Golden Age Memory Care

Residential Care Facility
14504 SE OATFIELD RD, MILWAUKIE, OR 97267

Facility Information

Facility ID 50R500
Status Active
County Clackamas
Licensed Beds 15
Phone 5033446272
Administrator Violet Puia
Active Date Aug 12, 2021
Owner Golden Age Memory Care LLC
14504 SE OATFIELD RD
MILWAUKIE OR 97267
Funding Private Pay
Services:

No special services listed

3
Total Surveys
13
Total Deficiencies
0
Abuse Violations
2
Licensing Violations
0
Notices

Violations

Licensing: OR0003393701
Licensing: 00178850-AP-142177

Survey History

Survey RL001995

6 Deficiencies
Date: 1/9/2025
Type: Re-Licensure

Citations: 6

Citation #1: C0295 - Infection Prevention & Control

Visit History:
t Visit: 1/9/2025 | Not Corrected
Regulation:
OAR 411-054-0050(1-5) Infection Prevention & Control

(Amended 03/18/2022)(1) Facilities must establish and maintain infection prevention and control protocols to provide a safe, sanitary and comfortable environment. This includes protocols to prevent the development and transmission of communicable diseases.(2) Each facility must designate an individual to be the facility ' s "Infection Control Specialist" responsible for carrying out the infection prevention and control protocols and serving as the primary point of contact for the Department regarding disease outbreaks. The Infection Control Specialist must:(a) Be qualified by education, training and experience or certification; and(b) Complete specialized training in infection prevention and control protocols within three months of being designated under this paragraph, unless the designee has received the specialized training within the 24-month period prior to the time of the designation. The Department will describe trainings that will be acceptable to meet the specialized training requirement in rule, by January 1, 2022.(3) Each facility must establish infection prevention and control protocols and have an Infection Control Specialist, trained as required in this rule, by July 1, 2022.(4) Facilities must comply with masking requirements as prescribed in OAR 333-019-1011 or, if applicable, OAR 437-001-0744, to control the spread of COVID-19.(5) Facilities must comply with vaccination requirements for COVID-19 as prescribed in OAR 333-019-1010.Stat. Auth.: ORS 410.070, 443.004, 443.012, 443.450Stats. Implemented: ORS 443.004, 443.400-443.455, 443.991
Inspection Findings:
Based on observation and interview, it was determined the facility failed to maintain infection prevention and control protocols to provide a safe, sanitary, and comfortable environment for 1 of 1 sampled resident (#1) and multiple unsampled residents dependent on staff for meal service. Findings include, but are not limited to:

General observations of lunch meal service were conducted from 01/06/25 through 01/08/25. The following was identified:

* Multiple care staff were observed providing hands on assistance with eating without preforming hand hygiene between assisting different residents;

*Multiple care staff were observed to remove dirty dishes from tables and return to assist residents with eating without preforming hand hygiene or donning clean gloves;

* One direct care staff was observed handling Resident #1’s sandwich with her bare hands and without preforming hand hygiene; and

* When providing one-on-one meal assistance, multiple care staff failed to wear a protective covering over potentially contaminated clothing.

The need to maintain effective infection prevention and control protocols was discussed with Staff 1 (Administrator) on 01/08/25 at 3:40 pm. She acknowledged the findings.
Plan of Correction:
1. The Policies and protocols we have in place to ensure a safe, sanitary, and comfortable environment are according to the Infection Prevention & Control regulations and all direct care staff have all the required trainings related to Infection Prevention & Control.
2. However, to correct this deficiency, our Infection Control Specialist immediately established a meeting with all direct care staff and discussed the topics of Infection Prevention & Control of hand hygiene, meal servings and/or feeding Residents, when and how to wear appropriate PPE. All our direct care staff have verbalized and demonstrated understanding of correct Hand Hygine performance, appropriate use of PPE, and correct steps of Infection Prevention & Control when feeding Residents.
3. Our Infection Control Specialist will supervise mealtimes arbitrarily, first weekly for a month, then once a month for three months, then quarterly, to ensure proper Infection Control & Prevention steps are followed.
4. Our Infection Control Specialist is reponsible for this plan of correction.

