AUBURN VIEW ASSISTED LIVING

A relicensure survey was completed on 11/1/23. No deficiencies were cited.

THIS PORTION OF THE REPORT IS FOR INFORMATIONAL PURPOSES ONLY.No response is necessary. The residence was advised it must review and maintain the following processes in accordance with existing program regulations found at 6 CCR 1011-1, Chapter 7.3.14 Section 25-27-106, C.R.S., allows the Department to impose intermediate restrictions or conditions on a licensee that may include at least one of the following:(E) Paying a civil fine not to exceed two thousand dollars ($2,000) in a calendar year. 6.8 The administrator shall be responsible for the overall day-to-day operation of the assisted living residence, including, but not limited to: (J) Complying with all applicable federal, state, and local laws concerning licensure and certification.

A recertification survey was completed on 11/1/23. No deficiencies were cited.

A licensure revisit was completed on 11/1/23 for all previous deficiencies cited on 7/11/23. The residence is in compliance with all regulations surveyed.

A licensure complaint, prompted by #CO32766, was completed on 7/11/23. Deficiencies were cited.

Based on record review and interview, the residence failed to have an administrator who had taken the training program that met all assisted living requirements including at least 40 actual hours of curriculum training, affecting six current residents. Findings include:1. Record Review On 7/11/23 at 9:01 a.m., the administrator provided her training document. However, the document revealed the administrator had completed a 30 hour administrator training program from an external training provider on 1/14/15 and not the 40 hour administrator training as required by regulation. Review of the department's database revealed the administrator had not been an administrator for assisted living prior to becoming the administrator of record at the residence on 11/17/17.2. InterviewOn 7/11/23 at 12:10 p.m., the administrator acknowledged she had participated in an administrator training program that included only 30 hours of curriculum. She stated she was not aware of the requirement to complete an administrator training course with 40 hours of curriculum.

Based on observation, record review, and interview the residence failed to provide either directly or indirectly through a resident agreement, a physically safe environment including, but not limited to, measures to reduce the risk of potential hazards, affecting six current residents. Specifically, the residence failed to monitor the outside areas of the residence for potential safety hazards. On 7/11/23 at 10:20 a.m., a swarm of bees congregated in the upper corner of the rafters of the outdoor covered patio common area. The swarm remained active for approximately one hour until the swarm dissipated. The residence had a history of hive removal. This failure created an immediate jeopardy risk of safety to all six current residents residing in the residence. On 7/11/23, the department directed the residence to provide written evidence that the risk had been removed. Findings Include: 1. Reference and Residence Policies: a. According to the Mayo Clinic, "Bee stings are a common outdoor nuisance. In most cases, bee stings are just annoying, and home treatment is all that's necessary to ease the pain. But if you're allergic to bee stings or you get stung numerous times, you may have a more-serious reaction that requires emergency treatment. Bee stings can produce different reactions, ranging from temporary pain and discomfort to a severe allergic reaction. In some cases a person will disrupt a hive or swarm of bees and get multiple stings. If you get stung more than a dozen times, the accumulation of venom may induce a toxic reaction and make you feel quite sick. Multiple stings can be a medical emergency in children, older adults, and people who have heart or breathing problems. Seek prompt medical care if you've been swarmed by bees and have multiple stings." https://www.mayoclinic.org/diseases-conditions/bee-stings/symptoms-causes/syc-20353869b. According to Bee-Commerce, "A swarm of honeybees may contain from 1,500 to 30,000 bees including, workers, drones, and a queen. The tendency to swarm is greatest when bees increase their population rapidly in late spring and early summer."https://www.bee-commerce.com/content/freedownloads/FactsAboutSwarms.pdfc. The residence's Resident Admission and Financial Agreement, undated, read in part: "Care Services: "The Facility will provide the Resident with room and board, three meals and snacks a day, house cleaning, laundry services and 24 hour assisted care with activities of daily living, medication assistance, recreation and social programs and safety and security". d. The residence's Pest Control Policy, undated, read in part: "It is the policy of the Assisted Living that unwanted pests will be managed by all persons (Administrator, caregivers, staff and applicators) utilizing the following procedures. Pest management services will be provided for the Residence." 2. Physically Safe Environment:a. ObservationOn 7/11/23 at 8:13 a.m., an environmental tour of the residence revealed approximately ten to twelve bees in the outdoor covered patio common area. Additionally, the bees were located in close proximity to the door utilized by the residents to exit and enter the residence and near a resident's stored bicycle. On 7/11/23 at approximately 10:20 a.m., a swarm of bees was observed through the window of the second level dining room area. The swarm congregated in the upper corner of the rafters in the outdoor covered patio common area. The administrator was notified of the swarm and the potential safety concerns for the residents and staff. 3. InterviewsOn 7/11/23 at 9:07 a.m., Resident #1 stated she had noticed several bees three days prior to the onsite visit. On 7/11/23 at 10:37 a.m., Resident #2 stated she had noticed several bees one day prior to the onsite visit. She further stated "there is a hive."On 7/11/23 at 10:27 a.m., the administrator was not aware of the swarm of bees. She stated the residence had a hive removed years ago and hasn't seen a swarm of bees until the onsite visit. on 7/11/23 at 1:22 p.m., Resident #3 stated he had noticed several bees within the last few days prior to the onsite visit and staff were aware the bees where there. 4. Immediate Jeopardy Risk - Written Evidence, Immediate Correction The investigation established that the findings above placed the six current residents at immediate jeopardy risk of harm in the event of one or more bee stings. 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 7/11/23 at approximately 12:44 p.m., the administrator submitted written evidence that read in pertinent part: "Today we observed bees in the backyard. Immediately, I took action and called a pest control service. They will have the bees removed by the end of today. Also, announced to the residents to not enter the backyard, temporarily until the bees are exterminated. Every day my staff or I will do a walk around the facility to ensure there are not any bees/pests. If we do observe bees or other pests, I will immediately call the pest control service to exterminate the pests. Meanwhile, I will continue to monitor the area and make sure any residents do not have contact or access to that area."

