CARE GROUP OF NORTHGLENN LLC

A licensure complaint, prompted by #CO36725, was completed on 7/17/24. Deficiencies were cited.

Based on record review, observation, and interview, the residence failed to maintain a safe and sanitary physical plant, either directly or indirectly through a resident agreement, affecting 15 current residents. (Cross-reference S2810)Findings include: 1. Record ReviewOn 7/17/24 at 1:05 p.m., the residence's environmental pest control policy and procedure was requested; however, it was not provided. A pest control agreement, dated 7/26/23, contracted an outside pest control provider to inspect the residence quarterly. The pest control contract read in part: "Quarterly inspections of all interior rooms/areas for bed bugs and other pests. Inspection services only." However, the inspection contract did not specify that the pest control provider provided actual extermination services. An inspection summary, dated 5/7/24, read in part: "Inspected all beds, chairs, and drapes for bed bug activity in all rooms on the lower floor. No activity to report!" However the inspection summary did not detail any extermination treatments provided for rats or other rodents. 2. ObservationsOn 7/18/24 from 1:20 p.m. to 1:30 p.m., an external environmental tour revealed no rat traps or other pest control methods on the grounds of the residence. On 7/18/24 from 4:50 p.m. to 5:00 p.m., an environmental tour a rat was observed by an extra pile of garbage located near the trash receptacles outside of Resident #1's and #14's bedroom windows. 3. InterviewsOn 7/17/24 at 1:14 p.m., Resident #6 stated she had seen rats outside her bedroom window for the last six months prior to the onsite investigation. She stated that she had spoken to the administrator about the rat problem but had not seen or heard of a resolution. Resident #6 mentioned that she heard that the administrator purchased a ball-bearing (BB) gun to shoot the rats. She stated that she suggested the use of an alternative pest control method because she was uncomfortable with the use of a BB gun to kill the rats. Resident #6 stated that she did not like the rats and added that they scared her. On 7/17/24 at 3:31 p.m., the administrator stated she was aware of the residence's rat problem. She stated that she had "tried everything" to get rid of the rats and purchased a BB gun to shoot them. The administrator stated she believed the neighbors were contributing to the rat problem but were unwilling to assist with the problem. The administrator confirmed they had yet to find a permanent solution to eradicate the rats. On 7/17/24 at 4:14 p.m., Resident #1 stated that she had seen multiple rats outside her window. She stated that she had told the administrator about the rats. Resident #1 stated that she was told that the administrator purchased a BB gun to kill the rats but it was not working. She stated the rat infestation had only gotten worse. Resident #1 stated the rats were unsanitary and expressed fears of contracting an illness related to the rats.

Based on observation, record review, and interview the residence failed to allow residents the right to full use of the assisted living residence common areas affecting four of four residents who lived on the lower level of the residence (#1, #3, #6, and #7). 1. Residence PolicyThe residence ' s undated house rules read in part, "common areas are for all residents to use with consideration to others. With prior arrangements, common areas are available for entertaining guests including parties, meetings, etc. Meeting residents' needs and routine shall have priority."2. ObservationsOn 7/17/24 throughout the onsite visit from approximately 1:00 p.m. to 5:30 p.m., a locked gate was observed inthe driveway of the residence that connected the front of the house to the back of the house. On 7/17/24 from 4:10 p.m. to approximately 4:25 p.m., the administrator opened the gate to the driveway escorted Resident #3 up the driveway from his room in the lower level of the residence to have dinner in the dining room located on the first floor of the residence. 3. InterviewsOn 7/17/24 at 1:14 p.m., Resident #6 stated she needed the chair lift to go up the stairs to the dining and common areas. She stated the chair lift had been broken for over one month prior to the onsite investigation without any updates from the administrator about when the repair would occur. Resident #6 said staff brought her meals to her in her room to eat since she was unable to use the stairs. On 7/17/24 at 1:31 p.m., Resident #3 stated he was unable to use stairs because he had poor balance and needed the chair lift. He stated he had to exit through the backdoor on the lower level of the residence, walk uphill on the driveway around the residence, and enter through the front door in order to access the dining area for meals. On 7/17/24 at 2:35 p.m., the administrator stated the chair lift had been broken twice in the past two months. She confirmed the chair lift was currently broken and had been broken for a week at the time of survey. She stated she called the repair company who repaired the lift the first time and was told it would take two weeks for a repair technician to come and repair it. The administrator stated residents had two options for receiving their meals and accessing the upstairs common area. She said option one was for residents to have their meals brought to them and the second option was for them to go outside and walk around the house on the driveway to reach the upstairs. On 7/17/24 at 4:16 p.m., Resident #1 stated she had a hard time using the stairs and benefited from the chair lift. She stated that the only other way to get upstairs was to go around the house using the driveway. Resident #1 stated, however, that the driveway had a gate that stayed locked. She stated that even if she wanted to walk around the house to go upstairs independently she had to ask for assistance from staff to unlock the gate before she could walk uphill around the house to access the dining room and common areas.

