Facility Evaluation Report

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct an annual inspection. LPA Moleski met with licensee Beatrice Clark and explained the purpose of the visit.

Upon entry, LPA Moleski observed two caregivers working in the facility (S1-S2). LPA Moleski reviewed Guardian records and observed that neither S1 nor S2 were associated to this facility. Clark said S1 had been working at this facility for just under one month. S2 said they had been working at the facility for one month. LPA Moleski asked to review this facility's centrally stored medication records. Clark said she did not have any current centrally stored medication records.

LPA Moleski reviewed five resident files (R1-R5) and two staff files (S1-S2). Resident files were missing several required forms. R1 had a blank PRN authorization on file, and had no needs and services plan. R2's appraisal was dated 8/1/23, which is more than one year old. R2 also had a blank PRN authorization form on file. R3 had a needs and services plan on file, but it was not complete and was missing significant pertinent information regarding R3's needs. R4's admission agreement was unsigned, and they did not have an appraisal, personal rights form, consent form, PRN authorization form, or needs and services plan on file. R5 did not have a needs and services plan or PRN authorization form on file. R6 did not have a file present at the facility. Clark emailed LPA Moleski a medical discharge form to LPA Moleski for R6, but could not produce further documentation regarding R6, such as a medical assessment.

LPA Moleski asked for S1 and S2's file. Clark said that S2 did not have a file at this facility. S1's file was missing an LIC 501. [continued on 809-C]