Harmony Living

The findings of the re-licensure survey, conducted 01/31/23 through 02/02/23, 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 and OARs 411 Division 004 for Home and Community Based Services Regulations.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 re-visit to the re-licensure survey of 02/02/23, conducted 07/13/23, 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.

Based on observation, interview and record review, it was determined the facility failed to ensure residents who had short-term changes of condition were evaluated, resident-specific instructions or interventions were developed and reviewed for effectiveness and progress monitored to resolution at least weekly for 2 of 2 sampled residents (#s 1 and 2) who experienced changes of condition. Findings include, but are not limited to:1. Resident 1 was admitted to the facility in 12/2022 with diagnoses including Schizoaffective Disorder. Interviews with staff and review of the resident's 12/04/22 service plan, 12/07/22 through 01/31/23 progress notes, hospital visit notes and incident investigations were completed.During the acuity interview on 01/31/23, Staff 1 (Administrator) reported the resident was independent with ambulation using a walker on admission, although within weeks of admission had declined in his/her ability to ambulate and was now using a wheel chair for mobility. She stated the resident had been to the emergency department and there had not been a medical cause identified for the decline.Resident 1 was observed using a wheel chair for mobility with staff assistance when in the common areas during survey.The resident experienced multiple short-term changes related to falls, without documented monitoring of progress until resolution, and interventions were not reviewed for effectiveness and/or lacked resident-specific directions to staff related to the following:* 12/30/22 - Found on floor crawling to the bathroom;* 01/12/23 - Non-injury fall in the bathroom; and* 01/24/23 - Non-injury fall.The need to ensure there was documentation for short-term changes of condition which reflected monitoring of progress to resolution at least weekly and provided resident-specific directions to staff was discussed with Staff 1 and Staff 2 (LPN) on 02/02/23. They acknowledged the findings.2. Resident 2 was admitted to the facility in 06/2016 with diagnoses including Schizophrenia and Chronic Obstructive Pulmonary Disease. The resident was receiving hospice services and had sustained severe weight losses.Observations of the resident, interviews with staff and review of the resident's 11/20/22 service plan, 10/11/22 through 01/31/23 progress notes, hospice visit notes and physician communications were completed.The resident experienced multiple short-term changes without documented monitoring of progress for the conditions at least weekly until resolution, and interventions lacked resident-specific directions to staff related to the resident's condition in the following areas:* 12/30/22 - A red area to the thoracic spine and blister wound to the coccyx;* 01/07/23 - Zithromax (antibiotic) ordered for suspected pneumonia; and* 01/13/23 - Increase dosage of scheduled Morphine Sulphate (for pain), and a new order for Prednisone daily for five days.The need to ensure there was documentation reflecting monitoring of progress through resolution and resident-specific directions to staff for short-term changes of condition was discussed with Staff 1 (Administrator) and Staff 2 (LPN) on 02/02/23. They acknowledged the findings.

Based on interview and record review, it was determined the facility failed to notify the physician/practitioner when a resident refused to consent to orders for 1 of 1 sampled resident (#2) who had documented medication refusals. Findings include, but are not limited to:Resident 2 was admitted to the facility in 06/2016 with diagnoses including Schizophrenia.Resident 2's 10/11/22 through 01/31/23 progress notes, physician communications, and 01/01/23 through 01/31/23 MAR were reviewed. The resident's record showed multiple refusals of the following medications:* Quetiapine (for behaviors);* Depakene (for mood);* Milk of Magnesia (for constipation);* Miralax (for constipation); and* Morphine Sulphate (for pain).There was no documented evidence the facility had a system for notifying prescribers each time the resident refused to consent to orders.The need to ensure the facility notified the physician/practitioner of medication refusals was discussed with Staff 1 (Administrator) and Staff 2 (LPN) on 02/02/23. They acknowledged the findings.

Based on observation and interview, it was determined the facility failed to keep all interior materials and surfaces in good repair. Findings include, but are not limited to:The interior of the facility was toured on 01/31/23. The following deficiencies were identified:* Doors and door frames throughout the facility had multiple scratches and gouges;* Carpet throughout the facility common areas and resident rooms was worn, with frayed and torn areas, and one square area in the middle of the hallway approximately 5 x 6 inches missing carpet;* Vinyl flooring in the kitchen, dining room and laundry room was worn and scratched, with seams pealing up and chipped off in multiple areas. Two areas observed in the kitchen were missing patches of vinyl, exposing bare floor beneath; * Wood doors on the activity cabinets were scratched and the finish worn off, exposing bare wood;* Vinyl on one cushion of the yellow love seat in the television room was cracked; and* The front edge of the counter top in the laundry room was peeled away from the counter face and was being held in place with tape.The areas needing repair were reviewed with Staff 1 (Administrator) and Staff 2 (Regional Director of Operations) on 02/01/23. They acknowledged the items needing repair and reported they were already getting bids to replace the flooring throughout the facility.