Sea View Senior Living Community

Assisted Living Facility
98059 GERLACH LANE, BROOKINGS, OR 97415

Facility Information

Facility ID 70A316
Status Active
County Curry
Licensed Beds 99
Phone 5414694500
Administrator TYANNA HANDY
Active Date Jun 1, 2010
Owner Sea View Assisted Living Community, LLC
560 FIRST STREET, STE 104
LAKE OSWEGO OR 97034
Funding Medicaid
Services:

No special services listed

4
Total Surveys
23
Total Deficiencies
0
Abuse Violations
10
Licensing Violations
1
Notices

Violations

Licensing: OR0005171901
Licensing: 00310253-AP-262871
Licensing: 00264311-AP-219353
Licensing: OR0004074200
Licensing: OR0002528700
Licensing: OR0002528701
Licensing: 00233797-AP-191389
Licensing: OR0003785100
Licensing: 00190949-AP-152606
Licensing: 00179929-AP-155471

Notices

CO16131: Failed to provide safe environment

Survey History

Survey KIT002626

1 Deficiencies
Date: 2/6/2025
Type: Kitchen

Citations: 1

Citation #1: C0240 - Resident Services Meals, Food Sanitation Rule

Visit History:
t Visit: 2/6/2025 | Not Corrected
1 Visit: 6/16/2025 | Not Corrected
Regulation:
OAR 411-054-0030 (1)(a) Resident Services Meals, Food Sanitation Rule

(1) The residential care or assisted living facility must provide a minimum scope of services as follows: (a) Three daily nutritious, palatable meals with snacks available seven days a week, in accordance with the recommended dietary allowances found in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables; (A) Modified special diets that are appropriate to residents' needs and choices. The facility must encourage residents' involvement in developing menus. (B) Menus must be prepared at least one week in advance, and must be made available to all residents. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served. Residents must be informed in advance of menu changes. (C) Food must be prepared and served in accordance with OAR 333-150-0000 (Food Sanitation Rules).
Inspection Findings:
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:

Observations of the main facility kitchen, food storage areas, food preparation, and food service on 02/06/25 at 10:30 am revealed the following:

a. An accumulation of food spills, splatters, loose food and trash debris, dirt, dust, and/or black matter was visible on or underneath the following:

* Can opener blade and casing;
* Ceiling vents throughout the kitchen;
* Toaster;
* Wall above the stainless-steel rinse sink in the dishwashing area;
* Walls and pipes behind the dish machine;
* Walls and mop bucket area in the janitorial closet;
* Garbage can near dishwashing station; and
* Walls and floors behind the equipment.

b. The following kitchen items were in need of repair:

* Doors and frames throughout the kitchen had scuffs, scrapes, and/or gouges with exposed surfaces rendering them uncleanable;
* The bottom of the exit door to the exterior of the building had scuffs and a buildup of rust underneath the kick plate;
* Multiple green wire racks for shelving throughout the kitchen had worn paint and paint chips with exposed steel.

c. Ice machine was observed with visible black and pink substances on interior of machine.

d. Alcohol wipes were not available to sanitize thermometer after use for temping food.

e. Test strips were not available to check sanitizers.

f. Multiple food packages in the dry storage area were not properly labeled and dated.

g. Tables in the dining area were set with cutlery with food surface contact areas exposed to potential contamination.

h. There was no written policy available for when kitchen staff were sick.

The areas in need of cleaning, repair and attention were reviewed with Staff 1 (ED) and Staff 2 (Dining Services Director) on 02/06/25 at 12:45 pm. They acknowledged the findings.

OAR 411-054-0030 (1)(a) Resident Services Meals, Food Sanitation Rule

(1) The residential care or assisted living facility must provide a minimum scope of services as follows: (a) Three daily nutritious, palatable meals with snacks available seven days a week, in accordance with the recommended dietary allowances found in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables; (A) Modified special diets that are appropriate to residents' needs and choices. The facility must encourage residents' involvement in developing menus. (B) Menus must be prepared at least one week in advance, and must be made available to all residents. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served. Residents must be informed in advance of menu changes. (C) Food must be prepared and served in accordance with OAR 333-150-0000 (Food Sanitation Rules).

This Rule is not met as evidenced by:
Plan of Correction:
OAR 411-054-0030 (1)(a) Resident Services Meals,
Food Sanitation Rule OAR 333-150-000.
1. Actions taken to correct the rule violation for each example/resident are as follows:
a. food spills, splatters, loose food and trash debris, dirt, dust, and/or black matter was cleaned on/in the following areas: * Can opener blade and casing;* Ceiling vents throughout the kitchen;* Toaster; * Wall above the stainless steel rinse sink in the dishwashing area; * Walls and pipes behind the dish machine; * Walls and mop bucket area in the janitorial closet; * Garbage can near dishwashing station; and * Walls and floors behind the equipment.
b. repairs and or replacement has been made to the following areas in the kitchen:* Doors and frames throughout the kitchen ; * The bottom of the exit door to the exterior of the building; * Multiple green wire racks for
shelving throughout the kitchen;
c. Ice Machine cleaned;
d. Alcohol wipes put in kitchen;
e. Test Strips for sanitizer obtained;
f. Food packages in storage area replaced, and or added dates/lables;
g. Cutlery removed from table;
h. written policy updated to "specify" kitchen staff protocol.

2. How will the system be corrected so this violation will not happen again are as follows:
a. Culinary Director will complete food safety training on kitchen sanitary practices and food storage/preparation in accordance with the Food Sanitation Rules, OAR 333-150-000.
b. All dining/kitchen staff trained on audit tools, and cleaning schudules

3. How often will the area needing correction be evaluated are as follows:
a. Daily when working by Culinary Director for Main Kitchen
b. Daily when working by MC Administrator or designee for MC Kitchen

4. Who will be responsible to see that the corrections are completed/monitored are as follows:
a. Culinary Director or designee
b. ED or designee
c. MC Administrator

Survey T7ZQ

1 Deficiencies
Date: 7/30/2024
Type: Complaint Investig., Licensure Complaint

Citations: 1

Citation #1: C0610 - General Building Exterior

Visit History:
1 Visit: 7/30/2024 | Not Corrected

Survey T3NE

2 Deficiencies
Date: 3/2/2023
Type: Complaint Investig., Licensure Complaint

Citations: 3

Citation #1: C0010 - Licensing Complaint Investigation

Visit History:
1 Visit: 3/2/2023 | Not Corrected
Inspection Findings:
Assisted Living and Residential Care Facilities must operate and provide services in compliance with all applicable State and local laws, regulations and codes. This report reflects the findings of the complaint investigation conducted 03/02/2023. The facility was evaluated for compliance with Oregon Administrative Rule 411, Division 54 and if applicable, Oregon Administrative Rule 411, Division 57. The following deficiencies were identified:Abbreviations possibly used in this document:ADL: activities of daily livingbid: twice a dayCBG: capillary blood glucose or blood sugar cc: cubic centimeterCG: caregivercm: centimeterF: FahrenheitHH: Home HealthHS or hs: hour of sleepLPN: Licensed Practical NurseMA: Medication AideMAR: Medication Administration RecordMCC Memory Care Communitymg: milligramml: milliliterO2 sats: oxygen saturation in the bloodOT: Occupational TherapistPT: Physical TherapistPRN: as neededqd: every day or dailyqid: four times a dayRN: Registered NurseSP: service planTAR: Treatment Administration Recordtid: three times a day

Citation #2: C0200 - Resident Rights and Protection - General

Visit History:
1 Visit: 3/2/2023 | Not Corrected
Inspection Findings:
Assisted Living and Residential Care Facilities must operate and provide services in compliance with all applicable State and local laws, regulations and codes. This report reflects the findings of the complaint investigation conducted 03/02/2023. The facility was evaluated for compliance with Oregon Administrative Rule 411, Division 54 and if applicable, Oregon Administrative Rule 411, Division 57. The following deficiencies were identified:Abbreviations possibly used in this document:ADL: activities of daily livingbid: twice a dayCBG: capillary blood glucose or blood sugar cc: cubic centimeterCG: caregivercm: centimeterF: FahrenheitHH: Home HealthHS or hs: hour of sleepLPN: Licensed Practical NurseMA: Medication AideMAR: Medication Administration RecordMCC Memory Care Communitymg: milligramml: milliliterO2 sats: oxygen saturation in the bloodOT: Occupational TherapistPT: Physical TherapistPRN: as neededqd: every day or dailyqid: four times a dayRN: Registered NurseSP: service planTAR: Treatment Administration Recordtid: three times a day

Citation #3: C0243 - Resident Services: Adls

Visit History:
1 Visit: 3/2/2023 | Not Corrected
Inspection Findings:
Assisted Living and Residential Care Facilities must operate and provide services in compliance with all applicable State and local laws, regulations and codes. This report reflects the findings of the complaint investigation conducted 03/02/2023. The facility was evaluated for compliance with Oregon Administrative Rule 411, Division 54 and if applicable, Oregon Administrative Rule 411, Division 57. The following deficiencies were identified:Abbreviations possibly used in this document:ADL: activities of daily livingbid: twice a dayCBG: capillary blood glucose or blood sugar cc: cubic centimeterCG: caregivercm: centimeterF: FahrenheitHH: Home HealthHS or hs: hour of sleepLPN: Licensed Practical NurseMA: Medication AideMAR: Medication Administration RecordMCC Memory Care Communitymg: milligramml: milliliterO2 sats: oxygen saturation in the bloodOT: Occupational TherapistPT: Physical TherapistPRN: as neededqd: every day or dailyqid: four times a dayRN: Registered NurseSP: service planTAR: Treatment Administration Recordtid: three times a day

Survey 57HV

19 Deficiencies
Date: 9/26/2022
Type: Validation, Re-Licensure

Citations: 20

Citation #1: C0000 - Comment

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Not Corrected
3 Visit: 2/27/2024 | Not Corrected
Inspection Findings:
The findings of the relicensure survey, conducted 09/26/22 through 09/28/22, 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 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 revisit survey to the re-licensure survey of 09/28/22, conducted 09/25/23 through 09/27/23, 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 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 second re-visit survey to the 09/22/23 re-licensure survey, conducted 02/26/24 through 02/27/24, 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 for Home and Community Based Services Regulations.

