Blueberry Hill Senior Living

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Cassie Yang arrived to the facility unannounced to conduct a case management visit to complete the annual inspection conducted on 5/17/2023. LPA met with Licensee, Megan Hamric, and explained the purpose of the visit. During today's visit, LPA observed caregiver serving lunch to residents in care. LPA and Licensee continued and completed the full CARE tool kit during today's visit. Facility was found to be in compliance. No deficiency was cited as a result of today's inspection. Additionally, LPA requested a copy of Administrator Certificate, liability insurance, LIC 500 and LIC 308 to be emailed to LPA Yang by Wednesday June 7, 2023. Licensee provided a copy of Administrator Certificate and certificate of liability insurance. Licensee will email LIC 500 and LIC 308. Exit interview conducted with licensee and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, May 31, 2023

Type of visit: Required - 1 Year

On 5/17/2023 at 1:30 PM, Licensing Program Analyst (LPA) Cassie Yang and Associate Governmental Program Analyst (AGPA) Matt Sparling arrived unannounced at the facility to conduct a Required-1 year inspection. LPA and AGPA met with caregiver, Stephanie Martinson, who contacted Licensee/Administrator, Keith Hamric, who arrived to the facility at approximately 2:05 PM. LPA and AGPA explained the purpose of the visit. LPA and AGPA wore the following Personal Protective Equipment; surgical mask. Facility is licensed for capacity of six (6) with hospice waiver of 4. Facility's census is six (6) with two (2) on hospice services. LPA will provided Licensee an updated license. During today's visit, LPA and AGPA toured the interior of the facility with Licensee. In areas toured included but not limited to: common areas, resident bedrooms, bathroom, kitchen, garage and laundry/medication room. At 2:15 PM, LPA, AGPA and Licensee entered the locked garage and found cleaning solutions on the floor. Additionally at 2:25 PM, LPA observed the fire extinguisher to be last serviced 9/9/2021. LPA was informed it may have been a mistake as the extinguisher has been serviced recently. LPA and AGPA conducted a personnel and resident file review and deficiencies were observed. Please see attached LIC 809-D. LPA, AGPA and Licensee was unable to complete the CARE tool during today's inspection, annual continuation is to follow. Exit interview conducted and a copy of the report and appeal rights was provided to Licensee.the state’s words, verbatim · CDSS document, May 17, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Christina Pena, caregiver, who contacted Administrator by phone. LPA spoke to Administrator, Keith Hamric and Activities Director, Megan Hamric, who were not able to be at the facility right away. LPA explained that annual inspection today is focused on Covid-precautionary measures in place. Administrator authorized caregiver to provide information, as needed, to LPA and sign today's report. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: KN95 mask. LPA observed (4) residents in the common area watching television, and (2) residents to be resting in their rooms. There is currently (1) resident on hospice services. LPA and caregiver toured the interior and exterior of the facility, including (4) private resident bedrooms, (1) shared resident bedroom, (2) bathrooms, kitchen, common areas, laundry/medication room, and garage/storage area. LPA observed all areas toured to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. Inside temperature was observed to be 74* F. Fire extinguisher last serviced 9/10//2021. LPA observed locked toxins, medications and sharps and sufficient 2+day perishable/7+day non-perishable food. First aid kit on site.. Exit doors have alarms on them. LPA observed paper towels, soap, sanitizer, and hand-washing posters in the bathrooms. LPA observed sufficient PPE supply and incontinent products. There is (1) outside gate that is unlocked from the inside. LPA observed various Covid posters throughout as well as other required postings. LPA observed Provider Information Notices (PIN) issued by the Department and the Emergency Disaster Plan (LIC610E) to be available for staff review in the medication room. report continued on 809C... Discussed vaccination status of residents and staff with Administrator and observed facility to be maintaining records of visitor and staff vaccination status. Discussed scheduling a first or second booster shot with families of residents that have not received it yet. LPA requested an updated copy of LIC308, LIC 500, current liability insurance and Administrator RCFE certificate be provided to the Department by 5/20/22. There were no deficiencies observed during today's inspection. Exit interview with caregiver. Copy of report left at facility.the state’s words, verbatim · CDSS document, May 13, 2022

