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 02/15/2023. 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
Based on interview, observation, and record review it was confirmed the facility failed to fully implement and update an Acuity Based Staffing Tool (ABST). Findings include:
During an onsite interview on 02/15/2023, Staff #1 (S1) stated the following,
"There are residents who no longer live there who need to be archived and residents who have moved in and have not yet been added to the tool.
"Resident #4-5 (R4 and R5) moved into the facility a week or two ago.
"For swing shift the ABST, posted staffing plan, and schedule states there are 2 Caregivers (CG) and 1 Med Tech (MT) working.
"R4 moved in on 2/3/2023 and R5 moved in on 2/9/2023.
During an unannounced site visit on 02/15/2023, The Compliance Specialist (CS) observed 2CG and 1 MT on duty.
A record review of the Posted Staffing Plan, Staff Schedule for February 2023, Resident #3 (R3) Service Plan, Progress Notes, the breakdown of their care on the facility's ABST, and the States internal ABST website. The States internal website shows resident #4-5 were not currently entered into the tool.
On 02/15/2023, these findings were reviewed and acknowledged by S1.