Citation #2: C0231 - Reporting & Investigating Abuse-Other Action

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Corrected: 11/27/2022
Inspection Findings:
Based on interview and record review, it was determined the facility failed to ensure all incidents involving residents were thoroughly investigated to determine if abuse or suspected abuse could reasonably be ruled out and/or report the incident to the local Senior and People with Disabilities Office (SPD) for 1 of 3 sampled residents (# 4) whose record was reviewed. Findings include, but are not limited to:Resident 4 was admitted to the facility in 11/2019, with diagnoses including anxiety and depression.Progress notes, dated 08/03/22, revealed care staff were providing care to a resident when Resident 4 walked into the resident's room and "started talking to & touching [the resident] while [s/he] was uncovered with a brief on." There was no documented evidence the incident had been investigated or reported to the local SPD office.During interviews on 09/28/22 with the Staff 2 (Interim ED), Staff 3 (Wellness Director/RN) and Staff 4 (Resident Care Coordinator) they stated they had not been informed of the incident. The need to ensure all incidents of abuse or suspected abuse were investigated and reported to the local SPD office was discussed with Staff 2 (Interim ED) on 09/28/22. Staff 2 reported the incident to the local SPD office per the survey team's request and provided confirmation of the report.
Plan of Correction:
OAR 411-054-0028 (1-3) Reporting & Investigating Abuse-Other Action1. What actions will be taken to correct the rule violation for each example/resident?a. Resident 4 incident was reported to the local SPD office and confirmation was provided to survey team.2. How will the system be corrected so this violaiton will not happen again?a.Training for all staff will be conducted by the Director of Health Services/RN to review policies and procedures for the prevention of Abuse and Neglect, and reporting of suspected abuse and/or neglect. This training will also include managing the incident, notifications, managing of the resident, medical needs, documentation and interventions. b. All staff will sign acknowledgment of this training.c. Documentation of this training will be maintained in the training records. d. All incidents will be reported immediately to the RN by the care staff member who witnessed or noted the incident and will be entered into the resident chart and the 24 hour communication binder.e. If abuse or neglect is suspected, witnessed or overheard, the care staff member will immediately report the incident to the SPD or the local AAA and the local Law Enforcement agency. f. The RN and RCC will review every incident and conduct an investigation of the incident to determine the abilty to rule out abuse and neglect. The investigation will include the time, date, place and any individual present, a description of the event as reported, the care staff response to the incident, any follow up action and the review by the Executive Director.g. If abuse and/or neglect is not able to be ruled out, the RN will immeditately report to the SPD or the local AAA and the local Law Enforcement agency. h. If the incident includes and injury of unknown cause, that cannot be ruled out as abuse or neglect, the RN will immediately report the injury to the SPD or local AAA. i. The RN will review each incident with the Executive Director daily during the SMART meeting.3. How often will the area needing correction be evaluated?a. All incidents will be reviewed during the SMART meetings conducted Monday through Friday during the week and involving the RN, RCC and Executive Director. This review will include review of incident, notifications, documentation of incident, interventions put in place and outcome or follow up.4. Who will be responsible to see that the corrections are completed/monitored?a.The Executive Director will monitor this process for compliance during the SMART meetings conducted each week day Monday - Friday.b. Exective Director will keep a binder of all incidents.

Citation #3: C0240 - Resident Services Meals, Food Sanitation Rule

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Corrected: 11/27/2022
Inspection Findings:
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:Observation of the kitchen on 09/27/22 at 8:27 am revealed an accumulation of food spills, splatters, loose food debris, dirt and/or dust on or underneath the following:* Door near reach-in refrigerator;* Ceiling vents throughout the kitchen;* Ceiling tiles near juice machine; * Venting plate on reach-in refrigerator;* Walls throughout the kitchen;* Flooring and baseboards throughout the kitchen;* Floor drains throughout the kitchen;* Clean dish rack near steam table;* Electrical box under steam table;* Pillar near steam table;* Toaster;* Microwave;* Shelves of steam table;* Commercial oven;* Stove/oven unit;* Floor mats throughout the kitchen;* Stand mixer;* Shelving above stand mixer;* Drawers throughout the kitchen;* Spice shelf;* Fire hydrant;* Waffle irons in pantry;* Pantry floors;* Back door;* Flooring in the walk-in refrigerator;* Shelving in the walk-in refrigerator; * Cooling rack in the walk-in refrigerator; and* Warewasher pipes.The following kitchen items needed repair:* Doors throughout the kitchen had scrapes and/or gouges with bare wood exposed rendering the surfaces uncleanable; * The walk-in freezer had pooled ice on the floor and around pipes leading to the fans;* The reach-in refrigerator had a ripped seal and large cracks in the interior floor of the unit; and* Tiles near rear exit were cracked in multiple places.The areas that required cleaning and repair were observed and discussed with Staff 2 (Interim ED) and Staff 7 (Dietary Supervisor) on 09/27/22 at 9:45 am. They acknowledged the findings.
Plan of Correction:
OAR 411-054-0030 (1)(a) ResidentServices Meals, Food Sanitation Rule 1. What actions will be taken to correct the rule violation for each exampe /resident are as follows: a. All food spills, splatters, loose food debris,dirt and/or dust on or underneath thefollowing areas have been cleaned:* Door near reach-in refrigerator;* Ceiling vents throughout the kitchen;* Ceiling tiles near juice machine;* Venting plate on reach-in refrigerator;* Walls throughout the kitchen;* Flooring and baseboards throughoutthe kitchen;* Floor drains throughout the kitchen;* Clean dish rack near steam table;* Electrical box under steam table;* Pillar near steam table;* Toaster;* Microwave;* Shelves of steam table;* Commercial oven;* Stove/oven unit;* Floor mats throughout the kitchen* Stand mixer;* Shelving above stand mixer;* Drawers throughout the kitchen;* Spice shelf;* Fire hydrant;* Waffle irons in pantry;* Pantry floors;* Back door;* Flooring in the walk-in refrigerator;* Shelving in the walk-in refrigerator;* Cooling rack in the walk-in refrigerator;* Warewasher pipes. b. The following kitchen items have been repaired:* Doors throughout the kitchen withscrapes and/or gouges with bare wood thatexposed rendering the surfacesuncleanable;* The walk-in freezer pooled ice onthe floor and around pipes leading to thefans;* The reach-in refrigerator that had a rippedseal and large cracks in the interior floorof the unit; and* Tiles near rear exit were cracked inmultiple places 2. How will the system be corrected so this violation will not happen is as follows: a. Kitchen cleaning schedule now in place with audits 3. How often will the area needing correction be evaluated is as follows: a. Daily when working by Kitchen supervisor or designee b. Weekly by Maintenance to check for repairs 4. Who will be responsible to see that corrections are completed/monitored are as follows: a. Kitchen Culinary Director or designee b. Maintenance Director

Citation #4: C0252 - Resident Move-In and Eval: Res Evaluation

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Corrected: 11/27/2022
Inspection Findings:
Based on interview and record review, it was determined the facility failed to ensure a resident move-in evaluation addressed all required elements for 1 of 1 sampled resident (# 3) whose move-in evaluations was reviewed. Findings include, but are not limited to:Resident 1 moved into the facility in 05/2022.The new move-in evaluation, dated 05/05/22, failed to address the following elements:* Mental health issues including effective non-drug interventions;* Cognition including memory, orientation, confusion and decision making abilities;* Personality, including how a person copes with change or challenging situations; * Independent activity of daily living including laundry status and transportation;* Skin status;* List of treatments;* Complex medication regimen; and* History of dehydration or unexplained weight loss or gain.The need to ensure new move-in evaluations contained all the required elements was discussed with Staff 2 (Interim ED), Staff 3 (Wellness Director/RN) and Staff 4 (Resident Care Coordinator) on 09/28/22. They acknowledged the findings.
Plan of Correction:
OAR 411-054-0034 (1-6) Resident move-in and Eval: Res Evaluation1. What actions will be taken to correct the rule violation for each example/ resident?a. Resident 1 current evaluation will be reviewed and updated to include:b. Resident routines and preferences including (A) Customary routines related to sleeping, eating and bathing.(B) Interests, hobbies, and social and leisure activities.(C Spiritual and cultural preferences and traditions(D) Additional elements as listed in 411-054-0027 (2)(b) Physical health status including:(A) List of current diagnoses(B) List of medications and PRN use(C visits to health practitioners, emergency room, hospital, or nursing facility in the past year; and(D) Vital signs if indicated by diagnoses, health problems, or medications.(c Mental health issues including:(A) Presence of depression, thought disorders, or behavioral or mood problem:(B) History of treatment; and (C Effective non drug interventions. (d) Cognition, including:(A) Memory;(B) Orientation;(C Confusion; and(D) Decision-making abilities.(e Personality, including how the person copes with change or challenging situations. (f) Communication and sensory abilities including; (A) Hearing;(B) Vision:(C Speech:(D) Use of assistive devices; and (E Ability to understand and be understood.(g) Activities of daily living including:(A) Toileting, bowel and bladder management;(B) Dressing, grooming, bathing, and personal hygiene;(C Mobility ambulation, transfers, and assistive devices; and(D) Eating, dental status, and assistive devices.(h) Independent activities of daily living including:(A) Ability to manage medications;(B) Ability to use call system;(C Housework and laundry ; and (D) Transportation(i) Pain pharmaceutical and non-pharmaceutical interventions, including how a person expresses pain or discomfort.(j) skin condition(k) Nutrition habits, fluid preferences, and wieght if inidcated. (l) List of treatments type, frequency, and level of assistance needed. (m) Indicators of nursing needs, including potential for delegated nursing tasks. (n) Review of risk indicators including:(A) Fall risk or history;(B) Emergency evacuation ability;(C Complex medication regimen;(D) History of dehydration or unexplained weight loss or gain;(E Recent losses;(F) Unsuccessful prior placement(G) Elopement risk or history;(H) Smoking. The resident's ability to smoke without causing burns or injury to themselves or others or damage to property must be evaluated and addressed in the resident's service plan: and (I) Alcohol and drug use. The resident's use of alcohol or the use of drugs not prescribed by a physician must be evaluated and addressed in the resident's service plan. (o) Environmental factors that impact the resident's behavior including, but not limited to:(A) Noise(B) Lighting(C Room temperature2. How will the system be corrected so this violation will not happen again?a. Executive Director, RN and RCC will review each element of the preadmission evaluation which includes all required elements and questions listed above. b. RN will author all preadmission evaluations with input from the RCC based on interview of potential resident, records review, family input and physician admission paperwork. c. RN will attend the Oregon Role of the RN class.3. How often will the area needing correction be evaluated? a. RN/RCC will review preadmission evaluation finding during stand up meetings and/or SMART meetings.b. Executive Director will review for content and sign the preadmission evaluation, care plan and level of care determination prior to admission during SMART meetings held each week day Monday through Friday. 4. Who will be responsible to see that the corrections are completed/monitored?a. Executive Director will review each preadmission evaluation and all subsequent evaluations for content prior to signing off on each evaluation.