Citation #2: C0362 - Acuity Based Staffing Tool - ABST Time

Visit History:
t Visit: 1/9/2025 | Not Corrected
Regulation:
OAR 411-054-0037 (1)(b-g) Acuity Based Staffing Tool - ABST Time

(1) DEVELOP AND MAINTAIN ACUITY-BASED STAFFING
(b) Accurately capture care time and care elements that staff are providing to each resident as outlined in each individual service plan. Established care time must be resident specific, rather than a predetermined average.
(c) Develop a staffing plan for each shift, that meets the scheduled and unscheduled needs of all residents.
(d) Develop ABST reports and posted staffing plans that reflect distinct and segregated areas as outlined in OAR 411-054-0070(1).
(e) If applicable, determine ABST time for residents on a Specific Needs Settings Contract and residents not on a Specific Needs Setting Contract to build posted staffing plan as outlined in this rule.
(f) Develop written policies and procedures to accurately and consistently implement the ABST. The policy must explain how a facility evaluates and accounts for both scheduled and unscheduled resident needs.
(g) Provide the relevant ABST information for a specific resident if requested by the Department, that specific resident, that specific resident’s legal representative, or the Long-Term Care Ombudsman.
Inspection Findings:
Based on observation, interview and record review, it was determined the facility failed to complete an acuity-based staffing tool (ABST) to accurately capture care time and care elements that staff are providing to each resident, as outlined in each individual service plan for 1 of 2 sampled residents (# 1) and multiple unsampled residents. Findings include, but are not limited to:

On 01/08/25 at 10:15 am, the facility provided a copy of the ABST for the current residents. All residents in the facility were entered in the ABST, but it was determined the ABST did not accurately capture care time minutes in the following areas:

a. The ADL minutes required for “resident-specific housekeeping or laundry services performed by care staff” was entered as “0” for all residents.

In an interview on 01/09/25 at 8:40 am, Staff 1 (Administrator) confirmed floor staff were regularly performing housekeeping and laundry tasks such as cleaning rooms, making beds, emptying trash cans, and laundering clothes.

b. Resident 1’s evaluation indicated s/he required cueing and supervision for eating.

Lunch meal observations on 01/07/25 and 01/08/25 showed s/he also required hands on assistance with eating and drinking, as needed.

Review of the ABST for Resident 1 indicated zero minutes for eating.

On 01/09/25 at 10:20 am, the need to maintain an ABST tool which accurately captured care time minutes in all required ADL areas was discussed with Staff 1. She acknowledged the findings.
Plan of Correction:
1. It is our Facilty Policy to use the ABST tool provided by the state in order to ensure that Golden Age Memory Care has the adequate numbers of direct care staff available to provide care and to safely meet all the scheduled and non-scheduled needs of our Residents.
*Due to the fact that our Facility has a cleaning company in place regularly for cleaning & housekeeping, in the ABST form, at the housekeeping section, we had marked 0 minutes.
*It is our Facility Policy to document in the state ABST tool if a Resident needs any type of assistance while eating. Sampled Resident 1, was going through multiple changes in condition, as evidenced by provided TCPs, as well as meeting scheduled for that week with Family, Hospice Team and Facility to discuss new goal of care and changes in Resident's POC, unfortunatelly, by the time we provided a copy of the ABST tool to DHS Inspector, these new chages, were not transcripted yet in minutes on the ABST tool.
2.*To correct this deficiency, we signed into our ABST tool portal and filled out the appropriate minutes at the cleaning and housekeeping section, for each Resident.
*To correct this deficiency, we verified every single Resident's "feeding" section in the ABST tool and ensured that is marked correctly, based on our current acuity.
3. We will continue to update the ABST tool quarterly, with every new Resident move-in and with every change in Resident's condition.
4. The Facility Administrator is respossible for this plan of correction.

