Inspection Details: C4CN


Date
11/15/2022
Event ID
C4CN
Inspection type(s)
Complaint Investig.
Deficiencies cited
11

Citation Details

C0010
Severity Level: 2
Visits: 1
Scope
Isolated/Minimal harm or potential for moderate harm
Visit Number
1
Visit Date
11/15/2022
Corrected Date
N/A
Details

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 11/15/2022.  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 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












































































C0130
Severity Level: 2
Visits: 1
Scope
Isolated/Minimal harm or potential for moderate harm
Visit Number
1
Visit Date
11/15/2022
Corrected Date
N/A
Details


C0243
Severity Level: 2
Visits: 1
Scope
Isolated/Minimal harm or potential for moderate harm
Visit Number
1
Visit Date
11/15/2022
Corrected Date
N/A
Details

Based on observation, record review and interview, it was confirmed that the facility the failed to keep clean all interior and exterior materials and surfaces necessary for the health, safety, and comfort of the resident. Findings include but not limited to:


During an unannounced site visit on 11/15/2022, Compliance Specialist (CS) observed Resident #1 (R1)'s room which was cluttered with clothes, books and at least two old meal containers, as well as electronic cords that present a tripping hazard for resident. R1's bed was piled with things and unusable. The recliner and carpet both had dark soilage spots and carpet was fraying in places.


A review of R1's service plan revealed that care staff are to pick up R1's trash daily and to declutter the apartment as R1 allows.


During interview, R1 stated that they want to declutter the apartment and that staff help is needed for this.

During interview, Staff #2 stated that they had just cleaned R1's apartment the day before.

During interview Staff #1 stated that the elevator plaster has been damaged multiple times in the past few weeks.


These findings were reviewed with and acknowledged by Staff #1 and Staff #10 on 11/15/2022.


Plan of Correction:  Facility to implement Point of Care documentation in Point Click Care. Staff to be educated on this procedure within two weeks. Administrator will audit missed charting.

C0252
Severity Level: 2
Visits: 1
Scope
Isolated/Minimal harm or potential for moderate harm
Visit Number
1
Visit Date
11/15/2022
Corrected Date
N/A
Details

Based on record review and interview it was confirmed that the facility failed to perform resident evaluation before the resident moves into the facility. Findings include but not limited to:


During an unannounced site visit on 11/15/2022 Compliance Specialist reviewed Resident #2 (R2)'s progress for January 2022, Service Plan initiated on 1/06/2022 and a CBC Level of Care Evaluation dated on 1/06/2022 which revealed R2 moved into facility on 01/03/2022. The facility was unable to provide any evidence that resident was evaluated or a care plan was initiated prior to move-in.


During interview, Staff #1 stated that they would hope pre-move-in evaluation was completed but they could not find any documentation.


These findings were reviewed with Staff #1 and Staff #10 on 11/15/2022.


Plan of Correction: New nursing staff to be trained on this during training and company facility admission checklist to be utilized for all new move-ins.

C0260
Severity Level: 2
Visits: 1
Scope
Isolated/Minimal harm or potential for moderate harm
Visit Number
1
Visit Date
11/15/2022
Corrected Date
N/A
Details

Based on record review and interview it was confirmed that the facility failed to complete resident's service plan before the resident moves into the facility. Findings include but not limited to:


During an unannounced site visit on 11/15/2022 Compliance Specialist reviewed Resident #2 (R2)'s progress for January 2022, Service Plan initiated on 01/06/2022 and a CBC Level of Care Evaluation dated on 01/06/2022 which revealed the R2 moved into facility on 01/03/2022. The facility was unable to provide any evidence that resident was evaluated or a care plan was initiated prior to move-in.


During interview, Staff #1 stated that they would hope pre-move-in evaluation was completed but they could not find any documentation.


These findings were reviewed with Staff #1 and Staff #10 on 11/15/2022.


Plan of Correction: New nursing staff to be trained on this during training and company facility admission checklist to be utilized for all new move-ins.

C0295
Severity Level: 2
Visits: 1
Scope
Isolated/Minimal harm or potential for moderate harm
Visit Number
1
Visit Date
11/15/2022
Corrected Date
N/A
Details

Based on interview and observation, it was determined the facility failed to comply with masking requirements. Findings include but not limited to:


During onsite visit on 11/15/2022 Compliance Specialist (CS) observed Staff #6 (S6) and Staff #8 (S8) wearing their surgical masks underneath their noses.


These findings were reviewed with and acknowlegded by with Staff #1(S1) and Staff #10 on 11/15/2022.


Plan of Correction: Facility to provide education to staff and post signage my time clock on masking requirements within one week.

C0301
Severity Level: 2
Visits: 1
Scope
Isolated/Minimal harm or potential for moderate harm
Visit Number
1
Visit Date
11/15/2022
Corrected Date
N/A
Details


C0303
Severity Level: 2
Visits: 1
Scope
Isolated/Minimal harm or potential for moderate harm
Visit Number
1
Visit Date
11/15/2022
Corrected Date
N/A
Details

Based on record review and interview it was confirmed that the facility failed to carry out medication orders as prescribed. Findings include but not limited to:


During an unannounced site visit on 11/15/2022, Compliance Specialist reviewed Resident #1 (R1)'s Medication Administration Record (MAR) and progress notes for July 2022 which revealed that 7/12/2022-7/14/2022 R1 missed and/or received the wrong dose of a medication.


During interview, Staff #1 stated that this incident was a self-report incident to Adult Protective Services (APS) for the error.


These findings were reviewed with and acknowledged by Staff #1 and Staff #10 on 11/15/2022.


Plan of Correction: All Med Techs have been re-trained on common med errors. This training to occur annually. Root cause analysis to be conducted after any med error.

C0360
Severity Level: 2
Visits: 1
Scope
Widespread/Minimal harm or potential for moderate harm
Visit Number
1
Visit Date
11/15/2022
Corrected Date
N/A
Details


C0361
Severity Level: 2
Visits: 1
Scope
Widespread/Minimal harm or potential for moderate harm
Visit Number
1
Visit Date
11/15/2022
Corrected Date
N/A
Details


C0613
Severity Level: 2
Visits: 1
Scope
Isolated/Minimal harm or potential for moderate harm
Visit Number
1
Visit Date
11/15/2022
Corrected Date
N/A
Details

Based on observation, record review and interview, it was confirmed that the facility the failed to keep clean all interior and exterior materials and surfaces necessary for the health, safety, and comfort of the resident. Findings include but not limited to:


During an unannounced site visit on 11/15/2022, Compliance Specialist (CS) observed a hole in the plaster of the elevator, roughly the size of a hand, which left an uncleanable surface. Additionally, CS observed Resident #1 (R1)'s room which was cluttered with clothes, books and at least two old meal containers, as well as electronic cords that present a tripping hazard for resident. R1's bed was piled with things and unusable. The recliner and carpet both had dark soilage spots and carpet was fraying in places.


A review of R1's service plan revealed that care staff are to pick up R1's trash daily and to declutter the apartment as R1 allows.


During interview, R1 stated that they want to declutter the apartment and that staff help is needed for this.

During interview, Staff #2 stated that they had just cleaned R1's apartment the day before.

During interview Staff #1 stated that the elevator plaster has been damaged multiple times in the past few weeks.


These findings were reviewed with and acknowledged by Staff #1 and Staff #10 on 11/15/2022.


Plan of Correction:  Facility to implement Point of Care documentation in Point Click Care. Staff to be educated on this procedure within two weeks. Administrator will audit missed charting. Wheelchair guard to be added to elevator.