Paramount Senior Living at Polaris

Based on observation, staff interviews, review of manufacturer guidelines, review of facility policy, and record review, the facility failed to ensure safe storage of insulin pens. This affected four Residents (#16, #17, #18, and #28) of four reviewed for medication storage. The facility identified 12 residents (#16, #17, #18, #28, #34, #37, #45, #47, #55, #58, #72, and #78) with orders for insulin injectable's. The facility census was 77.

Findings include:

1. Review of the medical record for Resident #16 revealed an admission date of 11/27/24. Diagnoses included heart failure, cerebral infarct, diabetes and metabolic encephalopathy.

Review of physician orders revealed orders dated 11/27/24 for Humalog kwikpen injection with instructions to inject subcutaneously before meals per sliding scale with instructions for blood sugar of 141 milligrams per deciliter (mg/dL) to 180 mg/dL give one unit, 181 to 220 mg/dL give two units, 221 to 260 mg/dL give three units, 261 to 300 mg/dL give four units, 301 to 340 mg/dL give five units, 341 to 380 mg/dL give six units and greater that 381 mg/dL give seven units. Additionally, there was an order for Humalog kwikpen injection with instructions to inject subcutaneously at bedtime per sliding scale for blood sugar of 251 to 300 mg/dL give one unit, 301 to 340 mg/dL give two units, 341 to 380 mg/dL give three units, and greater that 381 mg/dL give four units. The resident was also ordered Humalog kwikpen injection with instructions to inject three units subcutaneously before meals and Lantus solos injection with instructions to inject five units subcutaneously in the morning with instructions to not mix with other insulin's and discard 28 days after opening.

Interview and observation on 03/30/26 at 3:00 P.M. with Medication Tech #55 revealed in the medication cart, Resident #16's Humalog pen was found dated 01/29/26 with an expiration date of 02/27/26, the Lantus pen was found undated, and the Lispro was found dated 02/25/26 with an expiration date of 03/25/26. Medication Tech #55 confirmed the insulin's were considered expired and/or undated and should have been discarded.

Review of the manufacturer guidelines for Lantus dated 05/2025 stated vials shall be stored in the refrigerator prior to use. Once opened the vial can remain outside the refrigerator for 28 days then should be discarded.

Review of the manufacturer guidelines for Lispro dated 12/2018 stated vials shall be stored in the refrigerator prior to use. Once opened the vial can remain outside the refrigerator for at room temperature for 28 days then should be discarded.

Review of the manufacturer guidelines for Humalog dated 03/2013 stated vials shall be stored in the refrigerator prior to use. Once opened the vial can remain outside the refrigerator for 28 days then should be discarded even if it had insulin remaining.

2. Review of the medical record for Resident #17 revealed an admission date of 07/02/23. Diagnoses included chronic pulmonary disease, cognitive impairment, anxiety and diabetes.

Review of physician orders revealed orders dated 06/30/25 for ASPA (Novolog) injection flexpen with instructions to inject subcutaneously four times daily before meals and at bedtime with instructions stating if blood sugar was 151 to 200 mg/dL give three unit, 201 to 250 mg/dL give five units, 251 to 300 mg/dL give eight units, 301 to 350 mg/dL give 10 units, 351 to 400 mg/dL give 12 units, and greater that 400 mg/dL give 15 units.

Interview and observation on 03/30/26 at 3:00 P.M. with Medication Tech #55 revealed in the medication cart, Resident #17's Novolog insulin pen was undated. Medication Tech #55 confirmed the insulin was undated, it was unknown when it was opened, and should have been discarded.

Review of the manufacturer guidelines for Novolog dated 02/2023 stated vials shall be stored in the refrigerator prior to use. Once opened the vial can remain outside the refrigerator for 28 days then should be discarded even if it had insulin remaining.

3. Review of the medical record for Resident #18 revealed an admission date of 08/07/25. Diagnoses included hemiplegia and hemiparesis, dysphagia, cognitive communication deficit, muscle weakness and diabetes.