Based on observation and interview, the residence failed to keep the residence grounds free of garbage and rubbish, affecting 15 current residents. Findings include:On 7/17/24 throughout the onsite visit from approximately 1:00 p.m. to 5:30 p.m., the backyard had two walkers, two ladders, multiple empty car fluid containers, empty beer boxes, empty drink bottles, and broken glass. A broken bed frame piled with a chair, boxes, trash bags, cloth material was observed in the side yard of the residence. The trash area in the backyard was overflowing with boxes, trash bags, loose trash, and multiple broken appliances. The trash area was located adjacent to a resident ' s basement bedroom window. At the bottom of the window well for the basement bedroom window were broken cardboard boxes and bags of trash with maggots and flies flying around. On 7/17/24 at 3:31 p.m., the administrator stated that the walkers were from an external service provider, and they refused to pick up the walkers. She said if she was to get rid of them she would be fined. The administrator also stated that she had been calling the trash company to arrange a better way to dispose of the trash. She stated she had not found a long term solution to remove the excess garbage and rubbish. She stated the trash builds from the week because the residence produced a lot of trash in one week.

Based on record review and interview, the residence failed to have a written policy that provided for effective control and eradication of insects, rodents, and other pests, affecting 15 current residents. (Cross-reference S1110)Findings include: On 7/17/24 at 1:05 p.m., the residence's environmental pest control policy and procedure was requested; however, it was not provided. On 7/17/24 at 3:31 p.m., the administrator confirmed that the residence did not have a written pest control policy for effective pest control.

A relicensure survey was completed on 2/28/23. Deficiencies were cited.

Based on record review and interview, the residence failed to show compliance with the Colorado Adult Protective Services Data System (CAPS Check), prior to hiring staff who provided direct care to at-risk residents, affecting seven of 11 residents (#2, #3, #6-#10). Findings include:1. References 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. Record ReviewReview of the resident records revealed the following Residents ##2, #3, #6-#10 were either 70 years of age or older as follows:Resident #2 was 85Resident #3 was 79Resident #6 was 70Resident #7 was 83Resident #8 was 82Resident #9 was 75Resident #10 was 76Staff #1 and the administrator were hired in September 2022 and July 2022, respectively. Review of the personnel files for Staff #1 and the administrator revealed there was no evidence a CAPs check had been completed. The residence did not maintain a personnel record for Staff #2 and the residence did not provide a hire date for Staff #2 or evidence a CAPs check had been completed. 3. InterviewOn 2/28/23 at approximately 8:53 a.m., the administrator stated she was aware personnel files were required to contain CAPSs checks. She stated she had not had time to run the checks on herself or the other staff after the previous administrator took all of the files.

Based on record review and interview, the residence failed to have a quality management program (QMP) designed to improve resident safety and well-being, affecting 11 current residents. Findings include: On 2/28/23 at approximately 7:45 a.m., the administrator was asked to provide the residence's quality management program (QMP). However, no QMP was provided. On 2/28/23 at approximately 4:45 p.m., the administrator stated she was unsure if the previous administrator had created a QMP, and if he had, she was unable to locate it. She stated she was aware the residence was required to have a QMP; however, did not realize they did not have one until the onsite survey.

