The findings of the on-site investigation, conducted 12/18/23 are documented in this report. The investigation was conducted to determine compliance with the OARs 411 Division 54 for Residential Care and Assisted Living Facilities.

Abbreviations possibly used in this document:

ADL:activities of daily living

bid:twice a day

CBG:capillary blood glucose or

blood sugar

cc:cubic centimeter

CG:caregiver

cm:centimeter

F:Fahrenheit

HH:Home Health

HS or hs:hour of sleep

LPN:Licensed Practical Nurse

MA:Medication Aide

MAR:Medication Administration

Record

MCCMemory Care Community

mg:milligram

ml:milliliter

O2 sats:oxygen saturation in the

blood

OT:Occupational Therapist

PT: Physical Therapist

PRN:as needed

qd:every day or daily

qid:four times a day

RN:Registered Nurse

SP:service plan

TAR:Treatment Administration

Record

tid:three times a day

Based on interview and record review, conducted during a site visit on 01/23/24, it was confirmed the facility failed to fully implement an Acuity-Based Staffing Tool for 3 of 3 sampled residents (#s 1, 2, and 3). Findings include, but are not limited to:

During an interview on 01/23/24, Staff 1 (Administrator) stated the facility is currently working with the district team to ensure that all 22 Activities of Daily Living (ADLs) are listed, for each resident in the tool.

On 01/23/24, a record review (off site) of the facility's ABST report, dated 10/02/23, showed only 17 ADLs were listed for each resident. The occupancy and census for the facility was 67 on 01/23/24.

The findings of the investigation were reviewed with and acknowledged by Staff 1(ED) on 01/23/24, and Staff 4 (regional director of operations) on 02/06/24.

It was determined the facility failed to fully implement an Acuity-Based Staffing Tool.

Verbal Plan of Correction: The district team is working to include all 22 ADLs in the tool. Projected date of compliance unknown.