Citation #3: C0513 - Doors, Walls, Elevators, Odors

Visit History:
t Visit: 1/9/2025 | Not Corrected
Regulation:
OAR 411-054-0200 (4)(d-i) Doors, Walls, Elevators, Odors

(d) INTERIOR DOORS. Lever-type door handles must be provided on all doors used by residents.(e) EXIT DOORS. Exit doors may not include locks that delay evacuation except as specified by the building codes. Such locks may not be installed except with written approval of the Department.(A) Exit doors may not include locks that prevent evacuation.(B) If an electronic code must be entered to use an exit door that code must be clearly posted for residents, visitors, and staff use.(f) WALLS AND CEILINGS. Walls and ceilings must be cleanable in kitchen, laundry, and bathing areas. Kitchen walls must be finished smooth per OAR 333-150-0000 (Food Sanitation Rules).(g) ELEVATORS. A RCF with residents on more than one floor must provide at least one elevator that meets Oregon Elevator Specialty Code (OESC) requirements.(h) The interior of the facility must be free from unpleasant odors.(i) All interior and exterior materials and surfaces (e.g., floors, walls, roofs, ceilings, windows, and furniture) and all equipment necessary for the health, safety, and comfort of the resident will be kept clean and in good repair.
Inspection Findings:
Based on observation and interview, it was determined the facility failed to ensure all materials and surfaces were kept in good repair. Findings include, but are not limited to:

The interior and exterior of the facility was toured on 01/06/25 at 10:30 am and the following was identified:

Interior:

* Multiple doors, door frames, wall corners, baseboards, and trim and moldings had scrapes, dings, and missing paint;

* Resident dining tables had areas of wear and exposed wood creating an uncleanable surface; and

* A pipe under the sink in a staff bathroom had a ½ inch hole and damaged drywall surrounding the pipe.

Exterior:

* Metal railings on bilateral sides of a slope leading to the resident outside courtyard were unstable.

The facility was toured with Staff 1 (Administrator) and Staff 3 (Maintenance Director) on 01/07/25 at 1:45 pm. They acknowledged the areas in need of repair.
Plan of Correction:
1. Facility has attended to this deficiency immediately.
2.*All the doors, door frames, wall corners, baseboards, and trim and moldings that have been discovered having scrapes, dings and missing paint on them, have been resolved.
*The Resident dinning tables that had the small patches/areas of exposed wood has been resolved.
*The pipe under the sink in the staffs' bathroom that had the hole in the drywall has been resolved.
*The bilateral metal railings from the slope leading to the resident outside courtyard has been resolved and is now firm and secure.
3. Our Maintenance Director will do a monthly walk through and verify walls for any dings, scrapes, any holes, missing paint as well as on doorframes, baseboards corners, etc, and will check the dining room tables to ensure coating in place that will ensure appropriate cleaning and disinfecting of the tables surfaces, and will take action to repair immediatelly if any damages observed. Our Maintenance Director will also verify the durability/stability of our bilateral railing of the slope leading outside our courtyard.
4. Our maintenance director is responsible for this plan of correction.

Citation #4: C0530 - Housekeeping and Laundry

Visit History:
t Visit: 1/9/2025 | Not Corrected
Regulation:
OAR 411-054-0200 (7)(b-d) Housekeeping and Laundry

(b) HOUSEKEEPING AND SANITATION.(A) A RCF must have a secured janitor closet for storing supplies and equipment, with a floor or service sink.(B) The wall base shall be continuous and coved with the floor, tightly sealed to the wall, and constructed without voids that can harbor insects or moisture.(c) LAUNDRY FACILITIES. Laundry facilities may be located to allow for both resident and staff use, when a time schedule for resident-use is provided and equipment is of residential type. When the primary laundry is not in the building or suitable for resident-use, a RCF must provide separate resident-use laundry facilities. A CF is not required to provide resident-use laundry services.(A) Laundry facilities must be operable and at no additional cost to the resident.(B) Laundry facilities must have space and equipment to handle laundry-processing needs. Laundry facilities must be separate from food preparation and other resident-use areas.(C) On-site laundry facilities, used by staff for facility and resident laundry, must have capacity for locked storage of chemicals and equipment.(D) The wall base shall be continuous and coved with the floor, tightly sealed to the wall, and constructed without voids that can harbor insects or moisture.(d) SOILED LINEN PROCESSING. For the purpose of this rule, "soiled linens and soiled clothing," means linens or clothing contaminated by an individual's bodily fluids (for example, urine, feces, or blood).(A) There must be a separate area with closed containers that ensure the separate storage and handling of soiled linens and soiled clothing. There must be space and equipment to handle soiled linen and soiled clothing processing needs that is separate from regular linens and clothing.(B) Arrangement must provide a one-way flow of soiled linens and soiled clothing from the soiled area to the clean area and preclude potential for contamination of clean linens and clothing.(C) The soiled linen room or area, must include a flushing rim clinical sink with a handheld rinsing device and a hand wash sink or lavatory.(D) When washing soiled linens and soiled clothing, washers must have a minimum rinse temperature of 140 degrees Fahrenheit unless a chemical disinfectant is used.(E) Personnel handling soiled laundry must be provided with waterproof gloves.(F) Covered or enclosed clean linen storage must be provided and may be on shelves or carts. Clean linens may be stored in closets outside the laundry area.(G) The wall base shall be continuous and coved with the floor, tightly sealed to the wall, and constructed without voids that can harbor insects or moisture.
Inspection Findings:
Based on observation and interview, it was determined the facility failed to ensure a one-way flow of soiled laundry from the soiled area to the clean area and preclude potential for contamination of clean laundry. Findings include, but are not limited to:

Observations of the facility laundry room from 01/06/25 through 01/08/25 revealed the following:

* A basket of soiled laundry was observed on three occasions on the floor next to the countertop containing clean resident clothing;

* Uncovered pillows were stored on top of the storage cabinet and in a basket on the countertop; and

* The laundry room area housing the flushing rim sink and hand wash sink was used for storage and the sinks were not accessible to staff for soiled laundry. The area was blocked by a large storage rack from the rest of the laundry room preventing a one-way flow of soiled laundry.

The need to ensure a one-way flow of soiled laundry to preclude potential contamination was discussed with Staff 1 (Administrator) on 01/08/25 at 11:00 am. She acknowledged the findings.
Plan of Correction:
1. The Policies and protocols we have in place to ensure a safe, sanitary and comfortable environment are according to the Infection Prevention and Control regulations and all direct care staff have all the required trainings.
2. However, a meeting was established by our Infection Control Specialist and our direct care staff and the topics related to Clean versus Dirty laundry were discussed, as well as the room area housing the flushing rim sink and hand wash sink have been discussed with all direct care staff. All direct care staff have verbalized and demonstrated understanding of correct steps to fallow when performing laundry, including when handling soiled linnens.
*All the extra pillows and blankets that were stored on our laundry open shelve have been placed in covered containers.
*The additional storage shelve unit has been moved immediatelly, on 1/09/25, providing Staff will clear access to perform a one-way flow of soiled laundry.
3. Our Infection Control Specialist will verify quarterly, arbitrarily and ensure that all the correct steps of Inspection Prevention & Control are being followed when laundry is performed.
4. The Infection Control Specialist is responsible for this Plan of Correction.

Citation #5: Z0142 - Administration Compliance

Visit History:
t Visit: 1/9/2025 | Not Corrected
Regulation:
OAR 411-057-0140(2) Administration Compliance

(2) The licensee of a memory care community must comply with both the licensing rules for the facility and Chapter 411, Division 57.
Inspection Findings:
Based on observation, interview and record review, it was determined the facility failed to follow licensing rules for Residential Care and Assisted Living Facilities. Findings include, but are not limited to:

Refer to C 295, C 362, C 513 and C 530.
Plan of Correction:
This Residential Memory Care Facility took note of all listed deficiencies in the Statement of Deficiencies and a Plan of Corrections was estabished which will be fully implemented no later than 3/10/2025.

Citation #6: Z0163 - Nutrition and Hydration

Visit History:
t Visit: 1/9/2025 | Not Corrected
Regulation:
OAR 411-057-0160(2)(c)(A)(B) Nutrition and Hydration

(c) A daily meal program for nutrition and hydration must be provided based upon the resident ' s preferences and needs available throughout each resident ' s waking hours. The individualized nutritional plan for each resident must be documented in the resident ' s service or care plan. In addition, the memory care community must provide: (A) Visual contrast between plates, eating utensils, and the table to maximize the independence of each resident; and (B) Adaptive eating utensils for those residents who have been evaluated as needing them to maintain their eating skills.
Inspection Findings:
Based on interview and record review, it was determined the facility failed to ensure an individualized nutrition and hydration plan was developed and included in the service plan for 1 of 2 sampled residents (#1) who resided in the MCC. Findings include, but are not limited to:

Resident 1 moved into the MCC in 11/2024 with diagnoses including Alzheimer’s disease and aphasia. Resident 1 was receiving hospice services and was at risk for weight loss.

