SUNRISE AT FLATIRONS

A revisit survey was completed on 1/23/25 for all previous deficiencies cited on 9/10/24. 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 #CO33652, #CO34382, #CO35927, #CO36032, #CO36033, #CO36939, #CO37292, and #CO37343, was completed on 9/10/24. Deficiencies were cited.

Based on record review, observation and interview, the residence failed to maintain resident records that included progress notes that contained pertinent information on resident status and wellbeing, as well as documentation regarding any out of the ordinary event or issue that affected a resident's physical and functional condition, along with the action taken by staff to address the resident's changed needs, affecting four of four sample residents. (Cross-reference S2710) 1. References The residence policy, titled Injury of Unknown Origin, dated 4/4/23 read in part: the residence would investigate injuries of unknown origin including bruises, abrasions, and other injuries of unknown source. The residence would retain the documents related to the investigation, outcomes, and steps taken. The residence would make such documentation available for review at the Department's request. The policy also read documentation of the investigation, outcomes, and steps taken may be maintained separately from the resident record, in which case a summary of the investigation and steps taken shall be in the resident ' s health record and may include care plan and progress notes. The residence's Pest Control Policy dated 10/12/15 read in part: "Each community must notify residents when their suits will be inspected and/or treated." "Informal communication from one team member to another is not acceptable."2. Record ReviewA pest control company customer service report read on service date of 8/22/24, Former Resident #3's room was inspected. Bed bugs were noted during inspection and heavy activity noted during inspection. Bed bug inspection was the only service provided and the company recommended the room be taken out of service to be treated for bed bugs. An pest control company customer service report read on service dated 9/5/24, Former Resident #3 ' s room needed a one time service as of this time. Bed bugs were noted during treatment. This area was inspected and serviced. Progress notes, dated 8/4/24- 9/4/24, did not mention a room move, that the residence contacted the power of attorney (POA) or have any have documentation regarding bed bugs in the room of Former Resident #3. 3. InterviewOn 9/10/24 at 12:45 p.m., the acting Executive Director (ED) confirmed that any out of the ordinary event should have a follow up progress note and that is where any events would have been documented. On 9/10/24 at 8:20 a.m., an anonymous staff stated they had reported the bed begs to administration. They also stated there were bites on Resident #1. The anonymous staff also stated there were bed bugs found on the couches in the common area and they did not think the situation was handled properly. On 9/10/24 at 12:28 p.m., the POA for Former Resident #3 stated the residence did not have any communication regarding the bed bugs, and she learned of the bed bugs through word of mouth, not management. She also stated the residence moved Former Resident #3 to another room, however she was never notified that the room was being inspected for bed bugs. On 9/10/24 at 1:22 p.m., the Associate Executive Director (AED) acknowledged the progress notes did not include bed bugs although they should have. She also stated she does not routinely document phone calls in the progress notes. The AED acknowledged there should have been documentation in the progress note if a POA was notified of an out of the ordinary event. 4. Similar deficient practice for Resident #1, former Resident #2 and Former Resident #4.

Based on observation, record review, and interview, the residence failed to have written policies and procedures that provide for effective control and eradication of insects, and other pests, either directly or indirectly through a resident agreement, affecting 64 current residents. (Cross-reference S2230)Findings include 1. ReferenceThe residence's Pest Control Policy dated 10/12/15 read in part: [Residence] is committed to maintaining a pest free environment for residents, their families and team members."2. ObservationOn 9/10/24 at 8:28 a.m., during a walk through of the secure environment on the third floor of the residence, Resident #1 ' s room had clear trash bags with resident sheets inside. The trash bag had writing that read, "[Resident #1] treated". On 9/10/24 at 8:32 a.m., during a walk through of the secure environment on the third floor of the residence, former Resident #3 ' s room had a paper taped on the door. The paper was written by the resident's family notifying staff that all furniture may be disposed of and not to dispose of the clear bags being treated after a bed bug outbreak. 3. Record Review On 9/10/24 at approximately 10:30 a.m., a pest control invoice dated 9/5/24 read in part, rooms infested with bed bugs included former resident #3 ' s room and pest activity was found during the service. 4. Interviews On 9/10/24 at 8:20 a.m., an anonymous staff stated they had reported the bed begs to administration. They also stated there were bites on Resident #1. The anonymous staff also stated there were bed bugs found on the couches in the common area and they did not think the situation was handled properly. On 9/10/24 at 11:01 a.m., the director of maintenance stated the pest control company had come into the residence to treat Former Resident #3 ' s room on 9/5/24 and they were in the residence at 8:00 a.m., on 9/10/24 to do a second treatment, however they had not received an invoice yet. On 9/10/24 at 12:33 p.m., the acting administrator stated there was a bed bug infestation in former Resident #3's room during the first week of September 2024. She stated Former Resident #3 and Former Resident #4 had moved out of the residence due to the ongoing bed bug situation; however, they had not collected the rest of their belongings yet. The acting administrator stated Former Resident #3 and Former Resident #4 were moved to another room when the bed bugs were first discovered and the temporary room was being treated for bed bugs as a precaution. She stated Resident #1, was relocated to another room due to bed bug activity. She further stated after the room was treated, Resident #1 moved back into her original room. The acting administrator stated there was then bed bug activity in the room she had been temporarily moved to. The acting administrator acknowledged the resident rooms had bed bugs and were not sanitary for the residents. On 9/10/24 at 3:12 p.m., the director of maintenance acknowledged the bed bugs had been a recurring problem that began some time in May 2024, however he was unable to say an exact date. He also stated he was unsure why the bed bug problem had continued.

