Print Inspection: 1WFJ

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 10/18/2022.  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

Based on interview and record review it was confirmed that the facility failed to have an Acuity Based Staffing Tool that accurately reflected the resident population and their needs. Findings include the following:

During an unannounced site visit on 10/18/2022 Compliance Specialist (CS) reviewed the facilities Acuity Based Staffing Tool (ABST) against the facilities current resident roster and found 1 resident is not listed on the facility ABST but is listed on the facility roster. CS reviewed the most current service plan for Resident #1 (R1) against the facility ABST for R1 and inconsistencies were identified between R1s' service plan and their ABST questions. Service plan indicated that R1 has the need for assistance with bathing but the ABST indicates that no time is used for this activity.

In an interview with Staff #1 (S1) on 10/18/2022 who acknowledged that the facility ABST is not up to date.

Based on observation and interviews it was confirmed resident units do not have lockable doors with lever type handles. Findings include:

During tour of facility on 10/18/2022 Compliance Specialist observed that some resident rooms had deadbolt locks on their doors while other resident rooms did not have any locks on their doors.

Interview with Staff # 1 on 10/18/2022 who acknowledged the findings.

Faciltiy correction plan: Facility will have maintenance remove the deadbolt locks from some of the resident rooms and will add lever type handles with locks to resident rooms.