APPLEWOOD OUR HOUSE 4 LLC

A licensure complaint, prompted by complaint investigation #CO41529, was completed 5/14/26. No deficiencies were cited.

A revisit survey was completed on 4/16/26 for all previous deficiencies cited on 12/22/25. The facility is in compliance with all deficiencies that were cited.

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

A licensure complaint, prompted by #CO41161, #CO40878, and #CO40045, was completed on 12/22/25. Deficiencies were cited.

Based on observations, interviews, and record review, the residence failed to provide to the Department upon request, access to individual client records, reports, and other records as determined by the Department, affecting 16 current residents. Findings include:1. Record ReviewOn 12/17/25 at 8:59 a.m., the following were requested from the residence:-Incident reports from June to August 2025 and current-Staff schedule for March and September 2025 to current- Policies for reporting abuse, destruction of medications, medication storage, and lift assistance.- Administrator training for the current administrator - cardiopulmonary resuscitation (CPR) cards for current staff- medication destruction records- any allegations of abuse in 2025On 12/17/25 at 9:24 a.m., the activities director failed to provide the following: -Policies for reporting abuse, destruction of medications, medication storage, and lift assistance.- Administrator training for the current administrator - cardiopulmonary resuscitation (CPR) cards for current staff- medication destruction records- any allegations of abuse in 2025On 12/17/25 at 10:45 a.m., staff records with Current CPR, orientation, training before contact, and Dementia training were requested for Staff #1, #3, and #5 from the residence. On 12/17/25 at 11:11 a.m., Staff records were provided and were incomplete. On 12/17/25 at 11:15 a.m., records for staff #1, #3, and #5 were requested in person. A request for only CPR, orientation, training before contact, and dementia training was made. Staff records were not provided on 12/17/25. On 12/17/25 at 12:06 p.m., Medication Administration Records (MARs) for November and December 2025 and practitioner orders for Residents #1, #3, and #6 were requested. On 12/17/25 at 12:45 p.m., Resident #3's MAR was provided. On 12/17/25 at 1:10 p.m., Resident #1 and #6 MARs and practitioner orders were requested again. On 12/17/25 at 1:30 p.m., all resident MARs were provided. No practitioner orders were received. On 12/17/25 at 2:11 p.m., Resident Records for #1-#6 that included practitioner orders, care plans, assessments, progress notes, reports of abuse, and records for Staff #1-#8 were requested a second time, and asked to be provided by 7:00 a.m. on 12/18/25. On 12/18/25 at 7:02 a.m., partial staff records were provided; however, Staff #1-8 failed to have documentation of dementia training or training specific to job duties. Staff #1 did not have orientation, and the residence failed to provide any documentation for Staff #5 or #6 and #8. On 12/18/25 at 7:28 a.m., an email requesting resident records and staff files was sent. On 12/18/25 at 7:55 a.m., the interim administrator returned an email that read in part that the human resources individual would be providing staff documentation and the house manager would be locating the resident documentation. On 12/18/25 from 8:15 a.m. to 8:36 a.m., several emails from the human resources individual were received containing cardiopulmonary resuscitation (CPR) cards and a staff schedule. On 12/18/25 at 9:47 a.m., practitioner orders, progress notes, and care plans for residents were received; however, Resident #4 was missing a face sheet, Residents #1-#6 were missing assessments and the facility failed to provide investigations of abuse. 2. InterviewsOn 12/17/25 at 7:45 a.m., the activities director (AD) stated that she could not grant access to electronic health records (EHRs) that the human resources director would be able to grant access to EHRs, but was unavailable until later in the day. Further, the AD acknowledged she was unable to provide paper documentation upon request. On 12/22/25 at 3:00 p.m., the interim administrator and human resources individual stated that the house managers had access to resident records and that the activities director or house manager should have been able to provide the requested documentation. They could not answer why they did not provide the documentation. The interim administrator and human resources individual acknowledged this was a failure of the residence to provide documentation upon request.