Based on record review and interview, the residence failed to ensure the administrator complied with all applicable state laws to help prevent the possible development and transmission of coronavirus (COVID-19), affecting 11 current residents. Findings include:1. ReferenceThe Residential Care Facility (RCF) Comprehensive Mitigation Guidance updated 2/22/23, required residences to:-Ensure at least one designated person completes the Colorado RCF Infection Prevention Training using CO.TRAIN within two weeks of the assignment of duties and each following calendar year thereafter. The information must be reported in EMResource and remain updated.-Ensure staff vaccination status was reported to EMResource.-Ensure EMResource was updated bi-monthly. 2. Record ReviewReview of EMResource, dated 2/28/23, revealed it had not been updated twice per month as required by the RCF comprehensive mitigation guidance. The last update occurred on 5/13/22. Additionally, it revealed the designated infection control person and any completed infection control training had not been reported nor had influenza vaccinated staff. Review of the residence's ongoing vaccination treatment plan revealed it had not been updated with the current COVID-19 vaccination coordinator or backup coordinator. 3. InterviewOn 2/28/23 at 4:34 p.m. the administrator stated she was unaware of what EMResource was. She stated she was also unaware the number of influenza vaccinated staff were required to be reported.

Based on record review and interview, the residence failed to ensure personnel files contained written documentation including a description of the employee duties, date of hire, orientation and training, first aid and CPR certification, and tuberculin (TB) test results, affecting 11 current residents. Findings include:The residence's undated Personnel Files policy, read in part: "Personnel files include the following required documentation: Training; TB testing; Background checks; A copy of the certificate of completion of the medication training course required by the regulations for Qualified Medication Administration Persons (QMAP)."On 2/28/23 at 7:45 a.m., the personnel files for the administrator, Staff #1, and Staff #2 were requested from the administrator. Review of the personnel files for the administrator and Staff #1 revealed no written documentation including a description of the employee duties, date of hire, orientation and training, first aid and CPR certification, or TB test results. There was no personnel file readily available for Staff #2. On 2/28/23 at 8:54 a.m., the administrator stated the previous administrator was the only one who had access to staff personnel files because she had downloaded all of the required documentation onto her personal computer. She stated the background checks for herself and Staff #1 was the only documentation she had. She stated the previous administrator resigned two days after she (the current administrator) began employment at the residence as a QMAP in November 2022. The administrator stated she tried to build everything back up from scratch, but it had been difficult as she thought the resident files were a priority and had not gotten to the personnel files yet.

Based on observation, record review and interview, the residence failed to have at least one staff member onsite at all times who had current certification in first aid from a nationally recognized organization, affecting 11 current residents. (Cross-Reference Q0734)Findings include: 1. Reference and Residence Policya. According to VeryWell Health, "First aid is the emergency care a sick or injured person gets. In some cases, it may be the only care someone needs, while in others, it may help them until paramedics arrive or they are taken to the hospital. The best way to prepare for these events is to get official first aid training" Brouhard, R., EMT (11/30/21) First Aid, 10 Basic First Aid Procedures, retrieved from: https://www.verywellhealth.com/basic-first-aid-procedures-1298578b. The residence's undated Emergency Care/First Aid policy, read in part, "All employees are expected to attend inservices which include instructions and information regarding emergency care and first aid ..."2. ObservationOn 2/28/23 at approximately 7:00 a.m., Staff #1 was observed serving breakfast to the residents. On 2/28/23 at approximately 7:20 a.m., the administrator was observed passing medications to residents #1, #4, #5, #8 and #11. On 2/28/23, during the onsite visit, the administrator and Staff #1 were the only staff onsite. 3. Record ReviewThe administrator's personnel file contained First Aid certification, however, her certification expired in July 2021. Staff #1's personnel file did not contain evidence of First Aid certification. The residence did not maintain a personnel record for Staff #2 and the residence did not provide evidence that Staff #2 was First Aid certified. 4. InterviewsOn 2/28/23 at approximately 7:49 a.m., the administrator stated she had been First Aid certified; however, she recently realized her certification was expired and needed to schedule a class. She stated Staff #1 and #2 were not First Aid certified. The administrator stated that she and Staff #1 lived onsite and were the only residence staff, with the exception of Staff #2 who was on an as needed basis. On 2/28/23 at approximately 7:55 a.m., Staff #2 stated she was not First Aid certified.