Citation #5: C0260 - Service Plan: General

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Not Corrected
3 Visit: 2/27/2024 | Corrected: 12/11/2023
Inspection Findings:
Based on observation, interview and record review, it was determined the facility failed to ensure resident service plans were reflective of resident care needs and provided clear direction to staff regarding the delivery of services for 4 of 5 sampled residents (#s 1, 2, 3 and 4) whose service plans were reviewed. Findings include, but are not limited to:1. Resident 1 was admitted to the facility in 08/2017 with diagnoses including type II diabetes and tremors. Observations of Resident 1 during the survey revealed the resident was dependent on staff for most ADLs and used an air mattress while in bed.Observations of the resident, interviews with staff, review of the current 08/17/22 service plan and clinical records during the survey, revealed Resident 1's service plan was not reflective of the resident's status and did not provide specific directions to staff in the following areas:* Transfer status including level of assistance;* Use of oxygen including the setting of oxygen;* Use of an air mattress while in bed;* Use of overhead trapeze;* Use of denture/top part and care;* Hospice outside provider service including when to contact and who to contact;* Use of cushioned oxygen tubing;* Toileting status including level of assistance;* Bed mobility status including 2-person assist; and* Evacuation status and level of assistance needed.The need to ensure the service plan was reflective of the resident's needs and provided clear instruction to staff was discussed with Staff 2 (Interim ED), Staff 3 (Wellness Director/RN) and Staff 4 (Resident Care Coordinator) on 09/28/22. Staff acknowledged the findings.2. Resident 3 was admitted to the facility in 05/2022 with diagnoses including atrial fibrillation and pacemaker.Observations of the resident, interviews with staff, review of the current 07/24/22 service plan and clinical records during the survey, revealed Resident 3's service plan was not reflective of the resident's status and did not provide specific directions to staff in the following areas:* Who was responsible for checking blood sugar levels; and * Pacemaker.The need to ensure the service plan was reflective of the resident's needs and provided clear instruction to staff was discussed with Staff 2 (Interim ED), Staff 3 (Wellness Director/RN) and Staff 4 (Resident Care Coordinator) on 09/28/22. Staff acknowledged the findings.
3. Resident 4 was admitted to the facility in 11/2019, with diagnoses including anxiety and depression.Observations of the resident, interviews with staff and review of Resident 4's clinical record revealed the service plan, dated 09/11/22, was not reflective of his/her current needs and/or did not provide clear direction to staff in the following areas: * Verbal aggression directed towards staff and other residents;* Verbal altercations with spouse who shared the apartment with Resident 4;* Episodes of alcohol intoxication;* Intrusive behaviors directed towards other residents;* Refusals of staff safety escorts;* Episodes of extreme increases in anxiety and depression symptoms; and* Repeated behavioral episodes of yelling, using vulgar language, banging on walls, non-consensual physical contact towards residents and slamming doors and furniture in the common areas of the facility. The need to ensure service plans were reflective of residents' current needs and provided clear direction to staff was discussed with Staff 2 (Interim ED), Staff 3 (Wellness Director/RN) and Staff 4 (Resident Care Coordinator) on 09/28/22. They acknowledged the findings.
4. Resident 2 was admitted to the facility in 01/2022 with diagnoses including congestive heart failure, chronic obstructive pulmonary disease and depression.Review of Resident 2's service plan, dated 07/24/22, temporary service plans, observations during survey and interviews with staff determined the service plan was not reflective, or did not provide clear instructions to staff in the following areas:* Weight loss interventions;* Denture use and care; and* Interventions for behavior.On 09/28/22 the need to ensure service plans were reflective of residents' current status, provided clear instructions to staff and were followed was discussed with Staff 1 (Administrator), Staff 2 (Interim ED) and Staff 3 (Wellness Director/RN). They acknowledged the findings.



Based on observation, interview, and record review, it was determined the facility failed to ensure service plans were reflective of residents' current care needs and provided clear directions to staff regarding the delivery of services for 1 of 4 sampled residents (#9) whose service plan was reviewed. This is a repeat citation. Findings include, but are not limited to:Resident 9 was admitted to the facility in 08/2023 with diagnoses including chronic diastolic congestive heart failure, paroxysmal atrial fibrillation, and type 2 diabetes mellitus. Observations were made of the resident's care on 09/26/23. Interviews with facility staff and the resident were conducted. The current service plan dated 08/31/23 was reviewed. Resident 9's service plan was not reflective of the resident's current needs and lacked clear instructions to staff in the following areas:* Dietary and nutrition management;* Skin and wound condition monitoring;* Number of staff needed to assist with activities of daily living; * Instructions for bleeding precautions and interventions while on anticoagulation therapy; and* Electric mobility equipment precautions and instructions for proper maintenance.The need to ensure the service plan reflected residents' current needs and provided clear instructions to staff regarding delivery of services was reviewed with Staff 2 (ED) and Staff 33 (Regional Director of Memory Care) on 09/27/23 at 11:30 am. They acknowledged the findings. No further information was provided.OAR 411-054-0036 (1-4) Service Plan: General1. What actions wil be taken to correct the rule violation for each example/residenta. Resident #9 care plan will be reviewed by the RN and updated to accurately reflect the following:*Dietary and nutrition management*Skin and wound condition monitoring*Number of staff needed to assist with activities of daily living.*Instructions for bleeding precautions and interventions while on anticoagulation therapy*Electric mobility equipment precautions and instructions for proper maintenance of mobility equipment.2. How will the system be corrected so this violation will not happen again?a. RN will conduct a thorough assessment of each resident prior to care plan updates and ensure all needs are reflected in service plan.b. RN will review all service plans in collaboration with the RCC to include accurate content and specific instruction of all elements of assessment/service plan. c. Executive Director will review all service plan updates for content before signing service plan.d. All current reisdent service plans will be reviewed for content and specific instruction, and updates made where appropriate.3. How often will the area needing correction be evaluated?a. Each service plan update will be reviewed by the Executive Director for content prior to signing. This includes preadmission, admission, 30 day, quarterly and change of condition assessments/service plans.4. Who will be responsible to see that the corrections are completed/monitored?a. Executive Director will review each service plan for content and specific instruction and give feedback as needed to RN and RCC pror to signing off. This will include preadmission, admission, 30 day, quarterly and change of condition service plans.
Plan of Correction:
OAR 411-054-0036 (1-4) Service Plan: General1. What actions will be taken to correct the rule violation for each example/resident? a. Resident 1 care plan will be reviewed by the RN and updated to accurately reflect the residents status and specific directions to staff including*Transfer status including level of assistance needed.*use of oxygen including the setting of oxygen*Use of air mattress while in bed and maintenance of air mattress*Use of overhead trapeze*Use of denture/top part and care;*Hospice outside provider service including when to contact and who to contact;*Use of cushioned oxygen tubing;*Toileting status including 2-person assist; and*Evacuation status and level of assistance needed. b. Resident 3 care plan will be reviewed by the RN and updated to accurately reflect the residents status and specific directions to staff including:*who is responsible for checking blood sugar levels; and *Pacemaker c. Resident 4 care plan will be reviewed by the RN and updated to accurately reflect the residents status and specific directions to the staff including;*Verbal aggression directed towards staff and other residents;*Verbal altercations with spouse who shared the apartment with resident 4;*Episodes of alcohol intoxication;*Intrusive behaviors directed towards other residents;*Refusals of staff safety escorts;*Episodes of extreme increases in anxiety and depression symptoms/ and *Repeated behavioral episodes of yelling, using vulgar language, banging on walls, non-consentual physical contact towards residents and slamming doors and furniture in the common areas of the facility. d. Resident 2 care plan will be reviewed and updated to accurately reflect the resident status, care needs, and specific directions to staff including: *Weight loss interventions*Denture use and care; and*Interventions for behaviore. All resident care plans will be reviewed and updated for content and staff instruction. 2. How will the system be corrected so this violation will not happen again?a. RN will attend the Oregon Role of the RN class.b. RN, RCC and Executive Director will review each element of the evaluation/care plan which includes all required elements.c. RN will author all evaluations and care plans with input from RCC and resident to ensure all care needs are identified and will address each element of the evaluation and provide specific instruction to staff regarding care needs.d. All current resident service plans will be reviewed and updated to reflect accurate resident care needs and preferences. 3. How often will the area needing correction be evaluated?a. Each care plan update will be reviewed for content by the Executive Director prior to signing the new care plan. b. Quarterly and COC care plan updates will be reviewed during each SMART meeting Monday through Friday.c. SMART meeting minutes are maintained on the Seasons dashboard4. Who will be responsible to see that the corrections are completed/monitored?a. Executive Director will review each care plan for content and provide feedback as necessary prior to signing off on all careplans. OAR 411-054-0036 (1-4) Service Plan: General1. What actions wil be taken to correct the rule violation for each example/residenta. Resident #9 care plan will be reviewed by the RN and updated to accurately reflect the following:*Dietary and nutrition management*Skin and wound condition monitoring*Number of staff needed to assist with activities of daily living.*Instructions for bleeding precautions and interventions while on anticoagulation therapy*Electric mobility equipment precautions and instructions for proper maintenance of mobility equipment.2. How will the system be corrected so this violation will not happen again?a. RN will conduct a thorough assessment of each resident prior to care plan updates and ensure all needs are reflected in service plan.b. RN will review all service plans in collaboration with the RCC to include accurate content and specific instruction of all elements of assessment/service plan. c. Executive Director will review all service plan updates for content before signing service plan.d. All current reisdent service plans will be reviewed for content and specific instruction, and updates made where appropriate.3. How often will the area needing correction be evaluated?a. Each service plan update will be reviewed by the Executive Director for content prior to signing. This includes preadmission, admission, 30 day, quarterly and change of condition assessments/service plans.4. Who will be responsible to see that the corrections are completed/monitored?a. Executive Director will review each service plan for content and specific instruction and give feedback as needed to RN and RCC pror to signing off. This will include preadmission, admission, 30 day, quarterly and change of condition service plans.