Allegation investigated: Licensee is not following doctors orders Staff force residents to wake up at unreasonable time in the morning Licensee does not did not treat residents with dignity and respect

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to a complaint the department received on 12/17/2021. LPA's met with Christina Pena, caregiver, who contacted the Administrator, Keith Hamric, and staff, Megan Hamric, by phone. Caregiver confirmed there are (6) residents present and there are currently no residents receiving hospice services. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: KN95 mask. During the course of the investigation, LPA interviewed Administrator, (4) staff, (6) residents and (2) family members and reviewed documentation including, but not limited to, various documents from resident's (R1) file, and multiple pages of staff shift notes provided for random days from 7/19/2021 to 10/24/2021. The results of the investigation are as follows: cont on 9099C(1).. Unfounded 9099C(1).. Allegation: Licensee is not following doctors orders. Allegation states that on/around September/October 2021, the Administrator refused to allow resident (R1) to have her prescribed Ativan medication for pain because the Administrator would have to dispense the medication to her. Allegation further states that resident was believed to be in pain due due to picking the open wounds on her chest and arms, and the wounds are not healing because resident picks at them. Physician's orders dated 7/31/2021 note that R1 was to be discharged from hospice services and to discontinue multiple medications, including Ativan. A subsequent order was issued on 8/27/2021 to discontinue all hospice medications given at bed-time and to start Trazadone 100 mg at bedtime for insomnia. E-mail dated 8/2/2021 from R1's health care provider to the Administrator states that R1 is "being discharged from hospice services as her prognosis has extended" and discusses how home health will be able to assess and manage the "non-healing lesions" while R1 resides at the facility. Home Health Nurse charting notes, dated 9/23/2021 to 12/6/2021, document that wound care was being provided, R1 tolerated it well and there were no signs of infection. Notes dated 11/17/2021, indicate that the wound was "improving-doing well" and skin assessment was performed with no breakdown shown. Notes entered on 11/22/2021 document that R1 stated ""ouch" during wound care but shows no signs of being in pain". Staff (S1) stated in an interview that Ativan is a medication for agitation and not for pain. Staff (S2) stated that her understanding is that Ativan is a comfort medication that hospice care provides even if it is not needed and that if R1 shows discomfort from the wound, staff would give PRN medications. R1 was not able to be interviewed due to a diagnosis of Alzheimer's Dementia and being non-verbal, as noted on the Resident Appraisal, dated 12/6/2020. Based on information obtained, LPA finds the allegation to be UNFOUNDED- A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. cont on 9099C(2)... 90909C(2)..Allegation: Staff force residents to wake up at unreasonable time in the morning. Allegation states that since around June 2021, staff have been required to wake the residents up between 5:00 am- 6:00 am so that residents are prepared for the next shift. Staff (S5) informed LPA's Calzada and Yang that some residents are up already by the time she starts on the morning shift at 7:30 and explained that upon starting her shift, she takes vitals and temperature and then prepares breakfast for residents. S5 indicated that if residents choose to stay in bed, she will let them and reheat breakfast when residents wake up. Staff (S2) stated to to LPA's that staff does not force residents to get up in the morning at a certain time but rather staff knows each resident's routine. S2 explained that there is not a set schedule for residents to wake up at a certain time, and residents can get up when they prefer and know breakfast is served at 8:30 am and coffee is available before breakfast too. Staff (S1) explained that staff start with resident (R1) first, around 5:00 am, as it takes about 30 minutes to get R1 ready, including repositioning, and then she continues with the next resident, R2, who is also an early riser. Shift notes consistently show that R1 is the first resident staff help get ready in the morning and by 7:30 am, (5) of (6) residents are generally ready for the day at 7:30 am. S2 stated that resident (R3) is not a morning person and likes to wake up right before breakfast. Shift notes reflect that R3 is generally the last resident to wake up in the morning. R3 stated to LPA's that she wakes up around 8-8:30 am. Interview with (1) resident revealed that staff will enter her room around 6:00-7:00 am to wake her up, and if she wants to sleep in longer, she will notify staff and they will listen and leave her alone. Another resident stated she does not want to miss breakfast time because she loves coffee. Another resident stated she wakes up at 6:30 am and would like to sleep a little longer. A third resident stated she wakes up around 6:30 am and would prefer to sleep a little longer; however, stated that staff would let her continue sleeping until 7:00-7:30 am if she would like, and staff will get clothes ready for her. Staff (S3) informed LPA's that they do have a schedule, "but it is not a military schedule." and explained residents are allowed to decline and stay in bed if desired. Administrator explained that residents wake up around 7:00 am to get ready for breakfast, explaining the residents love coffee and want to wake up to socialize and drink coffee. cont on 9099C(3).. 9099C(3).Family member interviewed stated..residents do wake up early around 6:30- 7:00 am, but explained that staff needs to do vitals and give medications to residents in the morning. Based on information obtained, LPA finds the allegation to be UNFOUNDED- A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit Interview conducted. Allegation: Licensee does not did not treat residents with dignity and respect. LPA's interviewed (5) residents. One resident stated that facility staff listens to her concerns. A second resident stated that staff are responsive to residents' needs and she can communicate well with them. A third resident indicating staff treats her independently and are kind and respectful, stating "there's good staff here". LPA's interviewed (2) resident family members. One family member indicated that staff are very accommodating and provide lots of privacy for her sister, who does not have any issues with the facility. A second family member stated the facility treats the residents well, includes daily activities and denied having any issues with staff and/or the facility. Based on information obtained, LPA finds the allegation to be UNFOUNDED- A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit Interview conducted. There are no deficiencies cited on this report. Exit interview conducted with Administrator, Keith Hamric and staff, Megan Hamric, by phone. Administrator authorized caregiver on site, to sign today's reports.the state’s words, verbatim · CDSS document, Mar 4, 2022 · control 25-AS-20211217151503