Based on interviews and record review, the residence failed to have at least one staff member onsite at all times who had current certification in cardiopulmonary resuscitation (CPR) and obstructed airway techniques from a nationally recognized organization, affecting six of 11 residents who required CPR in the event of an emergency (#3, #4, #6, #8, #9, #11). (Cross-Reference Q0732) Specifically, the residence failed to have at least one staff member onsite at all times who had current CPR certification from a nationally recognized organization for six residents (#3, #4, #6, #8, #9, #11) who requested CPR in the event of an emergency. The administrator, and Staff #1 were the only staff onsite and did not have current certification. Additionally, the residence had 11 residents, and without CPR certification, staff have not been trained properly on obstructed airway techniques. This failure created an immediate jeopardy risk to the residents for serious injury or death. On 2/28/23, the department directed the residence to provide written evidence that the risk had been removed. Findings include: 1. References and Residence Policiesa. According to the American Heart Association, "Cardiopulmonary Resuscitation (CPR) - is an emergency lifesaving procedure performed when the heart stops beating. Immediate CPR can double or triple chances of survival after cardiac arrest. Immediate CPR can double or triple chances of survival after cardiac arrest. Why Is CPR Important? Keeping the blood flow active - even partially - extends the opportunity for a successful resuscitation once trained medical staff arrive on site." The American Heart Association (2021) What is CPR, retrieved from: https://cpr.heart.org/en/resources/what-is-cprb. According to Healthline, "An airway obstruction is a blockage in any part of the airway ... risk factors for airway obstruction include: severe allergies to insect stings such as those from bees or to foods such as peanuts structural abnormalities or inherited diseases that can cause airway problems ... neuromuscular disorders and other conditions that cause people to have a difficult time swallowing food properly. Some airway obstructions are minor, while others are life threatening emergencies that require immediate medical attention ... an emergency technique that may help a person who is choking on a foreign object: Stand behind the person who is choking, wrapping your arms around their waist. Make a fist with one hand and puts it slightly above the person's belly button. Grab that fist with your other hand and press into the person's abdomen with five quick thrusts. Repeat these five abdominal thrusts until the object becomes dislodged or emergency services arrive." Healthline (2018) What Causes an Airway Obstruction, and How Is It Treated?, retrieved from: https://www.healthline.com/health/acute-upper-airway-obstruction#treatmentc. The residence's undated CPR policy, read in part, "All residents in cardiac and/or respiratory arrest will be resuscitated unless the resident has a "Do Not Resuscitate" order in their record ..."d. The residence's undated Advanced Directives policy, read in part, "Unless specifically ordered otherwise in writing, CPR will be initiated should the need arise ..."2. ObservationOn 2/28/23 at approximately 7:00 a.m., Staff #1 was observed serving breakfast to the residents. On 2/28/23 at approximately 7:20 a.m., the administrator was observed passing medications to residents #1, #4, #5, #8 and #11. On 2/28/23, during the onsite visit, the administrator and Staff #1 were the only staff onsite. 3. Record Reviewa. Personnel FilesThe administrator's personnel file contained CPR certification, however, her certification expired in July 2021. Staff #1's personnel file did not contain evidence of CPR certification. The residence did not maintain a personnel record for Staff #2 and the residence did not provide evidence that Staff #2 was CPR-certified.b. Resident Files Review of the medical orders for scope of treatment forms for residents #3, #4, #6, #8, #9, #11 read the residents requested CPR in the event of an emergency. 4. InterviewsOn 2/28/23 at approximately 7:49 a.m., the administrator stated she had been CPR certified; however, she recently realized her certification had expired and needed to schedule a class. She stated Staff #1 and #2 were not CPR certified. The administrator stated that she and Staff #1 lived onsite and were the only residence staff, with the exception of Staff #2 who was on an as needed basis. On 2/28/23 at approximately 7:55 a.m., Staff #2 stated she was not CPR certified. 5. Immediate Jeopardy Risk - Written Evidence, Immediate Correction The survey investigation established that the findings above placed the residents at immediate jeopardy risk for serious injury or death for failure to ensure at least one staff member who was CPR certified was onsite at all times. The residence was directed to provide the department with written evidence that the risk had been removed. Part 3.16 of the Chapter VII regulations require residences to immediately correct the circumstances that gave rise to the immediate jeopardy situation. On 2/8/23 at 4:04 p.m., the administrator submitted written evidence that read in pertinent part: "The plan of correction for the immediate jeopardy CPR/First Aid for the state tag is scheduled for today (2/28/23) to get certified. My employee, Staff #1, is scheduled to take the class on 3/1/23. My action as administrator, for future employees, is to verify that their CPR/First Aid is current and for every employee."