Citation #6: C0270 - Change of Condition and Monitoring

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Corrected: 11/27/2022
Inspection Findings:
5. Resident 1 was admitted to the facility in 08/2017 with diagnoses including type II diabetes. During the survey, s/he was identified as having skin issues.Observations of Resident 1 during the survey revealed the resident was dependent on staff for most ADLs and used an air mattress while in bed.Clinical records, including progress notes from 07/04/22 to 09/26/22 and Resident Interim Service Plan (ISPs) were reviewed. The clinical record provided the following information:* On 07/30/22, placed on alert charting due to experience of delusion;* On 08/14/22, discontinued oxygen therapy;* On 08/28/22, redness on the right gluteus and an open area behind left ear; and* On 09/07/22, pulled catheter out.There was no documented evidence that the resident's short-term changes of condition and skin status were monitored, at least weekly, to resolution. On 09/28/22, the above findings were reviewed with Staff 2 (Interim ED), Staff 3 (Wellness Director/RN) and Staff 4 (Resident Care Coordinator). Staff acknowledged findings.6. Resident 3 was admitted to the facility in 05/2022 with diagnoses including Parkinson's disease and hypertension.Clinical records reviewed from 06/29/22 to 09/23/22 noted the following:* 08/19/22 - Staff documented carbidopa/levo (Parkinson's disease medication) was discontinued; and* 09/14/22 - Placed on alert charting due to high blood pressure.There was no documented evidence that the resident's short-term changes of condition were consistently monitored, at least weekly, to resolution. On 09/28/22, the above findings were reviewed with Staff 2 (Interim ED), Staff 3 (Wellness Director/RN) and Staff 4 (Resident Care Coordinator). Staff acknowledged findings.
2. Resident 6 was admitted to the facility in 06/2017, with diagnoses including dementia.Observations, interviews and review of Resident 6's clinical records revealed the following:Resident 6's service plan, dated 09/11/22, noted the following:* S/he shared an apartment with his/her spouse,* S/he displayed impairments in memory and judgement which interfered with daily functioning; * S/he did not always read social cues appropriately, "offering physical embrace, for example, to someone that did not desire it"; * S/he was not "able to recall when a person refused physical contact previously and could offer again"; and* Behavioral interventions included, Resident 6's spouse was to assist him/her with social situations and staff were to monitor Resident 6 anytime the spouse was not in the facility. * An incident report, dated 03/24/22, noted another resident reported Resident 6 had inappropriately touched him/her on the back and chest. An interim service plan, dated 03/28/2022, noted Resident 6 "needs to be with [spouse] at all times. Anytime staff sees [him/her] by [his/herself] please escort [him/her] to and from where [s/he] would like to go." There was no documented evidence the facility monitored the effectiveness of the intervention for spouse or staff escorts and/or had monitored the effectiveness of previous behavioral interventions for Resident 6. * An incident report, dated 09/14/22, indicated the same resident noted on 03/24/22, alleged Resident 6 had inappropriately touched and grabbed him/her again on his/her breast. An incident report dated 09/15/22, reviewed with the other resident's record, noted s/he was sent to the ER 09/15/22 and was diagnosed with a left breast contusion.There was no documented evidence the facility developed new interventions related to Resident 6's alleged behaviors of inappropriate physical contact with another resident and there was no documented evidence the facility monitored previous behavioral interventions for effectiveness.During an interview on 09/27/22, Staff 12 (MT) stated Resident 6's spouse usually escorted Resident 6 when they were out of the apartment together, but Resident 6 often did not remember to ask staff to escort him/her when the spouse was not available. During an interview with Resident 6 on 09/28/22, Resident 6 displayed symptoms of impaired cognition, had difficulty staying on topic and following the conversation and repeatedly provided the same answer which was not related to interview questions.On 09/28/22, staff were observed escorting Resident 6 and his/her spouse to and from the dining room and provided visual supervision during the lunch meal.The facility's failure to develop and monitor interventions to address Resident 6's repeated alleged behaviors placed other residents at risk of inappropriate physical contact with Resident 6.The need to ensure the facility developed and monitored interventions for effectiveness when residents experienced behavioral changes of condition was discussed with Staff 2 (Interim ED) on 09/27/22 and Staff 3 (Wellness Director/RN) and Staff 4 (Resident Care Coordinator) on 09/28/22. They acknowledged the findings and Staff 2 stated Resident 6's service plan was updated on 09/27/22, to include the use of a call pendant for Resident 6 and spouse to call staff for escorts to and from their apartment.3. Resident 4 was admitted to the facility in 11/2019, with diagnoses including anxiety and depression.Observations, interviews with staff and review of Resident 4's clinical records, revealed Resident 4 experienced the following changes of condition:* On 07/24/22, an alleged physical altercation with another resident;* On 07/24/22, Resident 4 self reported signs and symptoms of a "bad UIT [urinary track infection]"; and * On 08/03/22, behaviors related to alcohol intoxication and intrusive entrance into another resident's apartment. There was no documented evidence the facility determined resident specific interventions, or monitored the changes through resolution.The need to ensure the facility evaluated residents' changes of condition, determined and monitored interventions for effectiveness through condition resolution was discussed with Staff 2 (Interim ED), Staff 3 (Wellness Director/ RN) and Staff 4 (Resident Care Coordinator) on 09/28/22. They acknowledged the findings.4. Resident 7 was admitted to the facility in 04/2019, with diagnoses including macular degeneration and stroke.Observations, interviews with staff and review of Resident 7's clinical records indicated the following:*An investigation report, sent to APD on 07/25/22, noted another resident reported Resident 7 had pushed [him/her] on the shoulder enough to cause [him/her] to step back." Resident 7 denied ever touching the other resident.During observations and interview with Resident 7 on 09/28/22, the resident was alert and oriented and did not exhibit any behaviors. The need to ensure the facility developed and monitored interventions for effectiveness when residents experienced behavioral changes of condition was discussed with Staff 2 (Interim ED) on 09/28/22. He acknowledged the findings.
Based on observation, interview and record review, it was determined the facility failed to ensure resident changes of condition were evaluated, resident specific interventions were determined documented and monitored for effectiveness with weekly progress noted resolution for 6 of 7 sampled residents (#s 1, 2, 3, 4, 6 and 7) whose records were reviewed. Resident 6 had alleged behaviors of inappropriate touching of another resident. Resident 2 experienced severe weight loss. Findings include, but are not limited to:1. Resident 2 was admitted to the facility in 01/2022 with a diagnosis of congestive heart failure.During the acuity interview on 09/26/22, Resident 2 was identified to be at risk for weight loss.Review of Resident 2's charting notes, dated 06/29/22 through 09/26/22, interim service plans and weight records indicated the following:Resident 2's weights were noted as follows:*06/27/22 121 pounds;*07/15/22 113.6 pounds;*08/15/22 113 pounds; and*09/23/22 108.4 pounds.Between 06/27/22 and 07/15/22, Resident 2 lost 7.4 pounds or 6.1 % of his/her ideal body weight resulting in a severe weight loss.There was no documented evidence the facility evaluated Resident 2's weight loss including determining actions/interventions, referred to the facility RN or updated the service plan. Between 06/27/22 and 09/23/22 Resident 2 continued to lose a total of 12.6 pounds or 10.4 % of his/her body weight resulting in a severe loss in three months.Resident 2 was observed eating meals during breakfast and lunch on 09/27/22. The resident was able to eat meals without assistance, and consumed approximately 75% at each meal.During an interview on 09/28/22 with Staff 3 (Wellness Director/RN) she acknowledged the resident had experienced weight loss and there was no documented evidence an assessment had been completed.The facility failed to address the initial severe weight loss and the resident continued to lose weight. On 09/28/22, the Resident's weight loss was discussed with Staff 1 (Administrator) and Staff 2 (Interim ED). They acknowledged the findings.
Plan of Correction:
OAR 411-054-0040 (1-2) Change of Condition and Monitoring1. What actions will be taken to correct the rule violation for each example/resident?a. Resident 2 chart will be reviewed by RN for weight history. Evaluation and care plan will be reviewed and updated to reflect weight loss including interventions and direction to the staff.b. Communication will be initiated with physician and family regarding resident 2 weight loss. c. Physician orders will be implemented when received regarding interventions for weight loss.d. An audit of the past 6 months will be conducted on all residents to identify any weight changes. All changes above 3% will be reported to the physician and care plan will be updated to reflect interventions for identified reisdents with weight loss/gain.e. Resident 4, 6 and 7 chart and care plan will be reviewed by RN and updated to include identification of behaviors, interventions to be put in place and notification to physician. f. Behavior monitoring and a behavior strategy plan will be developed and put in place for both residents.g. Resident 1 and 3 chart and care plan will be reviewed by RN and updated to accurately include identification of changes in condition.h. RN will enter updated change of condition notation on each resident.2. How will the system be corrected so this violation will not happen again. a. RN will attend the Oregon Role of the RN class.b. All care staff will be trained on change of condition identifiers, signs of weight loss/gain, monthly resident weight protocols, recording of weights in resident chart and reporting variations.c. Care staff will enter monthly weights into QMAR by the 7th of each month. The RN will print a weight report monthly and review weights on all residents.d. RN will address any weight fluctuations above 3% in any given 3 month period. e. RN will make weekly chart notes on each resident with a change of condition until stable. f. RN and Executive Director will have weekly one on one meetings to discuss residents at risk, resident changes and coordination of care.g. All residents with change of condition needs will be discussed in SMART meeting daily Monday through Friday to ensure COC has been addressed.h. All residents identified as having a change of condition will be placed on alert charting for monitoring and an ISP will be put in place for care staff to review at the beginning of each shift until the RN can evaluate the change and update the care plan to reflect new needs. ISP's are reviewed daily Monday throught Friday during the SMART meeting.i. Installation of a white board in the RN office to track resident change of conditions. HIPPA will be maintained.3. How often will the area needing correction be evaluated? a. Weekly during ED and RN one on one meetings to review residents at risk, resident changes and coord. of care, including review of weekly notes on residents with changes.4. Who will be responsible to see that the corrections are completed/monitored?a. ED and RN during weekly one on one meetings.b. ED during daily SMART meetings. Minutes from these meetings will be maintained on the Seasons dashboard.

Citation #7: C0280 - Resident Health Services

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Not Corrected
3 Visit: 2/27/2024 | Corrected: 12/11/2023
Inspection Findings:
Based on observation, interview and record review, it was determined the facility failed to ensure an RN assessment was performed for a residents with significant changes of condition for 2 of 2 sampled residents (#s 2 and 5) who experienced changes of condition. Resident 2 experienced severe weight loss. Findings include, but are not limited to:1. Resident 2 was admitted to the facility in 01/2022 with a diagnosis of congestive heart failure.During the acuity interview on 09/26/22, Resident 2 was identified to be at risk for weight loss.Review of Resident 2's charting notes, dated 06/29/22 through 09/26/22, interim service plans and weight records indicated the resident experienced a severe weight loss without documented evidence of an RN significant change of condition assessment.During an interview on 09/28/22 with Staff 3 (Wellness Director/RN) she acknowledged the resident had experienced weight loss and there was no documented evidence an assessment had been completed.Refer to C 270, example 1. 2. Resident 5 was admitted to the facility in 12/2018. During the entrance conference on 09/28/22, Staff 4 (Resident Care Coordinator) stated the resident had a recent significant decline in health and returned from the emergency department on 08/19/22. Record review revealed Resident 5 had a fall on 08/18/22. The resident was sent to the ER due to hitting his/her head. Resident 5 returned to the facility on 08/19/22 with a new diagnosis of femur fracture and UTI.Resident 5's new diagnosis of a femur fracture and decline in health constituted a significant change in condition requiring an assessment by the facility RN.There was no RN assessment on findings, overall status of the resident, interventions as a result of the assessment and an update to the resident's service plan for changes in care needs.The requirement that the RN must assess all residents with a significant change of condition was discussed with Staff 1 (Administrator), Staff 2 (Interim ED), Staff 3 (Wellness Director/RN) and Staff 4 on 09/28/22 at 3:45 pm. They acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure an RN completed a significant change of condition assessment, including findings, resident status, and interventions made as a result of the assessment, for 1 of 2 sampled residents (#8) whose records were reviewed. This is a repeat citation. Findings include, but are not limited to:Resident 8 was admitted to the facility in 09/2022 with diagnoses including bi-polar disorder, anxiety, and dementia. Review of the resident's 03/22/23 through 09/12/23 charting notes, 03/2023 through 09/2023 weight records, and 08/22/23 service plan revealed the resident experienced severe weight loss between 04/07/23 and 05/07/23.Charting notes revealed the resident's severe weight loss was monitored and interventions were put in place; however, there was no documented evidence a significant change of condition assessment had been completed by an RN for the weight loss.Weight records indicated the resident had since returned to their weight prior to the weight loss.The need to ensure an RN completed an assessment for all significant changes of condition was discussed with Staff 2 (ED) and Staff 33 (Regional Director of Memory Care) on 09/27/23. They acknowledged the findings.
Plan of Correction:
OAR 411-054-0045 (1) (a-f) (A) (C-F) Resident Health Services1. What action will be taken to correct the rule violation for each example/resident?a. Resident 2 chart and careplan will be reviewed by the RN and updated to reflect weight changesb.Physician will be notified of weight changes and interventions will be put in place. c. Resident 5 chart and care plan will be reviewed by the RN and updated to reflect care needs and interventions. 2. How will the system be corrected so this violation will not happen again?a. RN will attend the Role of the RN class. b. RN will perform a new evaluation for any resident who has a change in condition and update the care plan to reflect changes identified. c. All resident changes will be placed on alert charting and an ISP will be put in place until concern is resolved or new baseline is established.d. RN will enter change of condition documentation into residents EMR.e. RN and ED will have weekly one on one meetings to discuss resident changes. f. Care staff will be trained by RN/DHS on use of care plan addendum tool for identifying and reporting noted changes of condition. 3. How often will the area needing correction be evaluated?a. All ISP's and Alert Charting will be reviewed during the daily SMART meeting Monday through Friday.b. Weekly during RN and ED one on one meetings. 4. Who will be responsible to see that the corrections are completed/monitored?a. ED and RN during weekly one on one meetings and daily SMART meetings. OAR 411-054-0045 (1) (a-f) (A) (C-F) Resident Health Services1. What action will be taken to correct the rule violation for each example/resident?a. Resident #8 chart and service plan will be reviewed by the RN and a change of condition will be completed for identified changes.b. Weights will be monitored monthly and entered into the system by the 10th of each month.c. RN will print a weight variance report by the 15th of each month and review all residents for weight changes and conduct an assessment and service plan update for change of condition when appropriate. d. Physician will be notified of all weight variances according to policy.2. How will the system be corrected so this violation will not happen again?a. Change of Condition Interpretive Guidelines given to the RN for review and reference going forward. b. RN will conduct a new assessment, enter chart notes and update service plan for any change of condition in a timely manner. c. All resident changes will be discussed during SMART meetings. SMART meeting minutes will be maintained by the Executive Director.d. All residents with COC will be placed on alert charting and an ISP put in place until the RN can do a COC update. e. RN and ED will discuss any resident changes during their weekly 1:1 meetings. f. Med Tech and Caregiver communications binders will be reviewed daily by the RN and RCC to capture resident changes that are documented during communication.3. How often will the area needing correction be evaluated. a. All residents on alert charting will be reviewed daily.b. All residents with an ISP will be reviewed daily to determine need for change of condition. c. RN and ED will review resident changes during weekly 1:1 meetings. 4. Who will be responsible to see that the corrections are completed/monitored?a. ED and RN during weekly 1:1 meetings and during SMART meetings.

