Based on observation, interview and record review, conducted during a site visit on 08/26/24 and 08/27/24, it was confirmed the facility failed to fully implement and update an acuity-based staffing tool for 3 of 4 sampled residents (#s 1, 2 and 3). Findings include, but are not limited to:

During an interview on 08/26/24, Staff 1 (Administrator) stated the ABST pulls information from their service plans to calculate the time needed for care and formulate their daily staffing plan. The facility was using a proprietary tool and stated the corporate office would be submitting their tool for approval by the department.

The following discrepancies were identified during the course of the site visit, which indicated the service plans and ABST were not being updated with changes of condition:

Resident 1 moved into the facility on 08/22/24.

A review of Resident 1's service plan created on 08/15/24 did not specify the number of people required to assist Resident 1 with transfers. No temporary service plans related to the change were available.

On 08/26/24, Resident 1 was observed to require the assistance of two people to transfer from bed to wheelchair.

During an interview on 08/27/24, Staff 1 stated the facility had evaluated Resident 1 at a Skilled Nursing Facility prior to moving into the facility and only required the assistance of one person for transfers.

A review of Resident 2's service plan indicated Resident 2 required the assistance of one person for transfers, walking with his/her walker and toileting or incontinence care. No temporary service plans related to the changes were available.

During an interview on 08/26/24, Staff 12 (CG) and Staff 13 (CG) stated Resident 2 required two person assistance to transfer, to stand or sit up, and for toileting and that Resident 2 had not been able to walk. Staff 13 stated Resident 2 had required two person assistance since Staff 13 started working in the facility in June 2024.

On 08/26/24 Resident 2 was observed to require the assistance of two people for toileting.

A review of Resident 3's service plan indicated Resident 3 was independent with transfers and walking using her FWW. No Temporary service plans related to this change were available.

On 08/26/24, Resident 3 was observed being assisted by two staff members with his/her FWW for ambulation.

Later on 08/26/24, Resident 3 was observed being assisted by Staff 8 (CG) and Staff 14 (RCC) into a wheelchair because Resident 3 was unable to stand or walk.

The findings were reviewed with and acknowledged by Staff 1 and Staff 2 (Operations Support Specialist) on 08/27/24.

The facility failed to fully implement and update an ABST.

Based on observation, interview and record review, conducted during a site visit on 08/26/24 and 08/27/24, it was confirmed the facility failed to ensure a resident monitoring and reporting system is implemented 24-hours a day for 1 of 1 sampled resident (#3). Findings include, but are not limited to:

On 08/26/24, Resident 3 was observed to have a large bruise on their left forearm.

During an interview on 08/26/24, Staff 11 (MT) stated the bruising on Resident 3's arm was present when Resident 3 returned from the hospital on 08/18/24. Staff 11 was present and assisted Emergency Medical Technicians (EMTs) in transferring Resident 3 when s/he returned from the hospital. Staff 11 stated normally they would document on bruising, but thinks they may have forgotten to do so that day.

A review of Resident 3's progress notes from 08/18/24 through 08/25/24 and available resident records revealed Resident 3 was assessed by Staff 3 (Corporate RN) on 08/19/24, but did not note any bruising. Bruising on resident 3's arm was not noted until 08/20/24.

During a phone interview on 08/27/24, Staff 3 stated she assessed Resident 3 on 08/19/24, but did not see any bruises.

The findings were reviewed with Staff 1 (Executive Director) and Staff 2 (Operations Support Specialist) on 08/27/24.

The facility failed to ensure a resident monitoring and reporting system was implemented 24 hours a day.

Verbal plan of correction: New residents should be on alert no less than 72 hours and all MTs should be documenting in progress notes, and CGs are reviewing Temporary Service Plans  that match what the MTs are doing for alert charting. Staff have access to TSPs and should sign. MTs will pull TSP and review at beginning of shift and have CGs review and sign. Any change outside of baseline CG s are to report to the MT. MTs come to clinical meeting every day and review changes. Administrator, Corporate RN and Corporate Operations Support Specialist will provide training to staff around the policies by end of week 08/30/24.

Based on interview and record review, conducted during a site visit on 08/26/24 and 08/27/24, it was confirmed the facility failed to ensure delegation and teaching was provided and documented by the facility's RN for 3 of 3 staff (#s 7, 11, and 15) and 4 of 4 sampled residents (#s 3, 9, 10, and 11). Findings include, but are not limited to:

In an interview on 08/27/24, Staff 3 (Corporate Nurse) stated the following:

* The facility's previous nurse left in April 2024.

* Staff 3 had not completed his/her own delegated resident assessments.

* His/her delegations were based on the previous nurse's delegated resident assessments.

A review of delegation records showed the last diabetic assessments for 11 out of 14 residents' delegation documents had dates of March 2024 to April 2024.