Review of physician orders revealed orders dated 08/07/25 to 08/08/25 for Lantus injection with instructions to inject 10 units subcutaneously in the morning. Additionally, there was a physician order dated 08/08/25 for Tresiba flex injection with instructions to inject 10 units subcutaneously in the morning and an order dated 08/08/25 for Novolog injection flexpen with instructions to inject subcutaneously before meals with instructions stating for blood sugar 151 to 200 mg/dL give two units, 201 to 250 mg/dL give four units, 251 to 300 mg/dL give six units, 301 to 350 mg/dL give eight units, and 351 to 400 mg/dL give 10 units.

Interview and observation on 03/30/26 at 3:00 P.M. with Medication Tech #55 revealed in the medication cart, Resident #18's Novolog pen was found undated, a Tresiba pen was found undated, and a Lantus pen was found to be dated 01/16/26 with expiration date of 02/16/26. Medication Tech #55 confirmed the insulin's were considered expired and/or undated and should have been discarded.

Review of the manufacturer guidelines for Novolog dated 02/2023 stated vials shall be stored in the refrigerator prior to use. Once opened the vial can remain outside the refrigerator for 28 days then should be discarded even if it had insulin remaining.

Review of the manufacturer guidelines for Tresiba dated 07/2022 stated vials shall be stored in the refrigerator prior to use. Once needed for use the vial can remain outside the refrigerator for 56 days then should be discarded.

Review of the manufacturer guidelines for Lantus dated 05/2025 stated vials shall be stored in the refrigerator prior to use. Once opened the vial can remain outside the refrigerator for 28 days then should be discarded.

4. Review of the medical record for Resident #28 revealed an admission date of 11/26/25. Diagnoses included atrial fibrillation, diabetes and multiple sclerosis.

Review of physician orders revealed orders dated 11/21/25 for Lantus solos injection with instructions to inject five units subcutaneously in the morning with instructions stating do not mix with other insulin's and discard 28 days after opening. Additional orders dated 11/26/25 revealed orders for Lispro injection with instructions to inject before meals and at bedtime if blood sugar was 151 to 200 mg/dL give two units, 201 to 250 mg/dL give four units, 251 to 300 mg/dL give six units, 301 to 350 mg/dL give eight units, 351 to 400 mg/dL give 10 units, and 401 to 500 mg/dL give 12 units.

Interview and observation on 03/30/26 at 3:00 P.M. with Medication Tech #55 revealed in the medication cart, Resident #28's Lispro and Lantus pen's were undated. Medication Tech #55 confirmed the insulin's were undated, it was unknown when they were opened, and they should have been discarded.

Interview with on 03/30/26 around 3:45 P.M. with Resident Care Manager #50 confirmed staff should be dating and labeling the insulin pens and they should be discarded once they go past expiration.

Review of the manufacturer guidelines for Lantus dated 05/2025 stated vials shall be stored in the refrigerator prior to use. Once opened the vial can remain outside the refrigerator for 28 days then should be discarded.

Review of the manufacturer guidelines for Lispro dated 12/2018 stated vials shall be stored in the refrigerator prior to use. Once opened the vial can remain outside the refrigerator for at room temperature for 28 days then should be discarded.

Review of facility policy titled, Diabetes Management dated 10/01/18 revealed all residents who were ordered blood glucose monitoring would have their own monitor, alcohol wipes, test strips and lancets. All insulin dependent diabetics would have their own supply of insulin and syringes. All insulin would be stored in the refrigerator before being opened. Once insulin pens were opened they would be dated and stored in the medication carts.

Review of facility policy titled, Pharmaceutical Services-Labeling of Medications dated 10/01/18 revealed all medications shall be maintained in the facility and properly labeled. Drug labels must be legible at all times and labels shall include date drug was dispensed and expirations date.

Based on record review and staff interview, the facility failed to ensure signed agreements were completed for residents receiving skilled care over 120 days. This affected two residents (#7 and #12) of two reviewed for skilled care. The facility identified six residents who had received greater than 120 days of skilled wound or tube feed care. The facility census was 77.

Findings include:

1. Review of the medical record for Resident #12 revealed an admission date of 06/13/24. Diagnoses included cerebral infarction, pulmonary embolism, and pressure ulcer of an unspecified site.

