Apple Country Care Home

Type of visit: Required - 1 Year

On 08/29/2023 10:00 AM Licensing Program Analyst (LPA) Sarah Benson and Licensing Program Analyst Lavinina Muscan arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Mary Hensley (cert #6020936740 exp.10-22-24) and explained the purpose of the visit. LPA's and administrator toured the facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to six (6) resident rooms, common areas, three (3) bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Staff and resident files were reviewed. Medications were also reviewed. Common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Cooking/dining equipment and utensils were present Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. Medication is locked in a locked closet. Administrator certificate is current. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors are all operational. All employees requiring background checks are cleared. All required postings are displayed within facility. No pools/bodies of water are on premises. No firearms are on premises. Last disaster drill was conducted August 15 2023, the facility has been conducting drills every 3 months. The facility is in compliance. No deficiencies are being cited as a result of today’s inspection. Exit interview conducted and copy of report was provided to administrator.the state’s words, verbatim · CDSS document, Aug 29, 2023

Allegation investigated: Resident sustained unexplained injuries.

On 5/17/23, Licensing Program Analysts (LPAs) Lavinia Muscan and Talwinder Bains arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with House Manager Laura Foss. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: **Report continued on 9099-C** Unsubstantiated Resident sustained unexplained injuries. During this investigation, staff and residents were interviewed and facility and medical records were reviewed. S2 acknowledged the incident in question and stated that S1 reported an incident on 01/12/2023 which resulting in R1 falling and sustaining a fracture. Specifically, S1 said R1 fell while in the bathroom during a diaper change. Present for the incident was S1. Based on interview with S1, R1 did not present any significant indication of immediate distress after their fall. S1 clarified that the incident was a fall that S1 witnessed versus an unwitnessed fall from R1’s bed. S1 was changing R1’s adult diaper when R1 abruptly tried to "bolt" away. In the process. S1 held onto R1’s adult diaper and pants to prevent R1 from falling or injuring themself. As a result, R1 fell backwards and onto S1. S1 was questioned as to why S1 did not call 911. S1 indicated that R1 did not appear in any distress, nor complained of pain. After the incident, S1 immediately reported the fall to facility management. Interviews indicated that S1 actively checked on R1 throughout the night to assess for a change in condition. S1 indicated that after R1 reported being in pain on 1/13/2023, R1 was promptly taken to the hospital. Based on the information and evidence, it was determined there is insufficient evidence to substantiate the allegation, therefore the allegation is unsubstantiated. This agency has investigated the above listed allegation(s). Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred therefore, we have found the allegation(s) to be UNSUBSTANTIATED. Exit interview was conducted with House Manager and a copy of this report was provided to the facility. The signature of the House Manager on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, May 17, 2023 · control 25-AS-20230118171400

Allegation investigated: Staff force fed resident. Staff yelled at resident. Resident was left soiled for a long period of time. Resident not allowed access to a telephone. Facility did not notice a change in resident's condition. Resident restrained to a wheelchair.

On 5/17/23, Licensing Program Analysts (LPAs) Lavinia Muscan and Talwinder Bains arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with House Manager Laura Foss. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: **Report continued on 9099-C** Unfounded Staff force fed resident. Department conducted interviews with staff and residents, records were reviewed, and facility observation was done to investigate this complaint allegation. Interviews indicated that facility staff were not forcing residents during their meals and providing assistance only to those residents who are unable to feed themselves. Staff interviews indicated that if residents refuse to eat, facility was offering meal replacement drinks or snacks to the residents. Based on this information, this allegation was found to be unfounded. Staff yelled at resident. Department conducted interviews with staff and residents, records were reviewed, and facility observation was done to investigate this complaint allegation. From the interviews, it has been concluded that facility staff were not yelling at residents. Residents’ interviews conducted on 3/20/23 and 5/17/23 indicated that staff were talking loud to those residents who were hard of hearing but not yelling at residents. Based on this information, this allegation was found to be unfounded. Resident was left soiled for a long period of time. Department conducted interviews with staff and residents, records were reviewed, and facility observation was done to investigate this complaint allegation. Staff and residents interviewed on 3/20/23 and 5/17/23 indicated that staff were providing incontinence care to residents every 2 hours or as needed per their needs and service plan. Residents interviewed indicated that staff were not leaving them soiled for long times and staff provide assistance for their incontinence care needs as needed. Based on this information, this allegation was found to be unfounded. Resident not allowed access to a telephone. Department conducted interviews with staff and residents and facility observations were done to investigate this complaint allegation. Based on interviews conducted it has been concluded that residents have access to the working phone, and they can speak to their family whenever they want to. During department visits on 3/20/23 and 5/17/23 it has been observed that facility has working phone in the common area accessible to all residents for use. Based on this information, this allegation was found to be unfounded. Continued on 9099-C ... Facility did not notice a change in resident's condition. Department conducted interviews with staff and residents, records were reviewed, and facility observation were done to investigate this complaint allegation. Based on interviews and records reviewed it has been concluded that facility staff document changes of condition for residents and notify their physician, family member and two other reporting agencies in a timely manner. Facility staff have access to all resident files and staff can call 9-1-1 for any emergency for residents as needed. Based on this information, this allegation was found to be unfounded. Resident restrained to a wheelchair. Department conducted interviews with staff and residents, records were reviewed, and facility observations were done to investigate this complaint allegation. Based on staff and residents’ interviews conducted on 3/20/23 and 5/17/23 it has been concluded that facility was not using any restrained for any residents. During the department visits on 3/20/23 and 5/17/23 it has been observed that all residents were attending activities, watching tv in the common area and resting in their rooms without any restraints. Based on this information, this allegation was found to be unfounded. Exit interview was conducted with House Manager and a copy of this report was provided to the facility. The signature of the House Manager on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, May 17, 2023 · control 59-AS-20230314115308