In an interview on 08/27/24, Staff 3 stated the date at the top of each delegation document was the day s/he observed the delegation tasks being performed and that the signature at the bottom of the page was a result of forgetting to "check a box."

A review of Staff 7's delegation document for Resident 3 showed the Corporate Nurse completed the delegation document on 06/22/24 without a signature until 07/23/24.

A review of Staff 7's delegation document for Resident 9 showed the Corporate Nurse completed the delegation document on 06/26/24 without a signature until 07/22/24.

A review of Staff 7's delegation document for Resident 10 showed the Corporate Nurse completed the delegation document on 07/08/24 without a signature until 07/23/24.

A review of Staff 7's delegation document for Resident 11 showed the Corporate Nurse completed the delegation document on 06/26/24 without a signature until 07/22/24.

A review of Staff 11's delegation document for Resident 3 showed the Corporate Nurse completed the delegation document on 07/08/24 without a signature until 07/23/24.

A review of Staff 11's delegation document for Resident 9 showed the Corporate Nurse completed the delegation document on 07/10/24 without a signature until 07/22/24.

A review of Staff 11's delegation document for Resident 10 showed the Corporate Nurse completed the delegation document on 07/10/24 without a signature until 07/23/24.

A review of Staff 11's delegation document for Resident 11 showed the Corporate Nurse completed the delegation document on 07/10/24 without a signature until 07/22/24.

A review of Staff 15's delegation document for Resident 3 showed the Corporate Nurse completed the delegation document on 05/05/24 without a signature until 07/23/24.

A review of Staff 15's delegation document for Resident 9's showed the Corporate Nurse completed the delegation document on 06/21/24 without a signature until 07/22/24.

A review of Staff 15's delegation document for Resident 10 showed the Corporate Nurse completed the delegation document on 06/21/24 without a signature until 07/23/24.

A review of Staff 15's delegation document for Resident's 11 showed the Corporate Nurse completed the delegation document on 05/24/24 without a signature until 08/26/24.

It was confirmed the facility failed to ensure delegation and teaching was provided and documented by the facility's RN

Findings were reviewed with and acknowledged by Staff 1 (Administrator) and Staff 2 (Operations Support Specialist) on 08/27/24.

Verbal Plan of Correction: RN will redelegate all day and evening med techs starting 08/27/24. RN will fill out delegation forms completely and sign within 24 hours of demonstration/delegation. That will be reviewed monthly, upon hiring of new med tech staff, and with new resident admissions.

Based on observation, interview and record review, conducted during a site visit on 08/26/24 and 08/27/24, it was confirmed the facility failed to fully implement and update an acuity-based staffing tool for 3 of 4 sampled residents (#s 1, 2 and 3). Findings include, but are not limited to:

During an interview on 08/26/24, Staff 1 (Administrator) stated the ABST pulls information from their service plans to calculate the time needed for care and formulate their daily staffing plan. The facility was using a proprietary tool and stated the corporate office would be submitting their tool for approval by the department.

The following discrepancies were identified during the course of the site visit, which indicated the service plans and ABST were not being updated with changes of condition:

Resident 1 moved into the facility on 08/22/24.

A review of Resident 1's service plan created on 08/15/24 did not specify the number of people required to assist Resident 1 with transfers. No temporary service plans related to the change were available.

On 08/26/24, Resident 1 was observed to require the assistance of two people to transfer from bed to wheelchair.

During an interview on 08/27/24, Staff 1 stated the facility had evaluated Resident 1 at a Skilled Nursing Facility prior to moving into the facility and only required the assistance of one person for transfers.

A review of Resident 2's service plan indicated Resident 2 required the assistance of one person for transfers, walking with his/her walker and toileting or incontinence care. No temporary service plans related to the changes were available.

During an interview on 08/26/24, Staff 12 (CG) and Staff 13 (CG) stated Resident 2 required two person assistance to transfer, to stand or sit up, and for toileting and that Resident 2 had not been able to walk. Staff 13 stated Resident 2 had required two person assistance since Staff 13 started working in the facility in June 2024.

On 08/26/24 Resident 2 was observed to require the assistance of two people for toileting.

A review of Resident 3's service plan indicated Resident 3 was independent with transfers and walking using her FWW. No Temporary service plans related to this change were available.

On 08/26/24, Resident 3 was observed being assisted by two staff members with his/her FWW for ambulation.

Later on 08/26/24, Resident 3 was observed being assisted by Staff 8 (CG) and Staff 14 (RCC) into a wheelchair because Resident 3 was unable to stand or walk.

The findings were reviewed with and acknowledged by Staff 1 and Staff 2 (Operations Support Specialist) on 08/27/24.

The facility failed to fully implement and update an ABST.