Prestige Senior Living High Desert

The findings of the re-licensure survey, conducted 09/26/22 through 09/27/22, are documented in this report. The survey was conducted to determine compliance with 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 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 revisit to the re-licensure survey of 09/27/22, conducted 01/09/23 through 01/10/23, are documented in this report. It was determined the facility was in compliance with OARs 411 Division 54 for Residential Care and Assisted Living Facilities and Home and Community Based Services Regulations OARs 411 Division 004.

Based on observation, interview and record review, it was determined the facility failed to ensure the kitchen was maintained in accordance with the Food Sanitation Rules OAR 333-150-000. Findings include, but are not limited to:Observations of the facility kitchen, food storage areas, food preparation, and food service on 09/26/22 revealed:* Splatters, spills, drips, and debris were observed on: - Storage shelves throughout the kitchen; - Interior flooring of the walk in refrigerator and freezer; - The dishwashing area walls, floors, and equipment; - The sides and the interior of the range, grill, and oven; - Beneath shelving and equipment throughout the kitchen; - Walls and flooring throughout the kitchen; and - Flooring and beneath shelving in the dry storage room.* Dishwashing racks were stored directly on the floor.The areas in need of cleaning were reviewed with Staff 1 (ED) and Staff 5 (Dietary Services Manager) on 09/26/22 and 09/27/22. They acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure evaluations were performed within the first 30 days of move in for 1 of 1 sampled resident (# 5). Findings include, but are not limited to:Resident 5 was admitted to the facility in 07/2022.There was no documented evidence a review of the evaluation of Resident 5 had been completed within the first 30 days of move in with updates and changes as appropriate. In an interview with Staff 4 (RCC) on 09/26/22, she acknowledged Resident 5's evaluation had not been reviewed within 30 days of move in.The need to ensure 30 day evaluations were completed with changes and updates as appropriate was discussed with Staff 1 (ED) on 09/27/22. She acknowledged the findings.

3. Resident 5 was admitted to the facility in 07/2022.There was no documented evidence Resident 5's service plan had been completed within the first 30 days of move in with updates and changes as appropriate. In an interview with Staff 4 (RCC) on 09/26/22, she acknowledged Resident 5's service plan had not been reviewed and updated within 30 days of move in.The need to ensure service plans were reviewed with changes and updates as appropriate within 30 days, was discussed with Staff 1 (ED) on 09/26/22. She acknowledged the findings.
Based on observation, interview and record review, it was determined the facility failed to ensure service plans were updated within 30 days of admission, reflective of residents' needs and provided clear direction to caregiving staff regarding the delivery of services for 3 of 5 sampled residents (#s 1, 4 and 5) whose service plans were reviewed. Findings include, but are not limited to:1. Resident 4 was admitted to the facility in 11/2022 with diagnoses including chronic obstructive pulmonary disease and depression.The resident's current service plan and progress notes dated 06/23/22 through 09/26/22 were reviewed. Resident 4 and staff were interviewed and the resident's room was observed. The service plan was not reflective and did not provided clear caregiving instructions in the following areas: * Medications the resident administered; * Evacuation assistance needed; * Activity participation; * Fall interventions; * Interventions for depression; * Assistance needed with the maintenance of an oxygen concentrator; and * Interventions for when the resident was intoxicated. The need to ensure service plans were reflective of the resident's current status and provided clear caregiving instruction was discussed with Staff 1 (ED), Staff 2 (RN) and Staff 3 (Health Services Director) on 09/27/22. They acknowledged the findings.
2. Resident 1 was admitted to the facility in 02/2020 with a diagnosis of schizophrenia.A review of the resident's most current service plan dated 09/15/22 revealed s/he needed assistance with the following:* Physical assist with bathing;* Oxygen at four liters;* Physical assistance with ambulation using four wheeled walker; and* Physical assistance with dressing.An interview with Staff 11 (CG) on 09/27/22 revealed Resident 1 was independent with all the above listed tasks. Staff 11 was unsure why the service plan was updated indicating the resident needed physical assistance.The need to ensure service plans reflected the current care needs of residents was discussed with Staff 1 (ED) on 09/27/22. She acknowledged the findings.

