Based on interview and record review conducted during a site visit on 07/17/24 it was determined the facility failed to implement a service plan that reflects the resident's needs as identified in the evaluation for 1 of 1 sampled resident (# 1). Findings include, but are not limited to:

A review of Resident 1's service plan, dated 06/17/24, indicated Resident 1 was admitted to hospice care on 03/05/24.

Resident 1's Alert Charting, dated 06/23/24, indicated Resident 1 was sick, had a fever, was refusing medication. Resident 1 was transported to the hospital and would stay in the hospital overnight. There was no documented evidence Resident 1's hopsice provider had been notified prior to Resident 1 being sent to the hospital.

In an interview with Staff 1 (Administrator) s/he stated s/he had been on the job for three days at the time of the incident and had not been aware Resident 1 was on hospice. Staff 1 stated the facility had made an error.

The findings were reviewed with and acknowledged by Staff 1 on 07/17/24.

Verbal plan of correction: Facility to hold a staff meeting to ensure familiarization with resident care plans.

Based on observation, interview, and record review, conducted during a site visit on 07/17/24, it was determined the facility failed to fully implement and update an acuity-based staffing tool (ABST) for 3 of 3 sampled residents (#s 1, 2, and 3). Findings include, but are not limited to:

Staff 1 (Administrator) stated the facility had been using the Oregon Department of Human Services ABST tool, but after a management take over they were moving to "Yardy" ABST and s/he was responsible for updating it. Staff 1 confirmed the posted staffing plan had not been updated to reflect the ABST and s/he had not entered all of the resident service plans as required.

Service planned needs for were not entered for Residents 1, 2, and 3.

The ABST had not been updated as required for all 42 residents in the facility.

The facility's posted staffing plan indicated:

* Day shift: two full time caregivers and one med tech scheduled from 6:00 am to 2:00 pm, for each side.

* Swing shift: two full time caregivers and one med tech scheduled from 2:00 pm to 10:00 pm, for each side.

* Night shift: one caregiver and a float (shared for each side) and one med tech from 10:00 pm to 6:00 am for each side.

The facility's staffing plan was not reflective of the ABST. Staff schedules for June 2024 indicated staffing levels were at the posted staffing plan but not reflective of recommended ABST hours as they were not entered.

On 07/17/24, the facility was staffed per the schedule and staffing plan for the day shift of two caregivers and one med tech per side.

The above information was shared on 07/17/24 and acknowledged by Staff 1.

It was determined the facility had not fully implemented an ABST.

PLAN OF CORRECTION:

Enter resident care plans into ABST Tool.