Review of the wound care log dated 03/26/26 revealed Resident #12 had a wound which originated on 11/12/23 (prior to facility admission). The wound was described as a surgical wound to the left flank and was noted to be healing.

Review of physician orders revealed an order dated 03/12/25-10/10/25 for Resident #12 revealed medication Triad wound dressing paste (topical ointment ordered to assist with wound healing) with instructions apply topically Triad to the periwound (skin surrounding the wound) and any other open wounds, cover with an abdominal (abd) pad (highly absorbent dressing), change daily and as needed for soilage/detachment.

Review of physician orders for 03/12/25-10/08/25 for Resident #12 revealed an order for the resident's wounds to be cleansed with Vashe (wound cleansing solution), pat dry, apply topical Gentamycin (antibiotic) ointment to the left lateral main hip wound, apply Fibrocol (a collagen-alginate wound dressing) and alginate cut to size, cover with an abd pad, and secure with tape. The dressing was ordered to be changed daily and as needed for soilage/detachment.

Review of physician orders for 04/07/25-07/16/25 for Resident #12 revealed medication Gentamicin Ointment 0.1 % with instructions apply topically to left flank wound bed daily during wound care.

Review of the Physician Provider plan of care dated 06/09/25 revealed Residents #12's primary diagnoses included cerebral infarction and chronic wounds. The assessment indicated the resident had a wound on the left hip with chronic scarring.

Review of physician orders for 07/28/25-10/08/25 for Resident #12 revealed an order to cleanse the left hip with Vashe for 3 minutes, apply Hydrofera Blue (a highly absorptive, antibacterial dressing used to kill bacteria and manage wound drainage) and foam/silicone daily and as needed for wound care.

Review of physician orders for 10/8/25 for Resident #12 revealed an order for Prisma (a sterile collagen matrix dressing which helps to create a moist wound bed and an environment that supports wound healing), with instructions to cleanse the left hip with soap and water, pat dry, apply slightly-moistened Prisma, cover with calcium alginate and a dry dressing. The dressing was ordered to be changed daily and as needed for soilage/detachment.

Review of physician order for 01/19/26 for Resident #12 revealed an order for Chlorhexidine Gluconate Liquid 4% (commonly known as Hibiclens) with instructions to cleanse the left hip wound with soap and water, apply Prisma to wound surface, apply calcium alginate over the area, and cover dressing with abd pad with each dressing change.

Review of home health care visit notes dated 03/09/26 revealed Resident #12 was seen by home health care for ongoing wound management.

Review of physician orders for 03/17/26 for Resident #12 revealed an order for Chlorhexidine Gluconate Liquid 4% with instructions to cleanse the left hip wound with Hibiclens, apply Silver Alginate (a sterile, highly absorbent wound dressing which releases silver to kill bacteria and form a moist gel to facilitate autolytic debridement) to wound surface, cover with an abd pad or border dressing, and apply to the surrounding skin a thin layer of a 1-1-1 mixture of Terbinafine, Triamcinolone and Zinc mixture (this mixture is often used in combination to treat complex and inflamed skin infections) daily with each dressing change.

Review of Resident #12's medical record from 06/13/24 to 03/31/26 revealed the facility had no agreement for skilled care to be provided which had been signed between a home health company representative, the physician, the facility, and the resident and/or resident representative.

Interviews on 03/31/26 from 10:30 A.M. to 10:53 A.M. with Wellness Director #50 revealed the home health provider and the residents typically have a signed agreement visit note but confirmed the facility did not have an agreement for Resident #12 to receive skilled care and confirmed the resident had received skilled care for greater than 120 days. Wellness Director #50 acknowledged facility staff were not aware of the requirement for a written agreement for skilled care.

2. Review of the medical record for Resident #7 revealed an admission date of 10/17/24. Diagnoses included heart failure, acute respiratory failure, cardiomyopathy, and cancer.

Review of the physician order for 10/17/24 for Resident #7 revealed an order to cleanse the resident's percutaneous endoscopic gastrostomy (PEG) tube site with soap and water, apply split gauze daily (wound care) and as needed.