Citation #8: C0290 - Res Hlth Srvc: On- and Off-Site Health Srvc

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Corrected: 11/27/2022
Inspection Findings:
Based on interview and record review, it was determined the facility failed to coordinate care with outside providers in order to ensure the continuity of care for 1 of 1 sampled resident (# 1) who received outside services. Findings include, but are not limited to:Resident 1 was admitted to the facility in 08/2017 with diagnoses including type II diabetes. During the acuity interview on 09/26/22, Resident 1 was identified as receiving hospice services.Resident 1's clinical record, dated 08/22/22 through 09/13/22, was reviewed during the survey and revealed the following:* On 08/22/22, "Red open area behind left ear. Hospice to provide cushioned oxygen. Please monitor skin, pressure area"; and* On 09/11/22, "Keep catheter high on thigh, be sure strap is in good condition."There was no documented evidence the recommendations were communicated to staff or implemented. On 09/28/22, the need to ensure on-going coordination of care was discussed with Staff 2 (Interim ED), Staff 3 (Wellness Director/RN) and Staff 4 (Resident Care Coordinator). Staff acknowledged the findings.
Plan of Correction:
OAR 411-054-045 (2) Resident Health Services: On and Off site Health Services1. What actions will be taken to correct the rule violation for each example/resident?a. Resident 1 will have review of all hospice communications conducted by RN. Chart and care plan will be reviewed for accuracy and will be updated to reflect care needs.b. ISP's will be put in place reflective of all hospice communications with changes. 2. How will system be corrected so this violation will not happen again?a. Communication forms will be completed by all off and on site providers. Receptionist will remind provider when screening them for entry.b. Completed communication forms will be placed in the RN mailbox for review. c. RN will review all off and on site provider communication forms, sign off on them and create ISP's for any recommendations and notify staff of changes.3. How often will the area needing correction be evaluated?a. Communication forms will be reviewed daily during SMART meetings Monday through Friday. 4. Who will be responsible to see that the corrections are completed/monitored?a. ED and RN will review communcation forms with each SMART meeting and ensure ISP's have been put in place.

Citation #9: C0302 - Systems: Tracking Control Substances

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Corrected: 11/27/2022
Inspection Findings:
Based on interview and record review, it was determined the facility failed to have a system in place for accurately tracking controlled substances administered by the facility for 1 of 1 sampled resident (# 1) whose MARs and Controlled Substance Drug Disposition logs were reviewed for accuracy. Findings include, but are not limited to:Resident 1 was admitted to the facility in 08/2017 with diagnoses including type II diabetes.Resident 1 had an order for Lorazepam 1 mg every 4 hours as needed for anxiety.Resident 1's Controlled Substance Disposition Logs and MARs, reviewed from 09/01/22 to 09/26/22, revealed three occasions, 09/05/22, 09/20/22 and 09/23/22, when staff signed on the drug disposition log that the medication was given. However, the MAR lacked documentation the resident received the medication.The inconsistencies between the MARs and Controlled Substance Disposition logs were reviewed with Staff 2 (Interim ED), Staff 3 (Wellness Director/RN) and Staff 4 (Resident Care Coordinator) on 09/28/22. They reviewed the documentation and acknowledged the discrepancies.
Plan of Correction:
OAR 411-054-0055 (1) Systems: Tracking Control Substances.1. What actions will be taken to correct the rule violation for each example/resident?a. Controlled substance logs will be reviewed by the Director of Health Services and compared with the medications administration record for accuracy. 2. How will the system be corrected so this violation will not happen again?a. All Medication Technicians will be trained by the RN/DHS on administration of controlled substances, signing out controlled substances and recording administration of controlled substances in the EMR.b. Medication Technicians must pass a written exam following this training. Record of this training and exam will be maintained in the training logs.3. How often will the area needing correction be evaluated? a. All PRN medications that have been administered will be reviewed daily during the SMART meetings. b. The RCC will conduct quarterly MAR reviews and compare with the disposition logs for accuracy.4. Who will be responsible to see that the corrections are completed/monitored?a. The RN/RCC

Citation #10: C0303 - Systems: Treatment Orders

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Not Corrected
3 Visit: 2/27/2024 | Corrected: 12/11/2023
Inspection Findings:
Based on interview and record review, it was determined the facility failed to carry out orders as prescribed for 3 of 5 sampled residents (#s 1, 2 and 5) whose orders and MAR/TARs were reviewed. Findings include, but are not limited to:1. Resident 1 was admitted to the facility in 08/2017 with diagnoses including type II diabetes.a. Resident 1 had a physician's order, dated 09/21/22, to apply antifungal powder to a back rash twice a day and as needed after bathing.Resident 1's 09/01/22 through 09/23/22 MAR revealed the scheduled antifungal powder treatment was not transcribed onto the MAR, only the as needed antifungal powder was transcribed to the MAR. During the survey, caregiving staff was observed to apply the antifungal powder to Resident 1.b. Resident 1's 09/01/22 through 09/23/22 MAR directed staff to apply CPS (Compounding Pharmacy Solutions) ABH (Ativan, Benadryl and Haldol) topical gel every 6 hours as needed for agitation. There was no signed physician order for the gel. The MAR revealed the topical gel was not administered to the resident during the review period. c. On 09/27/22, during the survey, Resident 1 was observed to have oxygen therapy via nasal canula at a setting of 2L/minute.There was no signed physician order for the oxygen therapy. On 09/28/22, the physician orders and the MARs were reviewed with Staff 2 (Interim ED), Staff 3 (RN) and Staff 4 (Resident Care Coordinator). Staff acknowledged the findings.
2. Resident 2 was admitted to the facility in 01/2022 with diagnoses including congestive heart failure and depression. During the acuity interview 09/26/22, Resident 2 was identified with a potential for weight loss. Review of the resident's MAR, dated 09/01/22 through 09/28/22 and physician orders identified the following: There was an order for monthly weights, but no weight values were documented on the MAR. On 09/28/22 the need to ensure all orders from a legally recognized prescriber were documented in residents' MARs and carried out as prescribed was discussed with Staff 1 (Administrator) and Staff 2 (Interim ED). They acknowledged the findings.
3. Resident 5's MAR, 09/01/22 through 09/26/22, and progress notes revealed the following:On 09/11/22, the facility LPN received a verbal order from Resident 5's physician with instructions to change his/her wound care from using triple antibiotic ointment and Band-Aid to wound cleaner with silicone foam non-bordered dressings. The telephone order was transcribed onto the MAR. The facility failed to obtain a signed order from the physician for the treatment. The need for signed physician or other legally recognized practitioner orders to be documented in the resident's facility record for all medications and treatments that the facility was responsible to administer was discussed with Staff 1 (Administrator), Staff 2 (Interim ED), Staff 3 (Director of Wellness/RN) and Staff 4 (Resident Care Coordinator) on 09/28/22. They acknowledged the findings.