Resident 1’s service plan dated 12/05/24 was reviewed during the survey and lacked an individualized nutrition and hydration plan.

The lack of individualized nutrition and hydration plan was discussed with Staff 1 (Administrator) on 01/09/25 at 9:41 am. She acknowledged the findings.
Plan of Correction:
1. Our Policies and protocols we have in place to ensure that the Move-In Evaluation as well as the Service Plans for each Resident addressess all the required elements related to individualized nutrition and hydration, are in accordance with the Regulations and do not need updating at this time.
2. However, we have re-educated ourselves on the importance of including more individualized and person-centered nutrition and hydration preferences in the specified section. Facility RN is already completing a Diatery Assessment for every Resident that moves in our Facility, where she includes information gathered from Resident's medical history, family and Resident. In addition to this Assessment completed by our Facility RN, we have built an additional form for each Resident that will contain any diet orders or restrictions the Resident may have, as well as their perefernces, likes and dislikes related to nutrition and hydration. This form will be accessible to the Kitchen Operator as well as to all direct care staff.
3. Facility Administrator will review each Resident's Evaluation, Service Plan and Nutrition & Hydration Preferences Form quarterly and as needed with any changes.
Facility RN will review each Resident's Dietary Assessment quarterly and as needed with any changes.
4.Facility Administrator is responsible for this Plan of Correction.

Survey Z8TV

0 Deficiencies
Date: 12/6/2023
Type: State Licensure, Other

Citations: 1

Citation #1: C0000 - Comment

Visit History:
1 Visit: 12/6/2023 | Not Corrected
Inspection Findings:
The findings of the kitchen inspection, conducted 12/06/23, are documented in this report. It was determined the facility was in substantial compliance with the OARs 411-054-0030 for Residential Care and Assisted Living Facilities for Resident Services- Meals, and Oregon Health Service Food Sanitation Rules OARs 333-150-0000.

Survey IMCB

7 Deficiencies
Date: 8/29/2022
Type: Initial Licensure

Citations: 8

Citation #1: C0000 - Comment

Visit History:
1 Visit: 8/30/2022 | Not Corrected
2 Visit: 12/29/2022 | Not Corrected
Inspection Findings:
The findings of the initial survey, conducted 08/29/22 through 08/30/22, are documented in this report. The survey was conducted to determine compliance with the OARs 411 Division 54 for Residential Care and Assisted Living Facilities, OARs 411 Division 57 for Memory Care Communities and OARs 411 Division 004 for Home and Community Based Services Regulations.Tag numbers beginning with C refer to the Residential Care and Assisted Living Facilities rules. Tag numbers beginning with the letter Z refer to the Memory Care Community rules.Abbreviations possibly used in this document:ADL: activities of daily livingbid: twice a dayCBG: capillary blood glucose or blood sugar CG: caregivercm: centimeterED: Executive DirectorF: FahrenheitHH: Home HealthLPN: Licensed Practical NurseMA: Medication AideMAR: Medication Administration RecordMCC Memory Care Communitymg: milligramml: milliliterMT: Medication TechnicianOT: Occupational TherapistPT: Physical TherapistPRN: as neededqd: every day or dailyqid: four times a dayQI: quality improvementRCC: Resident Care CoordinatorRN: Registered NurseTAR: Treatment Administration Recordtid: three times a day

The findings of the first revisit to the initial survey of 08/30/22, conducted 12/29/22, are documented in this report. It was determined the facility was in substantial compliance with OARs 411 Division 54 for Residential Care and Assisted Living Facilities, OARs 411 Division 57 for Memory Care Communities.