Based on observation, interview, and record review, the residence failed to ensure the administrator was responsible for managing the overall day-to-day operations of the assisted living residence as described in the resident agreement, affecting 16 current residents. Findings include: 1. ReferenceChapter VII regulations governing assisted living residences, part 2.2, defines "Administrator" as a person who is responsible for the overall operation, daily administration, management and maintenance of the assisted living residence. The term "administrator" is synonymous with "operator" as that term is used in Title 25, Article 27. 2. Record Review On 12/17/25, an emergency binder provided by the residence listed the former administrator as the administrator of record. On 12/17/25 at 8:00 a.m., department records indicated that the former administrator was still the administrator of record. On 12/22/25, a department email read in part that the residence submitted a request for a change of administrator on 12/18/25, which was after the start of the onsite investigation. 3. Interviews On 12/17/25 at approximately 11:08 a.m., the activities director stated that the administrator of record had resigned on 12/11/25 and had refused to serve as the interim administrator. She stated that she was under the impression that the residence had ten days to name another interim administrator. She stated that the residence's external consultant was the interim administrator, that the residence had been reaching out to her with questions, and that she would call the external consultant if there was an emergency. She acknowledged that the residence did not have an administrator of record as of 12/11/25. On 12/17/25 at 12:07 p.m., the external consultant stated that she was not the interim administrator and that the matter had been discussed but never decided. She was unaware of who was named the interim administrator after the former administrator resigned on 12/11/25. On 12/17/25 at approximately 2:00 p.m., the house manager and the activities director stated that the interim administrator had been named during the onsite survey on 12/17/25 and that the human resources individual would contact the department. On 12/18/25 at approximately 9:45 a.m., the interim administrator stated her previous title was the sales and admissions director. However, she stated that she was asked to be the interim administrator on 12/17/25 and had accepted the position. The interim administrator stated she would oversee the residence's daily operations until a permanent administrator was hired. On 12/22/25 at 3:00 p.m., the interim administrator and human resources stated they did not have a interim administrator or designee named for seven days. They acknowledged the failure to have an interim administrator or designee after the former administrator resigned on 12/11/25.

Based on record review and interview, the residence failed to provide an enhanced care plan that included approaches for staff that addressed residents with behavioral expressions and provided interventions to protect the resident and other residents with whom they have contact, for one of 16 sample residents (#1) who lived in a secured environment. Resident #1 was admitted to the residence on 4/8/25. A progress note dated 11/19/25, read in part that Resident #1 became upset with the residents singing Christmas songs. Resident #1 got into another resident's personal space, messing with their wheelchair, calling them names, and being inappropriate. Staff asked Resident #1 multiple times to take a few steps back and to be mindful and respectful of what he was saying and doing. Staff attempted to distract Resident #1 and move him to another part of the dining room where he would not be bothered. Resident #1 stated, "what are you going to do about it" and continued to harass Resident #1 refused to move and continued to harass the resident. Staff made the suggestion to Resident #1 to make his way to his room to get ready for bed. When staff were walking towards Resident #1 ' s room, they noticed Resident #1 was not following them and was a few inches from another resident ' s face with his right fist raised and whispering something to them. Staff said they could not hear what Resident #1 said but by the facial expression and body language they knew it was threatening or at least hostile. After multiple attempts to redirect Resident #1, staff were able to get Resident #1 back to his room. However, the residence's care plan for Resident #1, dated 12/18/25, read in part that Resident #1 could communicate his needs effectively. No behavioral interventions were listed on the care plan. On 12/22/25 at 3:00 p.m., the interim administrator and human resources director, stated the house manager was in charge of updating the care plans. The interim administrator acknowledged the residence failed to update the care plan and include enhanced individualized interventions for Resident #1.

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 7.7.10 All staff members shall wear name tags or other identification that is visible to residents and visitors. 14.29 All prescribed and PRN medications shall be listed and recorded on a medication administration record (MAR) which contains the name and date of birth of the resident, the resident's room location, any known allergies, and the name and telephone number of the resident's authorized practitioner. The medication administration record shall reflect the name, strength, dosage, and mode of administration of each medication, the date the order was received, the date and time of administration, any special considerations related to administration, and the signature or initial of the person administering the medication. 18.9 The face sheet shall be updated at least annually and contain the following information: (K) Resident's current diagnoses.

A revisit survey was completed on 7/17/23 for all previous deficiencies cited on 12/7/22. The facility is in compliance with all deficiencies were cited.