3. Resident 10 was admitted to the facility in 07/2021.The resident's physician orders and 09/01/23 through 09/25/23 MAR was reviewed. The following was identified:* The resident had a physician order for cyanocobalamin, 1000 mcg every Monday, Tuesday, Wednesday, Thursday, and Friday.* Cyanocobalamin was incorrectly administered to the resident on on eight occasions in September on Saturdays and Sundays. During an interview on 09/26/23 at 10:45 am, Staff 33 (Regional Director of Memory Care) confirmed the cyanocobalamin order was inputted incorrectly on the MAR, and it was administered to Resident 10 on Saturdays and Sundays. The need to follow physician orders as prescribed was discussed with Staff 2 (ED) and Staff 33 on 09/27/23. They acknowledged the findings.
Based on interview and record review, it was determined the facility failed to ensure medication and treatment orders were carried out as prescribed and written, signed or other legally recognized practitioner orders were documented in the resident's facility record for all medications and treatments the facility was responsible to administer for 3 of 4 sampled residents (#s 9, 10, and 11) whose orders were reviewed. This is a repeat citation. Findings include, but are not limited to:1. Resident 9 was admitted to the facility in 08/2023 with diagnoses including chronic diastolic congestive heart failure, paroxysmal atrial fibrillation, and type 2 diabetes mellitus. Resident 9's current physician orders and MAR from 09/01/23 through 09/25/23 were reviewed. Interviews with facility staff and the resident were conducted.There was no documented evidence the facility had written, signed physician or other legally recognized practitioner orders documented in the resident's facility record for the following medications and treatments the facility was responsible to administer:* Isosorbide Dinitrate 20 mg (atrial fibrillation);* Potassium ER 20 MEQ (supplement);* Nystatin 100,000/GM cream (skin care); and * Triple antibiotic ointment (wound care).The need to ensure written, signed or other legally recognized practitioner orders were documented in the resident's facility record for all medications and treatments the facility was responsible to administer was reviewed with Staff 2 (ED) and Staff 33 (Regional Director of Memory Care) on 09/27/23 at 11:30 am. They acknowledged the findings. No further information was provided.
2. Resident 11 was admitted to the facility in 03/2019 with diagnoses including chronic obstructive pulmonary disease and hypertension.A review of the resident's 09/01/23 through 09/25/23 MAR and signed physician orders revealed the following:* The resident had a physician order for twice daily blood pressure checks, with parameters stating "if systolic is above 160 or diastolic above 95 notify RN and PCP"; and* On the following occasions the resident's blood pressure was noted to be outside of the stated parameters:- 09/07/23 at 8:00 am - 161/83;- 09/12/23 at 8:00 am - 164/85;- 09/17/23 at 8:00 am - 161/83;- 09/18/23 at 8:00 am - 163/75;- 09/20/23 at 8:00 am - 177/98;- 09/20/23 at 8:00 pm - 170/68;- 09/22/23 at 8:00 am - 179/81;- 09/23/23 at 8:00 am - 168/62; and- 09/24/23 at 8:00 pm - 141/97.There was no documented evidence the resident's physician was notified the resident's blood pressure was outside the prescribed parameters on these occasions.The need to follow physician orders as prescribed was discussed with Staff 2 (ED) and Staff 33 (Regional Director of Memory Care) on 09/27/23. They acknowledged the findings.OAR 411-054-0055 (1) (f-h) Systems: Treatment Orders1. What actions will be taken to correct the rule violation for each example/residenta. Residents #9, #10, #11 physicians orders will be reviewed by the RN and compared to the MAR for accuracy. Any discrepancies will be addressed immediately. b. Med Techs and RCC's will be trained by the RN on physician orders with parameters and follow up for vital sign measurements outside of parameters, including documentation of actions taken. Notifications to physician and RN will be recorded. c. Medication Technicians and RCC's will be retrained on the system for processing orders using the 3 bin system with documented review by the MT, RCC and RN for all orders to ensure accuracy. 2. How will the system be corrected so this violation will not happen again?a. MAR audits will be conducted monthly by the RCC on a minimum of 10 random residents.b. Physician order sheets will be printed, reviewed by the RN and sent to the Physician for review/signature on a quarterly basis. Once signed by the Physician, they will be faxed to the pharmacy for any updates or changes.c. All med techs and RCC's will be retrained on utilization of the 3 bin system to ensure all orders are viewed in the EMAR for accuracy and signed off on by the Med Tech, the RCC and the RN before being filed. d. All orders will be faxed to and entered by the pharmacy. Orders are then reviewed prior to approval by the RCC/RN.3. How often will the area needing correction be evaluated?a. Quarterly Physican Order review by Physician and RN.b. Monthly the RCC will complete 10 MAR audits for compliance. 4. Who will be responsible to see that the corrections are completed/monitored?a. RN and RCC
Plan of Correction:
OAR 411-054-0055 (1) (f-h) Systems: Treatment Orders1. What actions will be taken to corret the rule violation for each example/resident?a. Residents 1, 2 and 5 physician orders will be reviewed by the RN/RCC and compared to MAR entries for accuracy.b. Physican Order Reviews will be printed, reviewed by the RN and sent to the physician for each resident to reconcile orders for accuracy.2. How will the system be corrected so this violation will not happen again?a. All orders will be processed through the 3 bin system to ensure each order is triple checked for accuracy by the MT, RCC and RN and to ensure each order is signed and entered into the MAR correctly by the pharmacy.b. All orders will be faxed to the pharmacy for entry into the MAR. c. Medication Technicians will be trained by the RN/DHs on proper order processing, medication administration, and documenting administration of medications in the MAR. All Med Techs will be required to pass a test. Record of this training will be maintained in the training file. d. Quarterly Physician Order Reviews will be reviewed by the RN and sent to the physician for signature. Upon return they will be faxed to the pharmacy with any updates or changes.e. No verbal orders will be accepted. All orders will be faxed directly to the community from the physicians office. 3. How often will the area needing correction be evaluated?a. Monthly the RCC will audit 10 MARs for compliance.b. Quarterly Physician Order reviews by the RN.4. Who will be responsible to see that the corrections are completed/monitored?a. RN and RCC OAR 411-054-0055 (1) (f-h) Systems: Treatment Orders1. What actions will be taken to correct the rule violation for each example/residenta. Residents #9, #10, #11 physicians orders will be reviewed by the RN and compared to the MAR for accuracy. Any discrepancies will be addressed immediately. b. Med Techs and RCC's will be trained by the RN on physician orders with parameters and follow up for vital sign measurements outside of parameters, including documentation of actions taken. Notifications to physician and RN will be recorded. c. Medication Technicians and RCC's will be retrained on the system for processing orders using the 3 bin system with documented review by the MT, RCC and RN for all orders to ensure accuracy. 2. How will the system be corrected so this violation will not happen again?a. MAR audits will be conducted monthly by the RCC on a minimum of 10 random residents.b. Physician order sheets will be printed, reviewed by the RN and sent to the Physician for review/signature on a quarterly basis. Once signed by the Physician, they will be faxed to the pharmacy for any updates or changes.c. All med techs and RCC's will be retrained on utilization of the 3 bin system to ensure all orders are viewed in the EMAR for accuracy and signed off on by the Med Tech, the RCC and the RN before being filed. d. All orders will be faxed to and entered by the pharmacy. Orders are then reviewed prior to approval by the RCC/RN.3. How often will the area needing correction be evaluated?a. Quarterly Physican Order review by Physician and RN.b. Monthly the RCC will complete 10 MAR audits for compliance. 4. Who will be responsible to see that the corrections are completed/monitored?a. RN and RCC

Citation #11: C0305 - Systems: Resident Right to Refuse

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Not Corrected
3 Visit: 2/27/2024 | Corrected: 12/11/2023
Inspection Findings:
Based on interview and record review, it was determined the facility failed to notify the physician when a resident refused consent to an order for 1 of 1 sampled resident (#2) who had documented medication refusals. Findings include, but are not limited to:Resident 2's MAR was reviewed from 09/01/22 through 09/28/22. Staff documented the resident refused multiple medications, including: diclofenac sodium 1% gel (for pain), Symbicort (for difficult breathing), and Metamucil (for bowel health) during the time period reviewed. There was no documented evidence the facility notified the physician when Resident 2 refused consent to orders.On 09/28/22 the need to notify the physician when a resident refused consent to an order was discussed with Staff 1 (Administrator) and Staff 2 (Interim ED). 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 consent to orders for 3 of 4 sampled residents (#s 9, 10, and 13), who had documented medication and treatment refusals. This is a repeat citation. Findings include, but are not limited to:1. Resident 10 was admitted to the facility in 07/2021.Resident 10 had a physician's order to fax the primary care physician of all refusals of acetaminophen, iron, multivitamin, vitamin B12, carisoprodol, arformoterol, and budesonide every week. The resident's 09/01/23 through 09/25/23 MAR was reviewed and revealed facility staff documented Resident 10 refused the following orders: * Acetaminophen (for pain) 15 times; * Slow release iron (for supplement) two times; and* Multivitamin tablet (for supplement) two times;There was no documented evidence the facility notified Resident 10's physician of the refusals.During an interview on 09/27/23 at 9:45 am, Staff 33 (Regional Director of Memory Care) confirmed the facility's process was to fax a refusal form to the prescriber. The faxed confirmation sheet of the medication refusals for September was unable to be located.On 09/27/23, the need to notify the physician/practitioner when a resident refused consent to orders was discussed with Staff 2 (ED) and Staff 33. They acknowledged the findings. No additional information was provided.2. Resident 13 was admitted to the facility in 01/2011.The resident's 09/01/23 through 09/25/23 MAR was reviewed and revealed facility staff documented Resident 13 refused the following order: * Polyethylene glycol (for constipation) four times.There was no documented evidence the facility notified Resident 13's physician of the refusals.During an interview on 09/27/23 at 9:47 am, Staff 33 (Regional Director of Memory Care) confirmed the facility's process was to fax a refusal form to the prescriber. The faxed confirmation sheet of the polyethylene glycol refusals for September was unable to be located.On 09/27/23, the need to notify the physician/practitioner when a resident refused consent to orders was discussed with Staff 2 (ED) and Staff 33. They acknowledged the findings. No additional information was provided.
3. Resident 9 was admitted to the facility in 08/2023.Resident 9's MAR from 09/01/23 through 09/25/23 and corresponding progress notes were reviewed. The resident's records showed the following medication and treatment refusals:* Nystatin 100,000/GM cream (for skin care) on 18 occasions; and* Metoprolol ER 25 mg (for hypertension) on 09/12/23.There was no documented evidence the facility notified the physician or other practitioner each time the resident refused to consent to the orders. The need to ensure the facility notified the physician or other practitioner of medication and treatment refusals was reviewed with Staff 2 (ED) and Staff 33 (Regional Director of Memory Care) on 09/27/23 at 11:30 am. They acknowledged the findings. No further information was provided.
Plan of Correction:
OAR 411-054-0055 (1) (j-k) Systems: Resident Right to Refuse1. What actions will be taken to correct the rule violation for each example/resident:a. Resident 2 MAR will be reviewed by the RN and notification to physician will be made of all medication refusals.2. How will the system be corrected so this violation will not happen again?a. Medication Technicians will be trained by the RN/DHS on managing refusals of medications/treatments and educating residents on their orders for medications/treatments. b. Every order refusal will be documented on the Medication Refusal Notification form and faxed to the physicians office the same day. c. Medication refusal notifications will be placed in the RN bin for review by the RN.d. RN will discuss refusals with resident to determine why the resident is refusing and find resolution.e. Residents refusing medications or treatments will be placed on alert charting for monitoring. Alert charting is reviewed each day during the SMART meeting.3. How often will the area needing correction be evaluated?a. Medication refusals are reviewed daily during the SMART meeting.b. Medication refusals will be reviewed by the ED and RN for follow through during weekly one on one meetings. 4. Who will be responsible to see that the corrections are completed/monitored?a. RN and ED during SMART meetings and weekly one on one meetings.OAR 411-054-0055 (1) (j-k) Systems: Resident Right to Refuse1. What action will be taken to correct the rule violation for each example/resident:a. Resident #9, #10, and #13 EMAR's will be reviewed by the RN to identify all refusals of orders and refusal notification will be sent to the Physician.b. All Med Techs and RCC's will be trained by the RN on notification of refusals to the Physician and documentation of the notification. 2. How will the system be corrected so this violation will not happen again?a. RCC will look at all medication and treatment refusals daily, print the report and give it to the RN for review. b. Refusals of medication will be reviewed during SMART meetings. SMART meeting minutes are maintained by the ED. c. RN will identify patterns of refusals of medication or treatments for each resident and will discuss alternatives or order changes with the Physician to accommodate resident choice.3. How often will the area needing correction be evaluated?a. Daily by RCC printed report of refusals from QMAR.b. Quarterly review of medications by RN and Physician. c. Daily during SMART meetings. SMART meeting minutes are maintained by the ED. d. Weekly by the RN and ED during weekly 1:1 meetings. 4. Who will be responsible to see that the corrections are completed/monitored?a. RN and ED during SMART meetings and weekly 1:1 meetings.