Review of physician order for 01/23/25 for Resident #7 revealed medication Jevity 1.5 calorie (tube feeding solution) with instructions to give 240 milliliter (ml) via peg tube four times daily. The order specified diamond does not supply.

Review of physician order for 04/10/25 for Resident #7 revealed an order for free water flushes with instructions for 120 ml of water to be administered via PEG tube four times daily.

Review of the Physician Provider plan of care dated 10/23/25 revealed Resident #7 had left-sided paralysis and a PEG tube. The physician noted the resident was ordered a mechanical soft diet and nectar thick liquids and also used Jevity 1.5 calorie solution 240 ml four times daily as a supplement. The physician indicated the resident's needs could be met in the residential care facility setting.

Review of the resident's medical record dated 10/17/24 through 03/31/26 revealed the facility had no agreement for skilled care to be provided which had been signed between physician, the facility, the resident and/or resident representative, and any outside provider if applicable.

Interviews on 03/31/26 from 10:30 A.M. to 10:53 A.M. with Wellness Director #50 revealed the facility and the residents typically have a signed agreement visit note but confirmed the facility did not have an agreement for Resident #7 to receive skilled care and confirmed the resident had received skilled care for greater than 120 days. Wellness Director #50 acknowledged facility staff were not aware of the requirement for a written agreement for skilled care.

Based on observation, staff interview, and review of facility policy, the facility failed to ensure food was stored in a safe and sanitary manner. The affected all 77 residents who received meals from the kitchen.

Findings include:

Observation on 03/30/26 at 9:30 A.M. of the facility kitchen revealed the following concerns:

a. In the freezer there were two bags of undated onion rings, an undated opened bag of tater tots, an undated bag of cheese stuffed pastries, and an undated opened bag of green beans. There was also a box with about six hamburgers, a package of chicken strips, a box of grilled chicken breasts, and three ice cream cups found to be open to air and uncovered.

b. In the refrigerator there was a large container of sour cream with a best by date of 02/25/26, four containers of vanilla yogurt with a best by date of 02/28/26, cottage cheese with a best by date of 03/09/26, a bag of five hard boiled eggs with no date, and an open pack of lettuce/salad mix with no date and it appeared brown and was a soup-like consistency. In the refrigerator was also a container of cheese and a container of lettuce that were left open to air and uncovered.

c. In the dry storage area there was an open bag of rice crispy cereal with a best by date of 01/2026 and over four bags of powdered sugar with a best by date of 01/31/26.

Interview on 03/30/26 at 9:30 A.M. with Kitchen Manager #70 confirmed the findings of foods not being dated and covered and confirmed dates on the expired food items. She stated they would be removed and thrown away.

Observation on 03/30/26 at 11:20 A.M. upon a return visit to the kitchen, the previous items identified to be improperly stored were still in place.

Review of facility policy titled, Food Storage/Dry Storage dated 06/20/17 revealed food storage areas shall be maintained in a clean and sanitary manner. All items shall be used on a first-in first-out rotation and food items shall be stored with labels facing outward with name, weight/count, and date. All open items must be dated with the date of opening and tightly covered to preserve freshness.

Based on observations, staff interview and record review, facility failed to ensure pureed food was made to the right consistency. This had the potential to affect four residents (#7, #16, #19 and #21) who the facility identified to have orders for puree textured foods. The facility census was 77.

Findings include

Observation on 03/30/26 at 11:20 A.M. revealed Cook #80 placed four servings of already grilled Reuben sandwiches in the blender along with about a half cup of broth. She reported the sandwiches included bread, corn beef, sauerkraut, cheese and thousand island dressing. The mixture was blended and the sides were scraped with a spatula. Another half cup of broth was added and the mixture was blended again. The Cook and Kitchen Manager #70 looked at the mixture and placed it into a metal serving dish.

Observation and interview on 03/30/26 at 11:30 A.M. with Kitchen Manager #70 revealed the mixture was tasted and found to have a chunky consistency. Pieces of meat were distinguishable from the mixture. Kitchen Manager #70 confirmed the mixture should be smooth and without chunks and instructed Cook #80 to place the food back in the blender to continue mixing.