Based on observation and interview, the residence failed to place in a visible location a list of all staff who had current certification in first aid and cardiopulmonary resuscitation (CPR) so that the information was readily available to staff at all times, affecting 11 current residents. (Cross-Reference Q0732, Q0734)Findings include: On 2/28/23 at approximately 8:00 a.m., an environmental tour of the residence revealed there was no list of staff who had current certification in first aid or CPR in a visible location inside the residence. On 2/28/23 at 4:34 p.m., the administrator stated she was not aware that a list of the staff who had current certification in first aid or CPR was required.

Based on record review and interview, the residence failed to develop policies regarding fall management and lift assistance, affecting 11 current residents. Findings include: On 2/28/23 the policies for fall management and lift assistance were requested; however, the policies were unable to be provided. On 2/28/23 at approximately 4:34 p.m., the administrator stated she was so new in the administrator roll, and was not aware those policies were required. She stated the previous administrator had created the current policies and procedures; however, she was unable to locate the fall management and lift assistance policies.

Based on record review and interview, the residence failed to ensure the resident roster contained emergency contact information along with a residence diagram that showed room locations, affecting 11 current residents. Findings include: On 2/28/23 at approximately 7:45 a.m., a resident roster was requested from the administrator. On 2/9/23 at approximately 8:00 a.m., the administrator provided a resident roster which included the resident's full name and birthdate. However, it did not contain emergency contact information or a residence diagram that showed room locations. On 2/28/23 at approximately 4:34 p.m., the administrator identified the document provided earlier was the resident roster. She stated she was unaware the resident roster was required to contain emergency contact information and the residence diagram that showed room locations.

Based on record review and interview, the residence failed to complete, at the time a new resident moved into the residence, a comprehensive assessment, affecting five of five sample residents (#1-#5). Findings include:1. ReferenceChapter VII regulations governing assisted living residences, part 12.7, requires that a comprehensive assessment includes all the following items:(A) Information from the comprehensive pre-admission assessment described in Part 11.1;(B) Information regarding the resident's overall health and physical functioning ability;(C) Information regarding the resident's advance directives;(D) Communication ability and any specific needs to facilitate effective communication;(E) Current diagnoses and any known or anticipated need or impact related to the diagnoses;(F) Food and dining preferences, unique needs and restrictions;(G) Individual bathroom routines, sleep and awake patterns;(H) Reactions to the environment and others, including changes that may occur at certain times or in certain circumstances;(I) Routines and interests;(J) History and circumstances of recent falls and any known approaches to prevent future falls;(K) Safety awareness;(L) Types of physical, mental, and social support required; and(M) Personal background, including information regarding any other individuals who are supportive of the resident, cultural preferences, and spiritual needs. 2. Record ReviewResidents #1-#5 were admitted to the residence on 11/18/18, 8/1/19, 3/3/18, 2/25/22, and 2/27/23, respectively. The record review for Residents #1-#5 revealed the files did not contain comprehensive assessments. 3. Interview On 2/28/23 at approximately 12:24 p.m., the administrator stated the previous administrator informed her that the residents' external service provider was responsible for resident assessments and that the residence was not required to complete resident assessments.

Based on record review and interview, the residence failed to have defined procedures to prevent the spread of influenza from unvaccinated staff, affecting 11 current residents. Findings include:On 2/28/23 at approximately 7:45 a.m., the administrator was asked to provide the residence's procedures to prevent the spread of influenza from unvaccinated staff. However, no such policy/procedure was provided. On 2/28/23 at approximately 4:30 p.m., the administrator confirmed the residence did not have a policy/procedure to prevent the spread of influenza from unvaccinated staff. She stated she was so new at the administrator role and was unaware it was a required policy.

Based on record review and interview, the residence failed to ensure the house rules addressed marijuana consumption, affecting 11 current residents. Findings include: The residence's undated House Rules were reviewed and revealed it did not address marijuana consumption. On 2/28/23 at approximately 4:34 p.m., the administrator stated she was aware marijuana consumption was a required element that needed to be addressed in the house rules. She stated the previous administrator created the current house rules. The administrator added she had been so busy after taking over the roll of administrator in November 2022 and had not had time to update the house rules.

Based on observations and interviews, the residence failed to store refrigerated medications in a refrigerator that did not contain food and was not accessible to residents, affecting 11 current residents. Findings include: On 2/9/23 at approximately 7:40 a.m., an environmental tour revealed the unlocked kitchen refrigerator, which was accessible to residents, contained a locked box which contained insulin for residents #3 and #8. On 2/28/23 at approximately 4:34 p.m., the administrator stated she was not aware medications were not permitted to be stored in a refrigerator that contained food. She stated the previous administrator informed her that as long as medication was locked in a lockbox, it was okay to be in the same refrigerator where food was stored.

