Valley View Adult Care LLC

Based on observation and interview, it was determined the facility failed to ensure the kitchen was clean and in good repair in accordance with the Food Sanitation Rules OAR 333-150-000. Findings include, but are not limited to: The facility kitchen was toured on 01/29/24. The unit was in the remodeled basement of a residential home. The ceiling was not enclosed, leaving the first floor wooden beams and joists, and plumbing, electrical and ventilation components exposed. This presented a risk of debris falling into food as it was being prepared in the kitchen. The risk related to the open ceiling was discussed with Staff 1 (Administrator/RN) and Staff 2 (Certified Nursing Assistant) on 01/31/24. They acknowledged the findings.

C240: Administrator and RN informed Maintenance of required change to install a dropped ceiling on 01/31/2024. Materials for the ceiling were ordered 02/02/2024 with planned arrival 02/14/2024. Installation should take approximately 3 days. Monthly cleaning log created to ensure dropped ceiling panels are cleared of debris from above. Administrator is responsible for monitoring cleaning log and inspecting ceiling tiles for cleanliness. For an immediate temporary solution, care staff are dusting and vacuuming the ceiling areas and cleaning up any debris before they prepare food.

Based on interview and record review, it was determined the facility failed to complete a resident evaluation before the resident moved into the facility that contained all required elements and failed to update the evaluation as needed within the first 30 days, for 1 of 1 sampled resident (#1). Findings include, but are not limited to: Resident 1 was admitted to the facility in 07/2022 with diagnoses including borderline personality disorder, factitious disorder, post-traumatic stress disorder, syringomyelia, and quadriplegia. The facility was asked to provide a copy of Resident 1's initial evaluation. In an interview on 01/29/24, Staff 1 (Administrator/RN) explained the facility had not completed an evaluation prior to admission but rather, the resident's interdisciplinary team (IDT) met together prior to admission and developed the resident's service plan. The facility did not have an evaluation tool/form that addressed all elements required in this rule. No evaluation had been reviewed and updated within 30 days of the resident's admission. The need to develop and utilize an evaluation tool that addressed all required elements in this rule was discussed with Staff 1 and Staff 2 (Certified Nursing Assistant) on 01/31/24. They acknowledged the lack of an evaluation.

C252: Administrator and RN created an initial Screening and Move-in evaluation form for future residents on 02/01/2024. This form will be completed by RN and/or Administrator prior to new resident admits again within 30 days of move-in, quarterly, and as needed with changes in resident status prior to updating the resident's service plan.

Based on interview and record review, it was determined the facility failed to ensure service plans were reflective of the resident's needs and included a written description of the services to be provided, for 1 of 1 sampled resident (#1) whose service plan was reviewed. Findings include, but are not limited to: Resident 1 was admitted to the facility in 07/2022 with diagnoses including borderline personality disorder, factitious disorder, post-traumatic stress disorder, syringomyelia, and quadriplegia. Because of Resident 1's physical and psychiatric status, the resident was not interviewed during the survey. Instead, interviews with multiple staff were conducted and the resident's current service plan and behavior support plan were reviewed. The following areas were not addressed in Resident 1's service plan or lacked adequate instructions for staff: * Positioning/height of the resident's hospital bed; * Use of an alternating pressure air mattress topper; * Use of pillow to support/position the resident's head in bed; * Use of a large bed pad to cover the resident's head pillow; * Use of pillows to float the resident's heels to prevent pressure injury; * Use and positioning of the resident's call light device; * Use of a Purewick external catheter device; * Current instructions regarding range of motion exercises for the resident's fingers; * Preferences for use of a flat sheet only as a cover when in bed; * Preferences for lighting in the hallway and living area outside the resident's room; * Preferences for lighting within the resident's room; and * Preferences for room temperature and use of the box fan in the room. The areas that were not addressed in Resident 1's service plan or lacked instructions for staff were reviewed with Staff 1 (Administrator/RN), Staff 2 (Certified Nursing Assistant) and Staff 3 (Certified Nursing Assistant/Emergency Medical Assistant) on 01/31/24. They acknowledged the findings.