Review of facility policy titled, NDDD Dysphagia Pureed dated 01/11/22 revealed the pureed diet is a modification of the regular diet and should be the consistency of smooth, moist mashed potatoes or pudding like consistency with no coarse texture or lumps allowed.

Based on observation, staff interview, review of temperature logs, and review of facility policy, the facility failed to ensure the dish washing machine was working properly to clean and sanitize dishes. The affected all 77 residents who received food and beverages from the kitchen.

Findings include

Observation and interview on 03/30/26 at 9:00 A.M. of Kitchen Staff #60 revealed she was actively washing dishes. The machine had a plaque on it stating for a high temperature wash the temperatures should read minimum of 150 degrees Fahrenheit (F) for the wash cycle and minimum of 180 degrees F for the rinse cycle. A cycle was started and the temperature for the wash cycle was 122 degrees F and the temperature for rinse cycle was 160 degrees F. Several additional cycles were observed with temperatures for the wash cycle being 120 to 125 degrees F and 160 to 182 degrees F for the rinse cycle. Kitchen Staff #60 watched the temperatures and confirmed the temperatures showed a wash cycle of 120 degrees to 125 degrees F and a rinse cycle of 160 to 182 degrees F. She stated she was not aware of what the temperature should be and reported she was not aware of any issues with the dishwasher. During this observation, dishes were being sent through the machine at an improper temperature and were subsequently being stored on the shelves for use. She acknowledged she did not know much about the dishwasher and continued to send through more sets of dishes.

Review of the temperature logs revealed multiple missing days with the last documented on 03/28/26.

Observation and interview on 03/30/26 at 9:30 A.M. with Kitchen Manager #70 confirmed the dishwashing machine was not getting to the required temperatures. The Kitchen Manager confirmed the temperature for the wash cycle was reading 122 to 125 degrees F and the rinse cycle was reading 160 to 182 degrees F. She agreed the wash was low and the rinse was not reading the right temperatures consistently. She confirmed the dishwashing temperature log had not been completed daily and was missing entries for the past two days.

Review of facility policy titled, Dish Machine and Pot Sink Temperature and Chemical Test Log dated 06/20/17 revealed the consistent water temperature monitoring promotes good performance and ensures sanitation of dishes. The policy referenced a chemical structured dishwasher and the one in use was a high temperature structured dishwasher.

Based on record review, staff interview, and policy review, facility failed to ensure fire drills were completed at least once each shift every three months. Facility also failed to document alarm transmission to the monitoring company. This affected all facility residents. Facility census was 77.

Findings include

Review of facility fire drills revealed first shift drills were completed on 04/30/25 at 1:30 P.M., 07/31/25 at 2:00 P.M., 08/30/25 at 10:30 A.M., 09/26/25 at 1:50 P.M., 11/27/25 at 10:30 A.M., 12/23/25 at 10:15 A.M., 01/30/26 at 7:15 A.M., 02/26/26 at 2:15 P.M.

Review of fire drill documentation revealed second shift drills were completed on 05/29/25 at 3:20 P.M. and 10/31/25 at 4:30 P.M.

Review of fire drill documentation revealed third shift drills were completed on 03/21/25 at 5:32 A.M. and 06/20/25 at 4:45 A.M.

Review of the Fire drill documentation revealed no mention of when the alarm was transmitted and confirmed of time it was received and no documentation of any delayed transmissions for alarms completed form 9:00 P.M. to 6:00 A.M.

Interview on 03/30/26 at 4:10 P.M. with Maintenance Director (MD) #65 confirmed fire drills should be completed monthly on a rotating basis and should include one drill every shift every three months. MD reviewed the fire drills and confirmed he had eight first shift drills, two second shift drills and two third shift drills. He also confirmed on third shift drills they did silent drills and inform the monitoring company the next day. He confirmed the documentation did not state any details of the monitoring company being notified the morning after a night fire drill.

Review of facility policy titled Fire Drill Procedure dated 10/01/18 revealed facility shall have 12 unannounced fire drills once every shift every three months.