Citation #2: C0242 - Resident Services: Activities

Visit History:
1 Visit: 8/30/2022 | Not Corrected
2 Visit: 12/29/2022 | Corrected: 10/29/2022
Inspection Findings:
Based on observation, interview and record review, it was determined the facility failed to provide a daily activity program of social and recreational activities based on individual and group interests, physical, mental and psychosocial needs, and created opportunities for active participation in the community at large. Findings include, but are not limited to:During the survey, the MCC was home to nine residents. Random resident observations made on 08/29/22 and 08/30/22, review of the activity calendar, and interviews with staff revealed the following: a. The August 2022 Memory Care Activity Program calendar posted in the facility indicated the following activities would occur on 08/29/22:* 10:00 am - 11:00 am: Background Music; and * 2:00 pm - 3:00 pm: Water Painting. On 08/29/22, the only facility led activity observed occurred at approximately 1:30 pm, when one resident was observed painting at a dining room table. Although television and music played continuously, no other activities were observed between 9:30 am and 3:30 pm. b. On 08/30/22, the activity calendar noted the following activities would occur:* 2:00 pm - 3:00 pm: Live Music. The only facility led activities observed between 8:30 am - 2:00 pm were a musical performance from a visitor between 11:00 am and 12:00 pm.Failure to provide a daily activity program of social and recreational activities based on individual and group interests, physical, mental and psychosocial needs, and that created opportunities for active participation in the community at large was discussed with Staff 1 (Owner) and Staff 1 (RN/Administrator) on 08/30/22 at 2:35 pm. They acknowledged the findings.
Plan of Correction:
Our Policies and tools we have in place to assure a daily program of social and recreational activities that are based upon individual and group interests, physical, mental, and psychosocial needs are in accordance with the regulations and do not need updating at this time. However, this Facility is in process of hiring new Activity Director to ensure a daily program of social and recreational activities are provided and maintained. The Activities Program/Schedule will be verified by Facility Owner on a weekly basis. The Facility Owner is responsible for this plan of correction.

Citation #3: C0545 - Plumbing Systems

Visit History:
1 Visit: 8/30/2022 | Not Corrected
2 Visit: 12/29/2022 | Corrected: 10/29/2022
Inspection Findings:
Based on observation and interview, it was determined the facility failed to ensure hot water temperatures in residents' units and common bathrooms were maintained within a range of 110 to 120 degrees Fahrenheit. Findings include, but are not limited to:On 08/30/22, the surveyor measured water temperatures in occupied residents' unit bathrooms including Rooms 3 and 10 and a common bathroom in the facility. Water temperatures measured were between 90 to 113 degrees Fahrenheit. On 08/30/22 at 1:50 pm, the surveyor informed Staff 3 (Maintenance Director) of the low-water temperatures. The surveyor and Staff 3 measured water temperatures in Room 10, using the surveyor's thermometer. The temperature reached 104 degrees Fahrenheit. Staff 3 stated he was aware of the findings and said he would inform Staff 1 (Owner) of the issue.On 08/30/22 at 2:35 pm, the low water temperatures were discussed with Staff 1 (Owner) and Staff 2 (Administrator/RN). They acknowledged the findings.
Plan of Correction:
Facility has attended to this dificiency immediately by contacting the landlord and making them aware of this issues and informed of urgency for hot water temperatures to be brought up to the building codes. Landlord scheduled services for additional pump to be installed to unit, that will cycle the hot water in order to assure the water temperature is maintained within a range of 110-120 degrees Fahrenheit.The Maintenance Director will meassure water temperatures monthly, in random units and Resident's Rooms to verify water temperaures are maintained within a range of 110-120 degrees Fahrenheit and will report to the Facility Owner. Facility Owner is responsible for this plan of correction.

