Print Inspection: FC5C

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 08/02/2022.  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, record review and observation it was determined the facility failed to keep interior materials and surfaces clean and all equipment in good repair.

Findings include:

During an onsite visit on 08/02/2022 Compliance Specialist (CS) spoke to Staff #1 (S1) who stated Resident #1's (R1) HVAC filter in their  apartment was being changed out as it is every quarter, when black mold was found to be in the HVAC compartment. S1 states bids have been received for a restoration company along with a HVAC company, however both are scheduling 2-3 weeks out as this is a busy time of year for them.

On 7/26/2022 R1 sent in photos for CS to review which shows the extent of damage in the apartment.

On 08/02/2022 CS observed R1's apartment to be taped off with plastic. R1 has been relocated to another, temporary apartment.

Facility Plan of Correction:

S1 states the restoration company and HVAC company will be out within the next few weeks. In the meantime, R1 has been put on alert charting and Primary Care Physician (PCP) has been notified. S1 has checked the surrounding apartments from R1 and determined no other apartments have been affected.