Citation #12: C0310 - Systems: Medication Administration

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Corrected: 11/27/2022
Inspection Findings:
Based on interview and record review, it was determined the facility failed to ensure MARs were accurate and included clear parameters for administration of prescribed medications for 2 of 4 sampled residents (#s 1 and 3) whose MARs were reviewed. Findings include, but are not limited to:1. Resident 1 was admitted to the facility in 08/2017 with diagnoses including environmental allergies.Resident 1's 09/01/22 through 09/26/22 MARs were reviewed during the survey and were found to be inaccurate in the following areas:* The MAR indicated the resident self-administered his/her nasal spray; and* Interview with the resident and staff, the resident was no longer using the nasal spray.On 09/28/22, the above findings were reviewed with Staff 2 (Interim ED), Staff 3 (Wellness Director/RN) and Staff 4 (Resident Care Coordinator). They acknowledged the findings.2. Resident 3 was admitted to the facility in 05/2022 with diagnoses including hypertension.Resident 3's 09/01/22 through 09/26/22 MARs were reviewed during the survey and were found to be lacking specific parameters to guide unlicensed staff in the following areas:a. Daily blood pressure results ranged from 122/62 to 192/94 and daily pulse rate results ranged from 63 to 149 per minute. Daily blood pressure and pulse rate lacked clear parameters regarding when to report.b. The MAR directed unlicensed staff to administer Trazodone 50 mg to 100 mg. The MAR lacked clear parameters including what dose of the PRN Trazodone to administer.c. The MAR directed unlicensed staff to administer Trazodone for depression. Staff documented on the MAR that Trazodone was administered as a sleep aid on 09/03/22. On 09/28/22, the above findings were reviewed with Staff 2 (Interim ED), Staff 3 (Wellness Director/RN) and Staff 4 (Resident Care Coordinator). They acknowledged the findings.
Plan of Correction:
OAR 411-054-0055 (2) Systems: Medication Administration1. What actions will be taken to correct the rule violation for each example/resident?a. Resident 1 and 3 MAR's will be reviewed for accuracy and complete medication administration instructions including parameter instruction and self administration. b. Resident 1 and 3 MAR's will be compared to written orders for accuracy and update where needed.2. How will the system be corrected so this violation will not happen again?a. Medication Technicians will be trained by RN/DHS on entering, reviewing and approving order entries.b. All new orders will be processed through the 3 bin system which requires 3 reviews of each order by the Med Tech, RCC and RN. These bins are checked daily.c. RN during their review will ensure all instructions are accurate, parameters are specific including instruction for outside of parameter actions are included. 3. How often will the area needing correction be evaluated?a. Monday through Friday the RN will process all new orders in her bin for accuracy and instruction. 4. Who will be responsible to see that the corrections are completed/monitored?a. RN during her final check of each order.

Citation #13: C0325 - Systems: Self-Administration of Meds

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Corrected: 11/27/2022
Inspection Findings:
Based on observation, interview and record review, it was determined the facility failed to evaluate a resident's ability to safely self-administer medications for 1 of 1 sampled resident (#3) who self-administered insulin injections and a topical cream. Findings include, but are not limited to:On 09/28/22 at 12:40 pm, a tube of cream and an insulin pen were observed in Resident 3's room. Resident 3 stated s/he managed the insulin injection daily and used the cream for psoriasis and itching on his/her arm as needed.Resident 3's 09/01/22 - 09/26/22 MAR indicated the resident self-administered the insulin injection and cream treatment.A review of Resident 3's clinical records revealed the following:* There was no documented evidence the facility evaluated Resident 3's ability to safely self-administered the topical treatment for psoriasis; and* There was no documented evidence the facility obtained a written physician order authorizing the resident to self-administer the insulin injection and the cream for psoriasis. On 09/28/22, Staff 3 (Wellness Director/RN) confirmed there was no evaluation related to the self-administration of the cream for psoriasis and no current signed physician order for the insulin injection and the topical treatment. The need to complete evaluations of a resident's ability to self administer medications initially and at least quarterly and obtained physician order authorizing the resident to self-administer the insulin injection and the cream for psoriasis was discussed with Staff 2 (Interim ED), Staff 3 and Staff 4 (Resident Care Coordinator) on 09/28/22. They acknowledged the findings.
Plan of Correction:
OAR 411-054-0055 (5) Systems: Self-Administration of Meds1. What action will be taken to correct the rule violation for each example/resident?a. Resident 3 chart will be reviewed by the RN and an order for self administration of insulin and creams will be obtained.b. RN will complete a self med administration evaluation on Resident 3 to assess ability to self administer.c. Residents chart will be updated with order and copy of self med evaluation once completed.d. All residents who self administer medications or treatments will have their chart reviewed by the RN/RCC to ensure a physicians signed order is in place and a self med admin evaluation completed by the RN is present. e. Self Administraton evaluations will be updated quarterly.2. How will the system be corrected so this violation will not happen again?a. RN will attend Role of the RN class.b. Self med administration evaluation will be conducted on each resident who self administers medications on a quarterly basis.3. How often will the area needing correction be evaluated?a. Upon move in, quarterly with care plan updates and upon change of condition. 4. Who will be responsible to see that the corrections are completed/monitored?a. RN during all care plan reviews.

Citation #14: C0330 - Systems: Psychotropic Medication

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Corrected: 11/27/2022
Inspection Findings:
Based on interview and record review, it was determined the facility failed to ensure non-pharmacological interventions were attempted and documented to be ineffective prior to the administration of psychotropic medications for 1 of 1 sampled resident (#1) who received psychotropic medications. Findings include, but are not limited to:Resident 1 was admitted to the facility in 08/2017 with diagnoses including type II diabetes.The resident's 09/01/22 through 09/26/22 MARs were reviewed and the following was noted:Resident 1 was prescribed Haloperidol 1 mg every six hours as needed for hallucinations and Ativan 1 mg every four hours as needed for anxiety.The MAR indicated Haloperidol was administered on 09/04/22, 09/06/22, 09/09/22, 09/19/22, 09/21/22 and 09/22/22, and Ativan was administered on 09/03/22, 09/05/22, 09/07/22, 09/08/22, 09/21/22, 09/22/22 and 09/23/22.The facility lacked documented evidence non-pharmacological interventions were attempted and ruled ineffective prior to administration of Haloperidol and Ativan.During an interview on 09/28/22, Staff 3 (Wellness Director/RN) confirmed the facility had not documented when non-pharmacological interventions were attempted and ineffective prior to administering those medications for Resident 1. The need to ensure non-pharmacological interventions were attempted and documented to be ineffective prior to the administration of psychotropic medications was discussed with Staff 2 (Interim ED), Staff 3 and Staff 4 (Resident Care Coordinator) on 09/28/22. They acknowledged the findings.
Plan of Correction:
OAR 411-054-0055 (6) Systems: Psychotropic Medications.1. What actions will be taken to correct the rule violation for each example/resident?a. Resident 1 chart, MAR and medication orders will be reviewed by the RN. Non pharmacologic interventions will be added to the QMAR to populate and be completed before PRN psychotropic medications are administered.b. All resident orders will be audited by the RN/Director of Health Services to ensure all PRN psychotropic orders have at least 3 accompanying non pharmacologic interventions in place per order. 2. How will the system be corrected so this violation will not happen again?a. Medication Technicians will be trained by the Director of Health Services and RN on non pharmacologic interventions to be attempted and failed prior to administering any PRN psychotropic medication. b. RN will ensure during her new order check that a minimum of 3 non pharmacologic interventions are entered into all PRN orders for psychotropic medications. c. Documentation of non pharmacologic interventions will be reviewed each day during SMART meeting.3. How often will the area needing correction be evaluated?a. Daily during SMART meeting Monday through Friday. 4. Who will be responsible to see that the corrections are completed/monitored?a. ED and RN during daily SMART meetings Monday through Friday.

Citation #15: C0370 - Staffing Requirements and Training – Pre-Serv

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Not Corrected
3 Visit: 2/27/2024 | Corrected: 12/11/2023
Inspection Findings:
Based on interview and record review, it was determined the facility failed to ensure pre-service orientation in all required topics was completed and documented for 4 of 4 newly hired staff (#s 17, 21, 31 and 32) and failed to ensure pre-service dementia training in all required topics was completed and documented for 1 of 4 newly hired direct care staff (# 21). Findings include, but are not limited to:Facility training records were reviewed on 09/27/22 with Staff 6 (Business Office Manager).Staff 17 Resident Assistant (RA) hired 07/19/22, Staff 21 (RA) hired 08/04/22, Staff 31 (Dietary Aide) hired 07/11/22 and Staff 32 (Housekeeper) hired 09/07/22, lacked documented evidence of completing the following required elements of the pre-service orientation:* Staff 17 lacked documentation of resident rights and values of CBC care;* Staff 21 lacked documentation of infectious disease prevention and all required pre-service dementia training; and * Staff 31 and Staff 32 lacked documentation of infectious disease prevention.The need for new staff to complete the required pre-service orientation training and pre-dementia training before working with residents was reviewed with Staff 2 (Interim ED), Staff 3 (Wellness Director/RN) and Staff 4 (Resident Care Coordinator) on 09/28/22. They acknowledged the findings. No additional information was received.

Based on interview and record review, it was determined the facility failed to ensure 4 of 4 newly hired staff (#s 11, 18, 35, and 39) completed all required elements of pre-service orientation and dementia training. This is a repeat citation. Findings include, but are not limited to:Staff training records were reviewed on 09/26/23.a. There was no documented evidence Staff 11 (RA), Staff 18 (RA), Staff 35 (MA), or Staff 39 (RA) completed one or more of the following pre-service orientation topics:* Resident rights and values of CBC care;* Abuse reporting requirements;* Infectious Disease Prevention; and* Fire safety and emergency procedures.b. There was no documented evidence Staff 11, Staff 18, Staff 35, or Staff 39 completed one or more of the following pre-service dementia training:* Dementia disease process including progression, memory loss, and psychiatric and behavioral symptoms; and* Specific aspects of dementia including addressing pain, providing food/fluids, preventing wandering, and use of a person-centered approach.The need to ensure all new hires complete the required pre-service orientation and dementia training within the required time frames was discussed with Staff 2 (ED) and Staff 33 (Regional Director of Memory Care) on 09/27/23. They acknowledged the findings.
Plan of Correction:
OAR 411-054-0070 (3-4) Staffing Rqmtsand Training: Caregiver Rqmts 1. What actions will be taken to correct the rule violation for eac example/resident are as follows: a.Staff 17 Resident Assistant (RA) hired07/19/22, Staff 21 (RA) hired 08/04/22,Staff 31 (Dietary Aide) hired 07/11/22and Staff 32 (Housekeeper) hired09/07/22, have all completed the required training with documented evidence of training completion on the following required elements of the pre-service orientation:* Staff 17 lacked documentation ofresident rights and values of CBC care;* Staff 21 lacked documentation ofinfectious disease prevention and allrequired pre-service dementia training;and* Staff 31 and Staff 32 lackeddocumentation of infectious diseaseprevention 2. How will the system be corrected so this violaton will not happen again are as follows: a. Business office manager will utilize training tracker for all staff during new hire process to track and audit compliance. b. BOM will coordinate with all department heads once training has been completed , with Dept heads verifying on tracker PRIOR to employee moving forward to next step of hire process. c. audit of all employee training records completed 3. How often will the area needing correction be evaluated are as follows: a. Daily when working for each new hire until process is complete 4. Who will responsible to see that the corrections are being completed/monitored are as follows: a. Daily when working by BOM or designee b. Daily check in's by Department Manager that is deisgnated to supervise new employee. OAR 411-054-0070 (3-4) Staffing Rqmtsand Training: Caregiver Rqmts1. What actions will be taken to correct the rule violation for each example are as follows: a. Staff 11 (RA), Staff 18 (RA), Staff 35(MA), and Staff 39 (RA) have all completed OCP pre-service orientation. b. Staff 11, Staff 18, Staff 35, and Staff 39 have allcompleted OCP pre-service dementia training.2. How will the system be corrected so this violation will not happen again are as follows: a. OCP will be utilized with all new hires for Pre-service Orientation b. OCP will be utilized for all Pre-service Dementia training c. Audit will be completed on all training records3. The area needing corrected will be evaluated as follows: a. Daily (if applicable) with each new hire during on-boarding training process through completion b. A monthly audit will be completed by BOM with Dept Managers to check complaince c. Daily check in with BOM from Dept managers on new hire process and training completion4. Who will be responsible to see that corrections are completed/monitored is as follows: a. Business Office Manager b. Department Manager or Designee c. Exeutive Director or Designee