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 7.10.1 The assisted living residence shall have readily available a roster of current residents, their room assignments and emergency contact information, along with a facility diagram showing room locations.

A revisit survey was completed on 9/1/23 for all previous deficiencies cited on 2/10/23. The facility is in compliance with all deficiencies that were cited.

A revisit survey was completed on 7/12/23 for all previous deficiencies cited on 5/10/23. No deficiencies 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 #CO31074, was completed on 5/10/23. Deficiencies were cited.

Based upon observation and record review, the residence failed to ensure each resident had the right to refuse medications, affecting one of seven sample residents, (#4), observed during the medication pass. Findings include: At approximately 8:10 a.m. staff #1 entered the room of resident #4, who was sleeping in bed. Staff #1 woke the resident and assisted her to sit at the edge of the bed. Staff #1 began administration of medications to resident #4, which included the following six medications: omeprazole oral suspension, acetaminophen oral liquid, citalopram, folic acid, vitamin D3, and memantine. During the administration, resident #4 repeatedly stated "No" and pushed the hand of Staff #1 away as she poured the liquid medications into her mouth. However, Staff #1 encouraged her to continue and directed her to drink water between administrations. Subsequently, Staff #1 directed the resident to open her mouth wider when she spooned medications in her mouth, placed in pudding. At the end of the administration, the resident was refusing to open her mouth wider and stated "No" and said "Get the hell out of here." The resident spit towards the floor and staff #1 asked the surveyor if she had spit out a medication, but none was found. The administration ended at approximately 8:15 a.m. At approximately 12:42 p.m., staff #1 stated that she had been trained that after three times if a resident refused a medication, she was to get another QMAP to help. She stated resident #4 would get aggravated during medication administration and sometimes she needed a break and one would need to come back and try later. She said last night, it took a QMAP forty-five minutes to administer her medications. The residence's medication adminstration policies were reviewed and did not contain specific direction regarding the above practice. The policies read the intial training for QMAPs read they were trained in "Recognizing and identifying "stop points.""

Based on observation, record review and interview, the residence failed to comply with practitioner orders for the administration of medications to two of seven residents (#3, #4) observed during the morning medication pass, and resident #1. Findings include:1. Resident #4: At approximately 7:58 a.m., staff #1 administered Omeprazole Oral Suspension to resident #4, instead of at 6:00 a.m. as practitioner ordered. The directions on the resident's May 2023 medication administration record (MAR)read, "PLEASE GIVE AT SPECIFIED TIME LISTED." Staff #1 also administered the following five medications to the resident at the same time: acetaminophen oral liquid, citalopram, folic acid, vitamin D3, and memantine. Reference: Mayo Clinic https://www.mayoclinic.org/drugs-supplements/omeprazole-oral-route/precautions/drg-20066836?p=1 reads that there needs to be caution when taking this medication with other medications and requires physicians to evaluate other medications for contradictions. 2. Resident #3: At approximately 7:45 a.m., staff #1 administered two tablets of acetaminophen to resident #3, instead of at 6:00 a.m. as practitioner ordered. Staff #1 also administered the following two medications to the resident at the same time: glycolax powder and senna S. 3. At approximately 12:42 p.m. staff #1 stated that she had administered 6:00 a.m. medications with other morning medications to the above residents, because she was unaware she had 6:00 a.m. medications to administer. She also stated she was trained that there was a three-hour window to administer medications, so if a medication was ordered for 6:00 a.m., she had until 9:00 a.m. to administer it. Staff #1 also stated she was "confused" and "did not understand" the residence's system for the administration of 6:00 a.m. medications, and the window in which to administer medications. 4. Resident #1: Prior to the investigation, the department received correspondence that read the residence had received two orders to discontinue the administration of Donepezil in February 2023: first on 2/10/23 and the second, on 2/14/23. However, the residence had failed to follow the orders. The February 2023 MAR read that donepezil (Aricept) was started on 2/1/23 as 10 mg, one tablet by mouth once a day related to mild cognitive impairment of uncertain or unknown etiology. The MAR read the medication was discontinued on 2/14/23 and the last dose was administered on 2/13/23. At approximately 1:32 p.m., the administrator stated she did not know why the medication was not discontinued the first time and identified that the QMAP supervisor or the two residence nurses may have known the circumstances. The QMAP supervisor stated at approximately 2:23 p.m. that the residence had received an order to discontinue the medication on 2/10/23, however it was not discontinued. The QMAP supervisor stated she did not know why it was not discontinued on 2/10/23. Nurse #1 stated at approximately 2:45 p.m. that an "honest error" had occurred where nurse #2 had failed "to take it out of the system" and the medication was administered for three more days until discontinued again by a second order. Nurse #1 stated the resident's physician assistant had directed them to discontinue it a second time on 2/14/23. At approximately 3:27 p.m., the resident's physician assistant stated that a neurologist had ordered the medication on 1/31/23 and confirmed it was to be discontinued on 2/10/23, but it was not until 2/14/23.