Allegation investigated: Facility not allowing resident to have visitors Facility staff verbally abusive towards resident Facility is not following resident's care plan

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver complaint findings to a complaint the department received on 6/23/2021. LPA discussed complaint findings with Administrator, Keith Hamric, by phone, who was not able to be at the facility at the time of the inspection. Caregiver confirmed there are (6) residents present and there are currently no residents receiving hospice services. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. During the course of the investigation, LPA interviewed Administrator, (1) staff, (3) residents, Ombudsman, resident's (R1) representative and family member. LPA reviewed documentation pertaining to resident, including, but not limited to, physician's report, appraisal, care plan and a letter from another resident's representative. The results of the investigation are as follows: Allegation: Facility not allowing resident to have visitors: Interview with (2) residents revealed they have had family visitors on a regular basis and there have been no situations where visitation has been denied, with one resident stating her family will inform the facility in advance prior to visiting. Resident (R1) stated the facility does allow her to have visitation with her family cont on 9099-C.(1) ... Unfounded 9099-C (1) since she and her family have been vaccinated and that another family member was also allowed to visit with her inside the facility. Resident’s (R1) representative stated that resident is not able to leave the facility unattended due to having a diagnosis of early stages of Dementia and been hospitalized in the past due to certain behaviors. Resident’s representative confirmed there are not any restraining orders in place currently. Resident’s (R1) physician’s report, dated 10/15/2020, states that she has a diagnosis of Cerebrovascular Disease and Mild Cognitive Impairment and is confused at times. Skilled Nursing facility notes, dated 10/29/2020, states resident (R1) has Dementia and will be going to assisted living. Care plans, dated 3/24/2021, indicate that resident has a diagnosis of Dementia and is at risk for wandering. Staff (S1) interviewed stated she is not aware of any issues with visitation. Administrator stated that he “appreciates advance notice” and schedules visiting in advance, staying within the facility’s visiting hours, due to Covid -19 precautionary measures. Administrator stated that he had spoken by phone with resident’s (R1) family member regarding visitation on/around 6/14/2021, and requested she provide him with advance notice in scheduling visitation to minimize the cross traffic at any given time at the facility, per Covid-19 precautionary measures. Administrator stated he did not tell resident's (R1) family member by phone she couldn't visit and did not refer her to resident's POA for approval prior to visiting. Additionally, Administrator stated there was never a discussion with resident's family member about taking resident (R1) off site for visitation. Administrator stated that when resident’s family member arrived at the facility on 6/19/2021, resident (R1) ran to the front door, without her walker and darted outside and almost fell. Administrator stated that resident’s family member was allowed to visit inside the facility with resident (R1) on 6/19/2021, as resident has dementia, is a fall-risk and often needs reminders to use her walker to ensure her safety. Resident’s (R1) family member stated resident heard her voice when she came to the door and the Administrator allowed them to have a visit inside. Resident’s family member stated that the Administrator told her he was “okay” with her visiting when they spoke on the phone, and she has been fully vaccinated so could not have been denied inside visitation. Letter provided from a resident’s representative states that the Administrator is “diligent about following all of the required licensing rules and Covid-related rules” and keeps families aware of visiting protocols to ensure the safety of the residents first. cont on 9099-C(2)... 