Based on record review, staff interview, and policy review, facility failed to ensure fire drill documentation included the method of activation of the alarm and staff attendance. This affected all facility residents. Facility census was 77.

Findings include:

Review of the fire drill documentation revealed no mention of when the alarm was transmitted or confirmation of the time it was received. Additionally, the fire drills contained no documentation of any delayed transmissions for alarms activated during fire drills conducted between 9:00 P.M. to 6:00 A.M.

Interview on 03/30/26 at 4:10 P.M. with Maintenance Director (MD) #65 confirmed the fire drill documentation did not include the method of activation. He also confirmed staff attendance was not documented on the fire drills completed 11/2025, 12/2025, 01/2026, and 02/2026.

Review of facility policy titled Fire Drill Procedure dated 10/01/18 revealed facility shall have 12 unannounced fire drills. Fire drill records shall include date and time, number of resident who evacuated, staff who participated, and if the alarm was activated.

Based on observation, record review, resident interviews, staff interviews and review of call light response logs, the facility failed to ensure residents were provided with adequate and timely personal care. This affected two (Resident #96 and #47) of three residents reviewed for incontinence care. The facility census was 78.

Findings include:

1. Review of Resident #96's medical record revealed the resident was admitted to the facility on 05/01/25 with diagnoses including multiple sclerosis, retention or urine, and hypertension.

Review of Resident #96's service plan dated 05/01/25 revealed Resident #96 required one- person assist for activities of daily living (ADL's), the resident was documented to be incontinent and require staff assist every two hours for care.

Observation on 06/05/25 at 9:15 A.M., revealed Resident #96's couch cushion wet with urine.

Interview on 06/05/25 at 9:15 A.M., Resident #96 verified the couch cushion cover was taken by an aide to be washed after it had urine on it because that is where the resident sometimes slept. Resident #96 stated it needed to be washed as it had urine on it for a few days but had gotten worse since the previous night.

Interview on 06/05/25 at 2:30 P.M. with the Director of Nursing (DON) verified residents should be given incontinence care and checked on every two hours or as needed.

Interview with the Executive Director (ED) and DON on 06/02/25 at 3:10 P.M. revealed the expectation for staff to answer call lights is ten minutes.

Review of the call light logs for 05/01/25 through 06/05/25 for Resident #96 revealed 68 of 144 call light response times were over ten minutes with the longest time being 55 minutes when the resident pendant was pressed at 4:17 P.M. and pendant was cleared at 5:13 P.M.

Interview on 06/05/23 at 5:30 P.M., with the ED verified the staff response to Resident #96's call light was often over the facility expected 10 minute response time.

2. Record of Resident #47's medical record revealed the resident was admitted to the facility on 03/05/25 with the diagnoses of Alzheimer's disease with early onset, dementia - moderate with agitation, and gastro-esophageal reflux disease with esophagitis.

Review of Resident #47's service plan dated on 03/05/25 revealed Resident # 47 required two-person assist, was incontinent, and requires staff assist every two hours for care.

Interview with Resident #47's Hospice Case Manager Registered Nurse # 205 on 06/05/25 at 1:17 P.M. revealed she and the hospice staff find Resident #47 saturated at least once weekly due to not having had timely incontinence care.

Interview on 06/05/25 at 2:30 P.M. with the Director of Nursing (DON) verified Residents should be given incontinence care and checked on every two hours or as needed.

Interview with the Executive Director (ED) and DON on 06/02/25 at 3:10 P.M. revealed the expectation for staff to answer call lights is ten minutes.

Review of call light logs for 04/05/25 through 06/02/25 for Resident #47 revealed 31 of 49 call light response times were over ten minutes with the longest time being on 57 minutes when the pendant was pressed at 8:23 A.M. and pendant was cleared at 9:20 A.M.

Interview on 06/05/23 at 5:30 P.M., with the ED verified the staff response to Resident #47's call light was often over the facility expected 10 minute response time. ED stated she will print the call light log each day and discuss with the aides to find out what caused a delay in answering call lights over ten minutes.

This violation represents non-compliance investigated under Complaint Number OH00165361.