C260: Administrator and RN have added all requested additional information to resident's service plan as of 01/31/2024 and completed 02/12/2024. Nurse and Administrator used the newly made New Resident Evaluation/Re-Evaluation form to update the resident's Service Plan. The Service Plan was also reviewed with the guardian and the entire Service Team that meets monthly to discuss patient needs. The plan was approved by all present. Nurse and Administrator will use New Resident Evaluation/Re-Evaluation form to update the Service Plan quarterly and as needed for changes in condition. The staff will also be given time in our monthly meetings to review the Service Plan and give input into needed changes. Updated Service Plans will be reviewed for approval by the Service Team quarterly and as needed for changes in condition.

Based on observation, interview and record review, it was determined the facility failed to ensure its designated Infection Control Specialist completed specialized training in infection prevention and control, and failed to maintain infection prevention and control protocols to provide a safe and sanitary environment. Findings include, but are not limited to: a. The facility designated Staff 3 (Certified Nursing Assistant/Emergency Medical Technician) as the Infection Control Specialist for the facility. The facility was unable to provide documentation of completed training in infection prevention and control. In an interview on 01/30/24, Staff 1 (Administrator/RN) stated Staff 3 was enrolled and currently completing a training program through the Association for Professionals in Infection Control and Epidemiology (APIC). She acknowledged Staff 3 had not completed the training. b. The care staff in the program were considered universal workers because besides providing direct resident care, they complete other tasks such as housekeeping, laundry and food preparation. During the survey, staff were observed to prepare the resident's meals after having provided personal care to the resident without donning some kind of clean protective clothing protection such as an apron. This put the resident at risk for the spread of germs. The need to ensure the Infection Control Specialist completed required training and staff practiced proper infection control practices was discussed with Staff 1, Staff 2 (Certified Nursing Assistant) and Staff 3 on 01/31/24. They acknowledged the findings.

C295: Staff 3 (Certified Nursing Assistant/Emergency Medical Technician) has completed her training as an infection control specialist. Date completed 02/07/2024. Staff 3 the infection control specialist has given certificate of completion to the Administrator. Staff 3 continues to progress toward completion of the Association for Professionals in Infection Control and Epidemiology (APIC) Certification. Violation will not happen again as RN and Administrator are aware of required training and are now assigning all required training to all staff on Relias/Oregon Care Partners. Administrator and RN provided aprons and installed hooks in the kitchen for meal prep on 02/02/2024. Staff were trained each shift in use of aprons for meal prep and in laundering at the end of each shift. Administrator and/or RN will ensure compliance by completing weekly random meal prep time check-ins.

Based on interview and record review, it was determined the facility failed to maintain an accurate medication administration record (MAR) for 1 of 1 sampled resident (#1) whose MAR was reviewed. Findings include, but are not limited to: Resident 1 was admitted to the facility in 07/2022 with diagnoses including borderline personality disorder, factitious disorder, post-traumatic stress disorder, syringomyelia, and quadriplegia. Resident 1's 01/01/24 through 01/28/24 MAR was reviewed. The resident was prescribed: * Polyethylene glycol 3350 powder (a laxative to prevent constipation) - give one capful mixed in at least six ounces of juice or smoothie by mouth once daily in the morning. Hold for one day if patient has diarrhea. a. Staff initialed and circled the MAR entries on 01/05/24, 01/07/24 and 01/14/24 indicating an exception to the normal administration of the medication. However, there was no documentation on the MAR or in progress notes indicating the reason for the exception. b. MAR entries on 01/18/24, 01/23/24 and 01/27/24 were left blank. There was no documentation on the MAR or in progress notes referencing the medication. Because the daily doses of the medication were not individually packaged, it was not possible to determine whether the medication was given or held on the above dates. The need to ensure the MAR was accurate and complete was reviewed with Staff 1 (Administrator/RN) and Staff 2 (Certified Nursing Assistant) on 01/30/24. They acknowledged the findings.

