The findings of the re-licensure survey conducted 01/23/23 through 01/25/23 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 Home and Community Based Services Regulations.

Abbreviations possibly used in this document:

ADL:activities of daily living

bid:twice a day

CBG:capillary blood glucose or

blood sugar

CG:caregiver

cm:centimeter

ED:Executive Director

F:Fahrenheit

HH:Home Health

LPN:Licensed Practical Nurse

MA:          Medication Aide

MAR:Medication Administration

Record

MCCMemory Care Community

mg:milligram

ml:milliliter

MT:Medication Technician

OT:Occupational Therapist

PT: Physical Therapist

PRN:as needed

qd:every day or daily

qid:four times a day

QI:     quality improvement

RCC:       Resident Care Coordinator

RN:     Registered Nurse

TAR:     Treatment Administration

Record

tid:           three times a day

The findings of the revisit to the relicensure survey of 01/23/23, conducted on 05/17/23 are documented in this report. It was determined the facility was in substantial compliance with the OARs 411 Division 54 for Residential Care and Assisted Living Facilities and OARs 411 Division 004 Home and Community Based Services Regulations.

Based on interview and record review, it was determined the facility failed to address all required elements on the move-in evaluation for 1 of 1 sampled resident (#5) whose evaluation was reviewed. Findings include, but are not limited to:

Resident 5 was admitted to the facility in 12/2022 with diagnoses including type II diabetes. The move-in evaluation, dated 12/13/22 was reviewed and the following required elements were not addressed:

* Personality including how the person copes with change or challenging situations;

* Pain status including how the person expresses pain, pharmaceutical and non-pharmaceutical interventions;

* Fall risk or history;

* Recent losses; and

* Environmental factors that impact the resident's behavior including, but not limited to noise, lighting, room temperature.

The need to address all required elements in the move-in evaluation was discussed with Staff 1 (Health Services Administrator) on 01/24/23 and 01/25/23. She acknowledged the findings.