Based on 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, the condition was monitored at least weekly to resolution, and that interventions were re-evaluated to determine effectiveness for 4 of 5 sampled residents (#s 2, 3, 4 and 5) who experienced changes of condition. 1. Resident 2 was admitted to the facility in 02/2018 with diagnoses including diabetes and paraplegia. Observations of the resident, interviews with staff, review of the service plan dated 07/20/22 and progress notes dated 06/26/22 through 09/26/22 were reviewed. The resident experienced multiple short-term changes without documented monitoring at least weekly until resolution, interventions were not reviewed for effectiveness and/or lacked resident-specific directions to staff in the following areas:* Toe infection; and* Coccyx break down.The need to ensure short-term changes of condition had documentation to reflect monitoring at least weekly to resolution, provided clear, resident-specific directions to staff and that interventions were evaluated for effectiveness was discussed with Staff 1 (ED), Staff 2 (Corporate RN) and Staff 3 (Health Services Director) on 09/27/22. They acknowledged the findings. 2. Resident 3 was admitted to the facility in 01/2017 with diagnoses including diabetes and Parkinson's disease.Observations of the resident, interviews with staff, review of the service plan dated 06/28/22, incident investigations and progress notes dated 06/14/22 through 09/26/22 were reviewed. a. The resident experienced multiple short-term changes without documented monitoring at least weekly until resolution, interventions were not reviewed for effectiveness and/or lacked resident-specific directions to staff in the following areas:* Blood in the urine;* Low blood sugars;* Vomiting;* Leaking catheter; and* Burn to the thigh.b. An incident investigation dated 09/03/22 indicated the resident sustained a burn to his/her left thigh while refilling his/her lighter. The resident was noted to be alert and oriented and could state what occurred. The investigation indicted no injury was observed at the time of the incident. There was no documentation of a thorough investigation of the burn incident to minimize reoccurrence, develop and implement interventions and to re-evaluate existing interventions for appropriateness and effectiveness. In interviews on 09/26/22 the resident indicated s/he had no concerns with his/her care. The resident denied any mistreatment by staff and indicated the cause of the burn was a "fluke accident." The resident stated s/he had never had any issue filling his lighter up in the past. On this occasion lighter fluid on his/her fingers and pants ignited when s/he tested the lighter. The resident stated s/he was able to put out the fire quickly and sustained a small burn which had been healing well. The need to ensure short-term changes of condition had documentation to reflect monitoring at least weekly to resolution, provided clear, resident-specific directions to staff and that interventions were evaluated for effectiveness was discussed with Staff 1 (ED), Staff 2 (Corporate RN) and Staff 3 (Health Services Director) on 09/27/22. They acknowledged the findings.
3. Resident 5 was admitted to the facility in 07/2022 with diagnoses including stroke and pulmonary embolism. Observations of the resident, interviews with staff and the resident, review of the service plan dated 07/20/22 and progress notes dated 07/20/22 through 09/26/22 were reviewed. The resident experienced multiple short-term changes without documented monitoring at least weekly until resolution, interventions were not reviewed for effectiveness and/or lacked resident-specific directions to staff in the following areas:* Emergency room visit; and* Diarrhea. The need to ensure short-term changes of condition had documentation to reflect monitoring at least weekly to resolution, provided clear, resident-specific directions to staff and that interventions were evaluated for effectiveness was discussed with Staff 1 (ED) and Staff 4(RCC) on 09/27/22. They acknowledged the findings.
4. Resident 4 was admitted to the facility in 11/2020 with diagnoses including hypertension, Type 2 Diabetes and depression.The resident's progress notes dated 06/23/22 through 09/26/22 and incident reports dated 06/10/22 through 09/25/22 were reviewed. Resident 4 and staff were interviewed. The following short term changes of condition were identified: a. Resident 4 had documentation of the following falls:* 06/10/22; * 06/16/22; * 07/28/22; * 08/14/22; * 08/16/22; and * 08/19/22.There was no evidence the facility determined and documented what interventions were needed for the resident nor was there documented evidence the fall interventions previously implemented were re-monitored for effectiveness. b. The following skin issues were identified: On 08/19/22, Resident 4 fell which resulted in him/her going to the ER and getting stitches.There was no documented evidence the facility monitored the area at least weekly through resolution. During an interview with Resident 4 on 09/26/22 at 2:37 pm, the resident lifted up his/her pant leg to rub his/her shin. There was one quarter sized, dark red scab located on the shin with smaller scabs around the area. There was no documented evidence the facility was aware of these areas or how the resident obtained the scabbing. When questioned, Resident 4 reported having "thin skin" and "it bleeds whenever I run into anything." c. There was a progress note dated 06/26/22 where the resident was quoted, "hates being here" and s/he "feels depressed all the time." There was no documented evidence the feeling of depression was monitored through resolution or the facility determined and documented what interventions were needed for the resident. The need to ensure short term changes of condition were monitored at least weekly through resolution, the facility determined and documented what interventions were needed for the resident, and the interventions were monitored for effectiveness was discussed with Staff 1 (ED) on 09/27/22. She acknowledged the findings.