Type of visit: Required - 1 Year

On 10/12/2022 Licensing Program Analyst (LPA) Lavinia Muscan, arrived at the facility unannounced to conduct an annual visit using the infection control tool visit. LPA met with Facility Administrator, Mary Hensley and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured she used hand sanitizer shortly after entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by Caregiver. LPA and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, outside area and common restrooms. Facility has a 2 day perishable and a 7 day non-perishable amount of food. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain and facility was found to be in substantial compliance at this time. Facility has 4 residents. Administrator agrees to send in LIC500 and liability insurance. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Oct 12, 2022

Allegation investigated: Resident sustained a fractured arm while in care Facility staff did not seek medical attention for resident Facility did not allow resident's medical provider to visit the resident Resident was inappropriately restrained while in care Facility staff did not follow resident's hospice plan Facility staff yelled at residents Facility staff placed residents medication in food

LPA Parks arrived on Monday October 3, 2022 to conclude a complaint investigation regarding the following allegations: resident sustained a fractured arm while in care, facility staff did not seek medical attention for resident, facility did not allow resident's medical provider to visit the resident, facility staff did not follow resident's hospice plan, and Facility staff placed resident’s medication in food, resident was inappropriately restrained whie in care and facility staff yelled at residents . Prior to the visit, LPA completed the required COVID-19 testing protocols and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. LPA Parks spoke with Licensee Mary Heider on the phone and expained the findings. LPA discussed the findings with Laura Foss at the facility. Throughout the course of the investigation, LPA interviewed Unfounded staff. Additionally, LPA reviewed R1’s admission agreement, progress notes, hospice medication list, physicians report and PT notes. While R1 did sustain a fractured arm while at the facility, this was not due to neglect or lack of staffing. R1 was an active resident who was able to ambulate from the recliner. LPA reviewed PT orders and progress notes. Hospice care plan was followed by the facility. Staff interviewed acknowledge that they follow the facility’s policy regarding falls. Additionally, morphine is given per the instructions on the medication order. All staff interviewed stated that they have never witnessed staff yelling or raising their voices. Based on LPAs interviews and review of documentation, the preponderance of evidence standards was not met, therefore, the above allegations are found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted. A copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 3, 2022 · control 25-AS-20210624152547

Type of visit: Required - 1 Year

Unannounced annual visit utilizing the infection control domain was performed by LPA Michael Smith. Contact with Laura Foss. A review of staff records on 10/7/21 indicates that all facility staff and other individuals who require caregiver background checks have received criminal record clearances. Facility has no signs posted regarding covid. As a result of this visit, there were no deficiencies. However, 12 technical violations were issued. Exit interview conducted.the state’s words, verbatim · CDSS document, Oct 7, 2021

Type of visit: Case Management - Other

On 8/23/2021 at 6:17 PM, Licensing Program Analysts (LPAs) Kevin MkNelly and Jacob Williams arrived unannounced to the facility. LPAs followed necessary COVID-19 protocol by getting tested weekly, daily symptom check, and wore N95 respirators. LPAs met with Administrator Mary Hensley and Caregiver Joe Hurt. LPAs spoke with Mary and Joe at length, illustrating the fact that Apple Country Care Home is currently in a "Red Zone" and should evacuate their residents. Staff stated that though resident belongings had been prepared for quick evacuation if needed, they will again be prepared for evacuation. LPA Mknelly spoke with Licensee Mary Heider by phone. Licensee stated that if the evacuation order stands until tomorrow 8/24/21, all residents will be evacuated. All resident families have been notified of the order and one resident, R1, left with family while LPAs were present. No deficiencies are being cited as a result of todays inspection. An exit interview was conducted with the Administrator. A copy of this report was provided to the facility. Signature of Administrator acknowledges receipt of this report.the state’s words, verbatim · CDSS document, Aug 23, 2021