Based upon observation, record review and interview, the residence failed to ensure one of two qualified medication administration persons (QMAP #2) applied nationally recognized protocols for basic infection control and prevention when preparing and administering medications. Findings include:At approximately 8:30 a.m. to 8:37 a.m., staff #2 removed medications from bubble packs for residents #5 and #6, by popping them into her gloved hand that had touched various items, including medications, cart handles and the computer mouse and placed them in plastic cups. Staff #2 then administered them to the residents. The residence's medication adminstration policies were reviewed and did not contain direction regarding the above practice. The administrator and QMAP Supervisor were informed of these findings and did not provide comment.

Based upon record review and interview, the Administrator and the QMAP Supervisor failed to audit the accuracy and completeness of medication adminstration records (MARs), affecting approximately 58 current residents, administered medications by the residence. Findings include: During the course of the investigation, non-compliance with practitioner orders was found. (Cross-reference Q1468) During interview at approximately 1:32 p.m., the administrator stated she was not aware there were issues with the 6:00 a.m. medication administration times. During interview at approximately 2:23 p.m., the administrator stated she was not conducting audits with the QMAP Supervisor. The QMAP Supervisor confirmed she was not conducting MAR audits with the administrator but stated she had conduced cart audits and the pharmacy had also conducted audits. The QMAP Supervisor provided cart audits which revealed she had checked the carts to determine the following items:- Cart is clean & organized; no team member personal items found in cart-Current Nursing Drug Handbook present-There are no discontinued medications or loose pills found in the cart-Eye drops, creams, liquids, inhalers, nebulizer treatment ampules, ear drops, nasal sprays that are indicated by pharmacy for dating when opening are dated appropriately -All insulin is dated when opened and stored according to the manufacturer requirements- Each insulin dependent resident has their own glucometer & case, labeled with their name, control solution stored within case. Control Solutions not expired. -All routine & PRN (as needed) medications are available in cart as ordered by MD (medical doctor)-No expired medications found in cart; or in medication refrigerator-Narcotic box is locked and secured; no issues noted with locks of security of medications-Narcotic log signed completely (full first & last name or first initial and last name) to date by authorized team members, acknowledging the narcotic count accurately matches the count-Sharps container is available in med (medication) cart, and is not filed about (3/4) -Med cart is properly stocked with spoons, cups, medicine cups, gloves, B/P (blood pressure) cuff, thermometer, pill crusher with plastic sleeves (if applicable) and alcohol-based hand sanitizer -Juice, water and yogurt or applesauce are dated with current date, covered in between med passes and kept at appropriate temperature- OTC (over the counter) meds are labeled with resident name and room #- Prescribed medications have accurate pharmacy label, noting the 5 rights: Name, Drug, Dose, Time, Rout-Are they any recommendations for the FCD/HCM? Meds that resident would prefer to be crushed? Meds that cannot be crushed? Resident preference with time of med administration?

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 VII. 10.1 The assisted living residence shall have readily available a roster of current residents, their roomassignments and emergency contact information, along with a facility diagram showing roomlocations. 14.7 The assisted living residence shall ensure that each resident receives proper administrationand/or monitoring of medications.

A relicensure survey was completed on 2/10/23. A deficiency was cited.

Based on observation, record review and interview, the residence failed to ensure a name-based criminal history record check conducted by the Colorado Bureau of Investigation (CBI) was completed for each prospective employee, affecting two of three sample staff (#1-#2). Findings include: A personnel file for Staff #1 contained a hire date of 1/15/20; however, the personnel file contained no name-based criminal background check conducted by CBI. A personnel file for Staff #2 contained a hire date of 6/10/22; however, the personnel file contained no name-based criminal background check conducted by CBI.The residence schedule, dated February 2023, read in part that Staff #1 worked at the residence on 2/1-2/2 and 2/5-2/7/23 and Staff #2 worked on 2/3-2/4, and 2/7-2/10/23. On 2/10/23 at approximately 2:30 p.m., the administrator stated the residence was expected to have completed a name-based criminal history report conducted by the CBI prior to staff member's hire; however, the residence had no proof the residence conducted the name-based criminal history report in the personnel files of Staff #1 and #2.