Citation #4: C0555 - Call Sys, Exit Dr Alarm, Phones, Tv, Or Cable

Visit History:
1 Visit: 8/30/2022 | Not Corrected
2 Visit: 12/29/2022 | Corrected: 10/29/2022
Inspection Findings:
Based on observation and interview, it was determined the facility failed to ensure exit doors were equipped with an alarming device or other acceptable systems for security purposes and to alert staff when residents exited the unit. Findings, include, but are not limited to:During the survey, the facility was identified to have a couple of exit doors, accessible to the secured courtyard.On 08/30/22 at 9:15 am, a tour of the facility with Staff 1 (Owner) revealed the doors failed to have a working alarm device to alert staff when residents exited the unit. On 08/30/22, the lack of alarms or other acceptable system was shared with Staff 1. She confirmed there was no system to alert staff when residents exited the unit.
Plan of Correction:
Facility has attended to this difficiency immediately by installing alarming devices on both exit doors accessible to the secured courtyard.These alarms provide a beeping sound each time a Resident exits any of the two doors, to access the secured courtyard, alerting the staff that a Resident is outside. The Facility Owner will verify functionality of the alarming devices installed on all exit doors periodically, at random times. The Facility Owner is responsible for this plan of correction.

Citation #5: Z0142 - Administration Compliance

Visit History:
1 Visit: 8/30/2022 | Not Corrected
2 Visit: 12/29/2022 | Corrected: 10/29/2022
Inspection Findings:
Based on observation and interview, it was determined the facility failed to follow licensing rules for Residential Care and Assisted Living Facilities. Findings include, but are not limited to:Refer to C242, C545 and C555.
Plan of Correction:
This Facility took note of all dificiencies listed in the Statement of Deficiencies and a Plan of Correction was established which will be fully impemented no later than 10/29/2022.

Citation #6: Z0155 - Staff Training Requirements

Visit History:
1 Visit: 8/30/2022 | Not Corrected
2 Visit: 12/29/2022 | Corrected: 10/29/2022
Inspection Findings:
Based on interview and record review, it was determined the facility failed to ensure 2 of 4 sampled newly hired staff (#s 3 and 6) completed all required pre-service training prior to performing any job duties. Findings include, but are not limited to:Staff training records were reviewed on 08/30/22. The following deficiencies were identified:1. Staff 3 (CG/Maintenance) was hired 05/07/22. a. There was no documented evidence he had completed the following elements of the required pre-service orientation prior to performing any job duties: *Infectious Disease Prevention.2. Staff 6 (CG) was hired 04/06/22. There was no documented evidence she had completed the following elements of the required pre-service orientation and dementia training prior to performing any job duties: * Dementia disease process including progression of the disease, memory loss and psychiatric & behavioral symptoms;* Dementia disease process including progression of the disease, memory loss and psychiatric & behavioral symptoms;* Techniques for understanding, communicating and responding to distressful behavioral symptoms;* Strategies for addressing social needs and engaging persons with dementia in meaningful activities;* Specific aspects of dementia care and ensuring safety of residents with dementia including addressing pain, providing food/fluids, preventing wandering, use of person-centered approach;* Environmental factors that are important to a resident's well-being (e.g. staff interactions, lighting, room temperature, noise, etc.)* Family support and the role the family may have in the care of the resident;* How to recognize behaviors that indicate a change in the resident's condition and report behaviors that require on-going assessment;* How to provide personal care to a resident with dementia, including an orientation to the resident's service plan; and* Use of supportive devices with restraining qualities in memory care communities.The need to ensure newly hired staff completed all required orientation and pre-service training was discussed with Staff 1 (Owner) on 08/30/22 at 12:20 pm. She acknowledged the findings.
Plan of Correction:
The policies and tools we have in place to ensure that all staff training requirements are met are in accordance with the regulations and do not need updating at this time. However we have re-educated our staff on the importance of completing all required trainings such as the pre-service Dementia care training and pre-service infection control and prevention training, prior to providing care to Residents. Staff 3 and Staff 6 immediatelly and effectively initiated completion of the missing trainings.Facility Owner and Facility Administrator will review every new-hire and will ensure all Caregivers have all the required trainings prior to initiating/providing care. Facility Owner and Facility Administrator are responsible for this plan of correction.