Based on observation and interview, it was determined the facility failed to ensure it consistently complied with masking requirements as prescribed in OAR 333-019-1011. Findings include, but are not limited to:Per Oregon Administrative Rule 333-019-1011(6), (8) and (10), persons employed in an assisted living or residential care facility are required to wear a face mask while they are in the facility except when the employee is alone in a closed room.Observations of staff during the survey revealed multiple instances where staff failed to wear their face mask properly, exposing their nose, or nose and mouth.The need to ensure staff consistently wore a face mask was reviewed with Staff 1 (ED), Staff 2 (RN) and Staff 3 (Health Services Director) on 09/27/22. They acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure all pre-service orientation and pre-service dementia training was completed prior to beginning job responsibilities for 3 of 3 newly hired staff (#s 8, 9 and 12) whose training records were reviewed. Findings include, but are not limited to:Staff training records were reviewed on 09/27/22.1. There was no documented evidence Staff 8 (MT), hired 06/06/22, Staff 9 (CG), hired 08/12/22, and Staff 12 (CG) hired on 03/30/22, completed the following elements of pre-service orientation:* Infectious disease prevention; and* Fire safety and emergency procedures.2. There was no documented evidence Staff 12 had completed pre-service dementia training. The need to ensure all newly hired staff completed pre-service orientation, infectious disease training, and pre-service dementia training before providing direct care to residents was discussed with Staff 1 (ED) on 09/27/22. She acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure 1 of 3 newly hired staff (#8) had documented demonstration of competency in all required areas and 2 of 3 (#s 8 and 9) had been trained in First Aid and abdominal thrust within 30 days of hire. Findings include, but are not limited to:Review of the facility's training records on 09/27/22 indicated the following:Staff 8 (MT), hired 06/06/22, lacked documented evidence observations and evaluations of competency had been completed within the first 30 days of hire for topics including: * The role of service plans in providing individualized resident care;* 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; and* General food safety, serving and sanitation.Staff 8 and Staff 9 (CG), hired 08/12/22, lacked documented evidence of First Aid and abdominal thrust training within 30 days of hire. The need to document demonstrated competency in job duties and to complete First Aid and abdominal thrust training within 30-days of hire was discussed with Staff 1 (ED) 09/27/22. She acknowledged the findings.

Based on interview and record review, it was determined the facility failed to have documented evidence the 12 hours of annual in-service training included six hours related to the care of residents with dementia, for 2 of 2 long-term staff (#s 7 and 11) whose training records were reviewed. Findings include, but are not limited to:The annual in-service training records were reviewed on 09/27/22.Staff 7 (MT), hired 09/14/21, and Staff 11 (CG), hired 01/31/18, failed to have documented evidence of completing 12 hours of hours of annual in-service training, including six hours on dementia care. There need to ensure staff completed 12 hours of on-going training, including six hours related to dementia, was reviewed with Staff 1 (ED) on 09/27/22. She acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure fire and life safety training and fire drills were conducted on alternating months and that all required fire drill components were addressed. Findings include, but are not limited to:Fire drill records were reviewed from 03/2022 to 09/2022. The following deficiencies were identified:* There was inconsistent documentation the facility was conducting fire drills every other month on alternating shifts; * There was inconsistent documentation the facility was conducting fire and life safety training on alternating months to fire drills; and * The evacuation/drill documentation did not contain information on the escape routes used, problems encountered, evacuation time period needed, and the number of occupants evacuated. The requirements regarding fire drills and fire and life safety instruction for staff were reviewed with Staff 1 (ED) on 09/27/22. She acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure general fire and life safety requirements were being met. Findings include, but are not limited to:Fire and life safety records revealed the facility lacked documented evidence residents had received annual training in the following areas: * General safety procedures;* Evacuation methods;* Responsibilities during fire drills; and* Designated meeting places inside or outside the building.The need to ensure residents received annual training in fire and life safety requirements was discussed with Staff 1 (ED) on 09/27/22. She acknowledged the findings.

Based on observation and interview, it was determined the facility failed to maintain all exterior pathways to the common-use areas in good repair. Findings include, but are not limited to:The exterior walkways of the building were toured on 09/26/22. There were multiple sections of the sidewalk with drop-offs of up to three inches measured from the concrete surface to the planting beds. These drop-offs represented tripping/fall risks for residents.The need to ensure exterior pathways to common-use areas were in good repair was discussed with Staff 1 (ED) on 09/27/22. She acknowledged the findings.

Based on observation and interview, it was determined the facility failed to ensure the interior environment was clean and in good repair. Findings include, but are not limited to:A tour of the facility was conducted on 09/26/22 and revealed the following:* Room 101, 105 and 128 had black stains on the carpet throughout high traffic areas;* Room 128 had a large portion of drywall that was damaged;* Toilet in room 155 was broken for over two weeks; and* Room 156 had dirty windows and the exterior light was broken.The need to ensure the facility interior was clean and in good repair was discussed with Staff 1 (ED) on 09/27/22. She acknowledged the findings.

Based on observation and interview, it was determined the facility failed to ensure covers, grates, or screens of wall heaters did not exceed 120 degrees Fahrenheit (F) when installed in locations that were subject to incidental contact by individuals. Findings include, but are not limited to:During an environmental walk-through on 09/26/22, the upper portion of the metal fireplace frame in the library was hot to the touch. The temperature was 247.6 degrees F when measured with the surveyor's thermometer. The fireplace was turned off. The need to ensure residents could not come into incidental contact with fireplace elements that exceeded 120 degrees F was discussed with Staff 1 (ED) on 09/26/22. She acknowledged the findings.