Based on observation and interview, the residence failed to ensure designated smoking areas and resident rooms occupied by smokers had fire resistant wastebaskets, affecting five residents (#1, #2, #4-#6). Findings include: An environmental tour of the designated smoking area located in the backyard revealed there were no fire resistant wastebaskets. The wastebasket located in the designated smoking area was plastic and had a large hole at the bottom where it melted from discarded cigarette butts. During the onsite visit, Resident #2 was observed in the designated smoking area throughout the day and used a cast iron skillet or an ashtray and distinguished his cigarettes.. An environmental tour of the room shared by Resident #2 and Resident #3 revealed a plastic wastebasket that was not fire resistant. An environmental tour of the room for Resident #1, the room for Resident #4, and the room for Resident #5 and #6 revealed a plastic wastebasket that was not fire resistant. On 2/28/23 at 4:45 p.m., the administrator stated she had recently ordered a fire resistant wastebasket for the designated smoking area, but it had not arrived yet. She stated she was not aware the current wastebasket located outdoors had melted at the bottom due to discarded cigarette butts. The administrator stated she was not aware that the rooms occupied by smokers were required to have fire resistant wastebaskets.

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 7.7.1 In order to ensure that staff members and volunteers are of good, moral, and responsible character, the assisted living residence shall request, prior to staff hire or volunteer on-boarding, a name-based criminal history record check for each prospective staff member and volunteer.(A) If the applicant has lived in Colorado for more than three (3) years at the time of application, the assisted living residence shall obtain a name-based criminal history report conducted by the Colorado Bureau of Investigation (CBI).(B) If the applicant has lived in Colorado for three years or less at the time of application, the assisted living residence shall obtain a name-based criminal history report for each state in which the applicant has lived for the past three years, conducted by the respective states' bureaus of investigation or equivalent state-level law enforcement agency or other name-based report as determined by the Department.(C) The cost of obtaining such information shall be borne by the assisted living residence, the contract staffing agency or the individual who is the subject of such check, as appropriate. 7.11 Personnel files for current employees and volunteers shall be readily available onsite for Department review. 12.10 Each resident care plan shall: (B) Reflect the most current assessment information. 14.32 The assisted living residence shall have policies and procedures for documenting, investigating, reporting, and responding to any errors related to accurate accounting of controlled substances and/or medication administration. 14.44 The assisted living residence shall have policies and procedures regarding the destruction and disposal of outdated, unused, discontinued, and/or expired medications which are not returned to the resident or legal representative. At a minimum, the policies and procedures shall include the following requirements:(A) Outdated, discontinued, and/or expired medications shall be destroyed in accordance with federal, state, and local regulations within thirty (30) days.(1) Medication shall be destroyed in the presence of two individuals, each of whom are either a qualified medication administration person, nurse, or practitioner;(2) All medications shall be destroyed in a manner that renders the substances totally non-retrievable to prevent diversion of the medication; and(3) There shall be documentation which identifies the medications, the date, and the method of destruction, and the signatures of the witnesses performing the medication destruction.(B) All destroyed medications shall be disposed of in compliance with Parts 24.2 and 24.3 regarding medical waste disposal. 18.8 Resident records shall contain, but not be limited to, the following items:(D) Progress notes which shall include information on resident status and wellbeing, as well as documentation regarding any out of the ordinary event or issue that affects a resident's physical, behavioral, cognitive and/or functional condition, along with the action taken by staff to address that resident's changing needs;(1) The assisted living residence shall require staff members to document, before the end of their shift, any out of the ordinary event or issue regarding a resident that they personally observed, or was reported to them. 19.2 The assisted living residence shall have and follow written policies and procedures that address the transmission of communicable diseases with a significant risk of transmission to other persons and for reporting diseases to the state and/or local health department, pursuant to 6 CCR 1009-1, Epidemic and Communicable Disease Control.(A) The policies and procedures shall be based on nationally recognized guidelines, such as those promulgated by the Centers for Disease Control (CDC), World Health Organization (WHO), or the Association for Professionals in Infection Control and Epidemiology (APIC), and comply with guidance from the Colorado Department of Public Health and Environment, as applicable.(1) The policies shall identify the nationally recognized guidelines and Department guidance upon which the policies are based.