Citation #7: Z0173 - Secure Outdoor Recreation Area

Visit History:
1 Visit: 8/30/2022 | Not Corrected
2 Visit: 12/29/2022 | Corrected: 10/29/2022
Inspection Findings:
Based on observation and interview, it was determined the facility failed to ensure the fence surrounding the perimeter of the outdoor recreation area was fully secured, and to have a written facility policy which detailed when doors to the outdoor recreation area may be locked during nighttime hours or during severe weather. Findings include, but not limited to:1. During a tour of the environment with Staff 3 (Maintenance Director) on 08/30/22, one of the secured outdoor recreation areas was observed. The area revealed the perimeter fence was not fully secured and fenced. The corner of the outdoor recreation area had no fence, but an unsecured bamboo screen and large bush/plant was in place.On 08/30/22, the need to ensure the fence surrounding the perimeter of the outdoor recreation area was fully secured was discussed with Staff 1 (Owner), Staff 2 (Administrator/RN) and Staff 3. They acknowledged the findings. 2. During the survey, the doors to the interior courtyard were observed to be unlocked during daylight hours and there was no device to lock the doors during nighttime hours or during severe weather.On 08/30/22 at 9:15 am, the surveyor requested the facility's written facility policy regarding the operation of the doors. Staff 1 (Owner) stated the facility did not have a written policy for when the courtyard doors would be locked. On 08/30/22 at 2:35 pm, the above findings were shared with Staff 1 and Staff 2 (Administrator/RN). They acknowledged the findings.
Plan of Correction:
Facility attended to this dificiency immediately by contacting landlord and making them aware of this issue and informing of urgency for fence surrounding the perimeter of the outdoor recreation area be fully secured and brought up to codes.Landlord scheduled services for specified section of fence to be replaced and secured. The facility also contacted the landlord regarding the doors to the interior courtyard and made aware of urgency for locks to be installed on both these doors in order to be brought up to building codes. Landlord scheduled services for locks to be installed on the two specified doors. The facility built a written policy regarding the operation of these doors, which will reflect when the doors accessing the secured recreational area will be locked for Resident's safety, as well as who will be responsible to implement the guidelines written in this policy. Facility Owner will review and make changes to this policy as needed and will verify randomly, at different times, with different shifts, to make sure the policy is implemented. Facility Owner is responsible for this plan of care.

Citation #8: Z0176 - Resident Rooms

Visit History:
1 Visit: 8/30/2022 | Not Corrected
2 Visit: 12/29/2022 | Corrected: 10/29/2022
Inspection Findings:
Based on observation and interview, it was determined the facility failed to consistently ensure residents were not locked inside or outside their rooms, and to individually identify residents' rooms to assist residents in recognizing their rooms. Findings include, but are not limited to:1. During the survey, observations revealed several resident rooms were locked from the outside. Caregiving staff each carried a key which could open all residents' doors. On 08/30/22 at 11:25 am, Staff 9 (CG) stated the facility kept resident doors locked because some residents wandered the facility, entering other resident rooms. However, this rendered residents unable to get into their rooms without staff assistance.On 08/30/22 at 2:35 pm, the requirement that residents could not be locked out of their rooms was shared with Staff 1 (Owner) and Staff 2 (Administrator/RN). They acknowledged the findings.2. The facility was toured on 08/30/22. Residents' rooms 4, 5, 6, 7, 8, 9, 10, 11 and 12 lacked any means of identifying the rooms for the residents. On 08/30/22, the need to ensure each resident room was identified to assist the resident in identifying their room was reviewed with Staff 1 (Owner) and Staff 2 (Administrator/RN). They acknowledged the findings.
Plan of Correction:
Our policies and tools we have in place to ensure residents are not locked inside or outside of their rooms, and to individually identify their rooms and to assist residents in recognizing their rooms, are in accordance with the regulations and do not need updating at this time. However, we have reeducated our staff and reenforced that every Resident should be able to enter and/or exit their rooms without requiring any assistance from staff. We reeducated our staff that even with behaviors of wandering in the facility, locking rooms in order to keep rooms tidy is not allowed and against the facility policy and against regulations.Facility Owner will verify this weekly at random times and different shifts, for the next quarter, then will continue verifying monthly at random times and different shifts. Facility had previously applied framed pictures by Resident's doors, but these have been removed by wondering Residents. Facility Owner applied new framed pictures on Resident's doors and secured them to prevent removal by wondering Residents. We also applied on some Resident's doors stickers with images that they can easily identify with, to assist them with identifying their rooms.Facility Owner will verify each Resident's room has identification in place at the door, on a quarterly basis. Facility Owner is responsible for this plan of correction.