available. He sated Staff #1 did not document on the MARs that the medication was out of stock. He stated Resident #2 was responsible for ordering his own medications and the resident did not order because he did not want the medication. However, he confirmed the resident was not administered medication as ordered. c. Resident #1 was admitted to the residence on 9/1/22 with an unknown diagnosis. HydroxyzineA written practitioner's order, dated 10/3/22, directed the residence to administer hydroxyzine HCL 50 mg once daily. However, the February 2023 MAR read the residence did not administer the medication from 2/7-2/14/23, for a total of eight missed doses. On 2/14/23 at 12:20 p.m., Staff #1 stated she administered medications according to the instructions on the MARs. She stated if there was a discrepancy from the medication list to the MARs, she followed to administer the medication per the MAR. Staff #1 confirmed Resident #1 did not receive his medication. On 2/14/23 at 12:30 p.m., the administrator stated he and the Staff #1 were responsible for ensuring medication orders were input into the resident files. The administrator stated Resident #1 telephoned and/or visited his practitioner every single day to complain about his health. The administrator stated Resident #1's external service providers discontinued (DC'd) medications for Resident #1 and send the list directly to the pharmacy. He stated the new signed DC'd order list was not sent to the residence and stated as a result residence was missing new orders for Resident #1. He stated he audited all the residents medication orders on 12/14/22 and failed to locate all the practitioner orders for Resident #1. However, he confirmed the resident was not administered medications as ordered. 2. Chapter VII regulations governing assisted living residences, part 14.11, requires that only medication that has been ordered by an authorized practitioner shall be prepared for or administered to residents.a. Reference Chapter VII regulations governing assisted living residences, part 2.26, defines medication administration as assisting a person in the ingestion, application, inhalation, or, using universal precautions, rectal or vaginal insertion of medication, including prescription drugs, according to the legibly written or printed directions of the attending physician or other authorized practitioner, or as written on the prescription label, and making a written record thereof with regard to each medication administered, including the time and the amount taken. b. Resident #3 was admitted to the residence on 4/10/17 with diagnoses including hypertension, depression, gastro esophageal reflux disease. The January and February 2023 medication administration record (MAR) for Resident #3 documented the administration of five medications in which no practitioner's order could be located. Aspirin 81 mg tablet once daily on 1/1-1/31, 2/1 to 2/14/23Glucosamine complex capsule one tablet once daily on 1/1-1/31, 2/1 to 2/14/23Pioglitazone 15 mg once daily from 1/1-1/31, 2/1-2/13/23Venlafaxine ER 150 mg every morning on 1/1-1/31, 2/1-2/14/23The record for Resident #3 revealed no evidence of signed practitioner's orders for the above four medications. c. Resident #1 was admitted to the residence on 9/1/22 with unknown diagnoses. The January and February 2023 MAR for Resident #3 documented the administration of Lamotrigine 200 mg daily in the morning in which no practitioner ' s order could be located from 1/1-31, 2/1-2/14/23. On 2/14/23 at approximately 12:25 p.m., the administrator stated he did not received an order for Lamotrgine. On 2/14/23 at 12:30 p.m., the administrator stated Resident #3 telephoned and/or visited his practitioner every single day to complain about his health. The administrator stated Resident #3's external service providers prescribed medications to Resident #3 and send the list to the pharmacy. He stated the new signed medication order list was not sent to the residence and stated as a result residence was missing orders for Resident #3. He stated he audited all the residents medication orders on 12/14/22 and failed to locate all the practitioner orders for Resident #1 and #3. He acknowledged that residence did not had all the signed orders for Resident #1 and #3.
Plan of correction
The state did not require a plan of correction for this citation.
2/14/2023Revisit: Licensure Complaint · ID Z6TL13No deficiencies
0000Initial CommentsSurveyor note
Findings
A licensure revisit was completed on 2/14/23 for all previous deficiencies cited on 10/19/20. The residence is in compliance with all regulations surveyed.
Plan of correction
The state did not require a plan of correction for this citation.

Reportable Occurrences

0 records
No reportable occurrences
The state has not published occurrence summaries for this facility.