Citation #16: C0372 - Training Within 30 Days: Direct Care Staff

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Corrected: 11/27/2022
Inspection Findings:
Based on interview and record review, it was determined the facility failed to ensure 4 of 4 sampled newly-hired direct care staff (#s 12, 17, 21 and 27) had documentation of demonstrated competency in all assigned job duties within 30 days of hire. Findings include, but are not limited to:Review of training records with Staff 6 (Business Office Manager) on 09/28/22, identified Staff 12 (Med Aide), Staff 17 Resident Assistant (RA), Staff 21 (RA) and Staff 27 (RA) lacked documented evidence competency was demonstrated in the following required areas: * Changes associated with normal aging;* Conditions that require assessment, treatment, observation and reporting;* General food safety, serving and sanitation; and * First Aid and abdominal thrust training.The need to ensure newly-hired direct care staff demonstrated competency in all assigned job duties within 30 days of hire was discussed with Staff 2 (Interim ED), Staff 3 (Wellness Director/RN) and Staff 4 (Resident Care Coordinator) on 09/28/22. They acknowledged the findings.
Plan of Correction:
OAR 411-054-0070 (6)(9) Training within30 days: Direct Care Staff 1. What actions will be taken to correct the rule violation for each example/resident are as follows: a. Staff 12 (Med Aide), Staff 17Resident Assistant (RA), Staff 21 (RA)and Staff 27 (RA) have completed with documented evidence of competency demonstration in the following required areas:* Changes associated with normal aging;* Conditions that require assessment,treatment, observation and reporting;* General food safety, serving andsanitation; and* First Aid and abdominal thrust training. 2. How will the system be corrected so this violation will not happen again are as follows: a. Business office manager will utilize training tracker for all staff during new hire process to track and audit compliance. b. BOM will coordinate with all department heads once training has been completed .Dept heads will verify on tracker. c. audit of all employee training records completed 3. How often will the area needing correction be evaluated are as follows: a. Weekly when working for each new hire until process is complete but before 30 days 4. Who will responsible to see that the corrections are being completed/monitored are as follows: a. Weekly when working by BOM or designee b. Weekly check in's by Department Manager that is deisgnated to supervise new employee.

Citation #17: C0420 - Fire and Life Safety: Safety

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Not Corrected
3 Visit: 2/27/2024 | Corrected: 12/11/2023
Inspection Findings:
Based on interview and record review, it was determined the facility failed to ensure fire drills were conducted in accordance with the Oregon Fire Code and fire and life safety instruction was provided to staff on alternate months. Findings include, but are not limited to:Fire and life safety records, reviewed between 03/2022 and 08/2022, revealed the following:1. The facility failed to relocate or evacuate residents during fire drills; therefore, documentation was lacking in the following areas: * The escape route used;* Problems encountered, comments relating to residents who resisted or failed to participate in the drills;* Evacuation time-period needed; and* The number of occupants evacuated.2. Fire and life safety instruction was not consistently provided to staff on alternate months. The requirements regarding fire drills and fire and life safety instruction for staff were reviewed with Staff 2 (Interim ED) on 09/27/22. He acknowledged the findings.

Based on interview and record review, it was determined the facility failed to conduct fire drills every other month at different times of the day, evening, and night shifts and to document all required elements. This is a repeat citation. Findings include, but are not limited to:Fire and life safety records were reviewed on 09/25/23 and 09/26/23.The facility provided documentation of two fire drills in the last six months. Neither fire drill report documented all required elements.The need to document the required elements for all fire drills and to conduct drills on all shifts was discussed with Staff 2 (ED) and Staff 33 (Regional Director of Memory Care) on 09/27/23. They acknowledged the findings.
Plan of Correction:
OAR 411-054-0090 (1-2) Fire and LifeSafety: Safety 1. What actions will be taken to correct the rule violation for each axample/resident are as follows: a. Training of Fire and Life Safety provided to ED, ED Designee, and Maintenance Director by RDO. b. Review of Fire Drill form to ensure understanding of the following areas was completed: * The escape route used;* Problems encountered, commentsrelating to residents who resisted orfailed to participate in the drills;* Evacuation time-period needed; and* The number of occupants evacuated. c. Fire drill with full evacutaion has been completed. 2. How will the system be corrected so this violation will not happen again are as follows: a. Tels system will be followed for scheduled drills with use of appropriate form b. Training calendar made to track assignement of staff training on alternate months. 3. How often will the area needing correction be evaluated are as follows: a. Monthly per maintenance program (Tels) for drills b. Every other month per staff training calendar 4. Who will responsible to see that the corrections are being completed/monitored are as follows: a. Monthly by Maintenance Director or designee b. Every other month by Maintenance Director, ED or ED Designee OAR 411-054-0090 (1-2) Fire and LifeSafety: Safety1. What actions will be taken to correct the rule violation for each example are as follows: a. Training on required elements and proper documentation has been provided to Executive Director and Director of Maintenance by Director of Operations2. How will the system be corrected so this violation will not happen again are as follows: a. ED will review Fire Drill documentation for accuracy to OAR. b. ED and or Maintenance Director will send/or upload to Tels the Fire Drill form for review from Director of Operation for accuracy c. Maintenance program Tels checked for accuracy and scheduling of drills3. How often will the area needing correction be evaluated is as follows: a. Every other month following drill schedule4. Who will be responsible to see that the corrections are completed/monitored is as follows: a. Maintenance Director b. Executive Director

Citation #18: C0422 - Fire and Life Safety: Training For Residents

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Corrected: 11/27/2022
Inspection Findings:
Based on interview and record review, it was determined the facility failed to provide fire and life safety instruction for residents at least annually in accordance with the Oregon Fire Code (OFC). Findings include, but are not limited to:In an interview on 09/27/22 with Staff 2 (Interim ED), it was determined the facility lacked documented evidence residents were being instructed on general fire and life safety procedures, evacuation methods, responsibilities and designated meeting places inside or outside the building in the event of an actual fire at least annually. The need to provide and document annual fire and life safety instruction for residents was reviewed with Staff 2. He acknowledged findings.
Plan of Correction:
OAR 411-054-0090 (5) Fire and LifeSafety: Training for Residents1. What actions will be taken to correct the rule violation for each axample/resident are as follows: a. Training of Fire and Life Safety provided to ED, ED Designee, and Maintenance Director by RDO. b. Review of Fire and Life Safety annual Resident Acknowledgement form and requirement to meet the following requirements: residents were being instructed on general fire and life safety procedures,evacuation methods, responsibilities anddesignated meeting places inside oroutside the building in the event of anactual fire at least annually c. Fire drill with full evacutaion has been completed. 2. How will the system be corrected so this violation will not happen again are as follows: a. Resident calendar made to track resident annual training based off move in date. 3. How often will the area needing correction be evaluated are as follows: a. Monthly per resident education calendar 4. Who will responsible to see that the corrections are being completed/monitored are as follows: a. Monthly by Maintenance Director or designee

Citation #19: C0455 - Inspections and Investigation: Insp Interval

Visit History:
2 Visit: 9/27/2023 | Not Corrected
3 Visit: 2/27/2024 | Corrected: 12/11/2023
Inspection Findings:
Based on observation, interview, and record review, it was determined the facility failed to ensure their re-licensure survey plan of correction was implemented and satisfied the Department. Findings include, but are not limited to:Refer to C 260, C 280, C 303, C 305, C 370, and C 420.
Plan of Correction:
OAR 411-054-0105 (2-4) Inspectionsand Investigation: Insp IntervalRefer to C 260, C 280, C 303, C 305, C370, and C 420

Citation #20: C0613 - General Building: Doors-Walls, Cleanable

Visit History:
1 Visit: 9/28/2022 | Not Corrected
2 Visit: 9/27/2023 | Corrected: 11/27/2022
Inspection Findings:
Based on observation and interview, it was determined the facility failed to ensure all interior materials and surfaces were kept clean and in good repair. Findings include, but are not limited to:Observation during the survey from 09/26/22 to 09/28/22, revealed the following areas in need of cleaning or repair:* Baseboards outside kitchen were scratched and missing paint; * Stained carpet in common areas and corridors throughout the first, second and third floor halls; * Carpet flooring was stained in both elevators; * Weight room on first floor had black streaks on the floor, paint missing on the walls, and a sink with dirt and debris;* The window screens in resident laundry rooms on the first and second floor had spider webs and dead bugs in them; * Resident laundry room doors on the first and third floor was gouged and scratched, missing paint:* Resident laundry room on third floor, near Room 308, had torn and cracked linoleum; * Baseboard in hallway out side Room 101 was missing paint:* Gouges and missing paint on the door to Room 206 and the carpet inside the apartment was stained;* A coffee table in the second floor billiard area was warped and there was a green chair with staining on the arm;* Floor in the vending machine room was dirty with spills and dirt;* Chairs in hallway between Rooms 352 and 354 were scuffed and missing varnish; and* The couch in the third floor library had stains on the arms.Ensuring the environment was kept clean and in good repair was discussed on 09/28/22 with Staff 1 (Executive Director) and Staff 5 (Maintenance Supervisor). They acknowledged the findings.
Plan of Correction:
OAR 411-054-0300 (4)(d-i) GeneralBuilding: Doors-Walls, Cleanable 1. What actions will be taken to correct the rule violation for each example/resident are as follows: Clening, repair, and or painting has been done on the below items:* Baseboards outside kitchen werescratched and missing paint;* Stained carpet in common areas andcorridors throughout the first, second andthird floor halls;* Carpet flooring was stained in bothelevators;* Weight room on first floor had blackstreaks on the floor, paint missing on thewalls, and a sink with dirt and debris;* The window screens in resident laundryrooms on the first and second floor hadspider webs and dead bugs in them;* Resident laundry room doors on thefirst and third floor was gouged andscratched, missing paint:* Resident laundry room on third floor,near Room 308, had torn and crackedlinoleum-replaced;* Baseboard in hallway out side Room101 was missing paint:* Gouges and missing paint on the doorto Room 206 and the carpet inside theapartment was stained;* A coffee table (removed) in the second floorbilliard area was warped and there was agreen chair with staining on the arm-clened;* Floor in the vending machine room wasdirty with spills and dirt;* Chairs in hallway between Rooms 352and 354 were scuffed and missingvarnish; and* The couch in the third floor library hadstains on the arms. 2. How will the system be corrected so this violation will not happen again are as follows: a. Daily wak through with audit tool developed b. Training provided to housekeeping and Maintence Director on the audit tool and OAR 3. How often will the area needing corrected be evaluated is as follows: a. Daily when working by Maintenance Director b. Daily by Housekeeping per cleaning schedule c. Weekly by ED or ED Designee 4. Who will be responsible to see that the corrections are completed/monitored are as follows: a. Maintenance Director b. Housekeeping c. ED or ED Designee