C310: Administrator and RN on 02/01/2024 created a form where staff are now documenting reasons for not giving/refusing medication (instead of the back page of the MAR). This form was introduced to all staff members and took effect on 02/01/2024. A second form was also created for staff documentation what symptoms resident is requesting PRN meds to treat. Administrator and/or RN will monitor daily with staff being required to return to document, explain reasons not completed, and how they will improve.

Based on interview and record review, it was determined the facility failed to ensure newly-hired staff completed all required orientation and pre-service dementia training prior to providing care to residents. Findings include, but are not limited to: Training records were reviewed on 01/30/24. The following deficiencies were identified: a. The facility was not requiring staff to complete a Department-approved infectious disease prevention training. b. Staff were not provided a written description of their job responsibilities. c. Staff 6 (CG), hired 06/22/23, lacked documented evidence she had completed an approved dementia training. The need to ensure all staff completed all required orientation and pre-service training prior to providing care to residents was discussed with Staff 1 (Administrator/RN) and Staff 2 (Certified Nursing Assistant) on 01/31/24. They acknowledged the findings.

C370: The facility gave notice to all staff on 01/31/2024 of the requirements of pre-service infection prevention and control training, pre-service dementia training, and medication administration training on Oregon Care Partners. The deadline given to staff for completion is 02/16/2024. Administrator and RN willl check on 02/16/2024 to determine if certificate will be printed and placed in their employee folders. Additional training requirements have been added to the New Hire Check List. Administrator is now assigning all required trainings to each employee. Administrator and RN created a form describing the job description for this facility. This form was added to the new employee's orientation packet. Administrator and /or RN will monitor and evaluate with each new hire.

Based on interview and record review, it was determined the facility failed to verify and document that direct care staff demonstrated knowledge and performance in all required areas within 30 days of hire. Findings include, but are not limited to: Training records were reviewed on 01/30/24. The following deficiencies were identified: a. Staff 4 and 6 (CGs), hired 06/16/23 and 06/22/23, respectively, lacked documented evidence of demonstrated knowledge and performance in the following areas: * Providing assistance with the activities of daily living; * Changes associated with normal aging; * Identification of changes in the resident's physical, emotional and mental functioning and documentation and reporting on the resident's changes of condition; * Conditions that require assessment, treatment, observation and reporting; * General food safety, serving and sanitation; and * If the direct care staff person's duties include the administration of medication or treatments, appropriate facility staff, in accordance with OAR 411-054-0055 (Medications and Treatments) must document that they have observed and evaluated the individual's ability to perform safe medication and treatment administration unsupervised. b. Staff 8 (CG), hired 09/23/23, lacked documented evidence of demonstrated knowledge and performance in the following areas: * Providing assistance with the activities of daily living; * Identification of changes in the resident's physical, emotional and mental functioning and documentation and reporting on the resident's changes of condition; * Conditions that require assessment, treatment, observation and reporting; * General food safety, serving and sanitation; and * If the direct care staff person's duties include the administration of medication or treatments, appropriate facility staff, in accordance with OAR 411-054-0055 (Medications and Treatments) must document that they have observed and evaluated the individual's ability to perform safe medication and treatment administration unsupervised. The need to ensure the facility verified and documented that direct care staff demonstrated knowledge and performance in all required areas within 30 days of hire was discussed with Staff 1 (Administrator/RN) and Staff 2 (Certified Nursing Assistant) on 01/31/24. They acknowledged the findings.

C372: New Hire Orientation packet updated with 30 Day Evaluation column for evaluation of knowledge and perfomance in required areas. This evaluation will be completed by the Administrator and/or RN after 20 days and no later than 30 days of each new hire. Oregon Care Partners medication training added New Hire Checklist and to each employee's training account at onboarding and for yearly education. RN will evaluate within 30 days of hire for new employees and yearly for current employees after online medication training had been completed.