Based on interview and record review, the residence failed to develop a detailed care plan to reflect the most current assessment information, promote resident choice, mobility, independence and safety, detailed specific personal service needs and preferences along with the staff tasks necessary to meet those needs and external service providers along with care coordination arrangements, affecting one of one sample resident (#1). Findings include: 1. Residence Policiesa. The residence's Resident Admission and Financial Agreement, undated, read in part: "Move-In Process: The facility will have ongoing assessments and monitoring of resident needs, including updating the resident service care plan. A pre-admission assessment will be done by a facility staff member. The resident shall be reassessed yearly or more frequently, if necessary, to address any significant changes in the resident's physical, behavioral, cognitive, and functional condition and identify the services the facility shall provide to address the resident's changing needs." b. The residence's Care Plan Process, undated, read in part: "The facility will maintain a written description in lay person terminology of the functional capabilities of a resident and their individual need for personal assistance and the services provided by the facility in order to meet the individual's needs. The care plan will be created when the resident is admitted. The care plan will be reviewed and revised annually and as changes in the resident's care improve or decline." 2. Record Review Resident #1 was admitted to the residence 1/11/23 with diagnosis including bipolar disorder. A behavioral contract, dated 12/27/22, read behavioral expectations regarding smoking in the room, leaving the facility without signing out, not following the house rules, not taking medication as prescribed by the doctor and yelling at staff and other residents and invading the other resident's private space. An updated behavioral contract, dated 4/17/23, read Resident's #1 observed behavioral expectations regarded yelling at staff and other residents, invaded other residents' private space, had gone outside without wearing shoes and used bad language. A progress note, dated 7/4/23, read Resident #1 was in the backyard of the residence for a 4th of July celebration. Resident #1 was observed leaving the celebration and area. A police officer showed up to the residence and notified the administrator Resident's #1 family called 911. Resident #1 stated she felt scared and did not feel good and requested to be transferred to the hospital. A psychiatric discharge summary, dated 7/6/23, read in part Resident #1 was initially admitted due to suicidal ideation (SI) with intent to self harm in the setting of past trauma revolved around death of family members and discord with host home provider. In addition, a new medication was prescribed and Resident #1 was psychiatrically cleared for discharge. No care plan was found in the resident's record. The administrator was asked for the residence's care plan. Administrator subsequently left and returned with a care plan she admittedly created during the onsite visit for Resident's #1 initial assessment. 3. InterviewOn 7/11/23 at approximately 3:30 p.m., the administrator stated she filled out Resident's #1 care plan after being asked during the onsite visit and acknowledged did not reflect the most current assessment information, promote resident choice, mobility, independence and safety, detailed specific personal service needs and preferences along with the staff tasks necessary to meet those needs and external service providers along with care coordination arrangements as required.

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 7.6.8 The administrator shall be responsible for the overall day-to-day operation of the assisted living residence, including, but not limited to: (J) Complying with all applicable federal, state, and local laws concerning licensure and certification.

A certification complaint, prompted by #CO32767, was completed on 7/11/23. No deficienices were cited.