9099-C(2)....PIN 21-17.2 issued 5/14/2021 states, in part, that “Licensees should allow indoor visitation, including in-room visitation, at all times and for all residents…” when Covid-19 precautionary measures are followed, and that “At all times when visitation is restricted under this waiver, licensees must allow for scheduled outdoor visits…” when Covid-19 precautionary measures are followed. Administrator stated he had reiterated to resident’s family member twice to call ahead of time for visitation on/around 6/14/2021 when they spoke by phone. LPA observed visiting hours to be posted by the visitor sign-in log at the facility entrance. Based on information obtained, LPA finds the allegation to be UNFOUNDED- A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Allegation: Facility staff verbally abusive towards resident. Interview with (2) residents indicated that all staff is very caring, listens well to resident’s concerns, is always kind and professional and does not yell, but sometimes may have to raise their voice slightly, or speak sternly, to get a resident’s attention. Resident (R1) stated that she enjoys living at the facility and staff does not yell at anyone. Resident’s (R1) representative stated that he has not observed any staff to be verbally abusive to resident (R1) when he visited. Staff (S1) interviewed stated she has never yelled at a resident or observed other staff to do so. Administrator stated he has never been verbally abusive or asked any inappropriate questions to any residents or staff. Letter from another resident’s family member states that the Administrator does not raise his voice at residents, even if a resident can be challenging and doesn’t want to initially follow safety protocols. The letter continues to state that Administrator will calmly, but firmly, speak to residents about following safety guidelines. Ombudsman stated he spoke with resident’s (R1) representative who indicated that resident(R1) has never told him that facility staff have been rude or disrespectful or said anything inappropriate to resident (R1) at any time. Additionally, Ombudsman indicated that resident (R1) told him that she enjoys living at the facility and all staff have been respectful to her. cont on 9099-C (3)... 9099-C(3)...Based on information obtained, LPA finds the allegation to be UNFOUNDED- A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Allegation: Facility is not following resident's care plan One resident interviewed stated that she receives help with medications and shower reminders. Another resident interviewed stated that staff is “very helpful and meet my needs” and staff does not yell but possibly talks loudly and she is receiving the assistance she needs with showering, toileting and medications. Resident (R1) stated she receives assistance with her hair, making her bed, showers and medications. Care plan notes that resident (R1) does not need help with food or nourishment but receives assistance with bathing and needs a walker to get around safely due to her fall history and wandering tendencies. Resident’s (R1) updated care plan, dated 3/24/2021, from resident’s home health care, indicates that resident has Dementia or cognitive impairment and is at risk for wandering and uses a walker. Staff (S1) interviewed stated she reviews each resident’s care plan to know if a resident has mild dementia or mild cognitive impairment and for medication information. Staff confirmed that the facility has an awake night staff. When asked if the facility is following resident’s (R1) care plan, Administrator stated that resident is a fall risk, requires a chaperone to the bathroom, assistance with showering, is independent with dressing and is "stand by" with brushing her teeth. Letter provided from another resident’s representative states that the facility has provided “excellent care” to all residents and has closely monitored and cared for her family member whose health quickly improved after moving to the facility. Based on information obtained, LPA finds the allegation to be UNFOUNDED- A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit Interview conducted. There are no deficiencies cited from this report and allegations are being dismissed. Exit interviewed conducted with caregiver, Victoria, who is authorized by Administrator to sign today's reports. Copy of report left at facility.the state’s words, verbatim · CDSS document, Oct 6, 2021 · control 25-AS-20210623104810