Based on interview and record review, it was determined the facility failed to conduct fire drills every other month according to the Oregon Fire Code (OFC) or develop an alternative fire drill plan with the local Fire Authority. Findings include, but are not limited to: Fire drill records were reviewed on 01/30/24 with Staff 1 (Administrator/RN), Staff 2 (Certified Nursing Assistant) and Staff 3 (Certified Nursing Assistant/Emergency Medical Technician). The facility was conducting practice fire drills at least every other month via a walk-through of the duties or a discussion exercise with a hypothetical event, commonly known as a tabletop exercise. The facility was varying the location of the simulated fire origin and discussing the use of alternate escape routes. All employees participated in these trainings. However, because of Resident 1's physical and psychiatric status, the facility was not including the resident in the fire drills. Therefore, the facility was not able to document the evacuation time needed or any problems encountered related to the resident resisting or refusing to participate in the drills or an evacuation. The facility had not developed an alternative fire drill plan for the facility with the local Fire Authority. The need to ensure the facility conducted fire drills per the OFC or developed an alternative fire drill plan with the local Fire Authority was discussed with Staff 1, Staff 2 and Staff 3 on 01/30/24. They acknowledged the findings.

C420: RN emailed Fire Marshal a written description of the fire drill and emergency evacuation plan on 02/02/2024. Awaiting message back at this time. RN will call if no return message by 02/12/2024. If unable to reach Fire Marshal, RN will deliver printed copy of plan to Fire Marshal for signature of approval by 3/15/2024.

Based on interview, it was determined the facility failed to instruct each resident within 24 hours of admission, and re-instructed at least annually, in general safety procedures, evacuation methods, responsibilities during fire drills, and designated meeting places outside the building or within the fire safe area in the event of an actual fire. Findings include, but are not limited to: Fire and life safety training records were reviewed on 01/30/24 with Staff 1 (Administrator/RN) and Staff 2 (Certified Nursing Assistant). They stated that because of Resident 1's physical and psychiatric status, the facility had not provided fire and safety instruction to the resident upon admission to the facility, nor had they provided re-instruction at least annually. The facility had not documented its attempts to provide instruction to Resident 1 and the resident's response, nor had the facility obtained a waiver for this rule requirement. The need for the facility to document it provided, or attempted to provide, fire and safety instruction to the resident upon admission and re-instruction at least annually was discussed with Staff 1 and Staff 2 on 01/30/24. They acknowledged the findings.

C422: New form created to document fire/evacuation plan with residents acceptance or refusal of education. Review attempted with resident yelling and not participating. Review and documented on new form. Administrator and/or RN will review annually with residents. Task added to new Administrator Task calendar.

The findings of the initial survey conducted 01/29/24 through 01/31/24 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 and OARs 411 Division 004 Home and Community Based Services Regulations. Abbreviations possibly used in this document: ADL:   activities of daily living bid: twice a day CBG: capillary blood glucose or blood sugar CG: caregiver cm: centimeter ED: Executive Director F: Fahrenheit HH: Home Health LPN: Licensed Practical Nurse MA: Medication Aide MAR: Medication Administration Record MCC: Memory Care Community mg: milligram ml: milliliter MT: Medication Technician OT: Occupational Therapist PT: Physical Therapist PRN: as needed qd: every day or daily qid: four times a day QI: quality improvement RCC: Resident Care Coordinator RN: Registered Nurse TAR: Treatment Administration Record tid: three times a day

The findings of the first re-visit to the initial licensure survey of 01/31/24, conducted 06/11/24, are documented in this report. It was determined the facility was in substantial compliance with the OARs 411 Division 54 for Residential Care and Assisted Living Facilities and OARs 411 Division 004 Home and Community Based Services Regulations.