Fisher Family Home, LLC.

“Based on record review and interview, the assisted living home failed to maintain a standardized form for each resident that included the information prescribed in subsection A of this section, except for the information prescribed in subsection A, paragraph 1 of this section, which shall be provided at the time the emergency responder was contacted. Findings include: 1 . A review of R1's and R2's medical record revealed documentation of a maintained standardized form for the emergency responder was not available for review at the time of inspection. 2 . In an exit interview, the findings were discussed with E1 and no additional information was provided.”

“Based on record review and interview, the manager failed to ensure medication administered to a resident was documented in the resident's medical record, for four of six residents sampled. Findings include: 1 . A review of R3's medical record revealed a signed medication order list for the following medications: -Levothyroxine 200 MCG 1 tablet daily; -Losartan 25 MG 1 tablet daily; -Amlodipine 10 MG 1 tablet daily; -Cetirizine 10 MG 1 tablet daily; -Famotidine 10 MG 1 tablet daily; -Pantoprazole 40 MG 1 tablet twice a day; -Methenamine 1 tablet twice a day; -Memantine 10 MG 1 tablet twice a day; and -Tamsulosin HCI 0.4 MG 1 capsule daily. However, the following medication was not documented as administered on the following dates: -Levothyroxine from November 19, 2025 to November 21, 2025; -Losartan from November 19, 2025 to November 21, 2025; -Amlodipine from November 19, 2025 to November 21, 2025; -Cetirizine from November 19, 2025 to November 21, 2025; -Famotidine from November 19, 2025 to November 21, 2025; -Pantoprazole from November 18, 2025 (PM) to November 21, 2025 (AM); -Methenamine from November 18, 2025 (PM) to November 21, 2025 (AM); -Memantine from November 18, 2025 (PM) to November 21, 2025 (AM); and -Tamsulosin HCI from November 19, 2025 to November 20, 2025.  2 . A review of R4's medical record revealed a signed medication order list for the following medications: -Sertraline 50 MG 1 tablet daily; -Albuterol 0.833 MG twice a day; -Ondansetron 4 MG 1 tablet twice a day; -Mirtazapine 30 MG 1 tablet daily; and -Gabapentin 250 MG 3 times a day. However, the following medication was not documented as administered on the following dates: -Sertraline from November 19, 2025 to November 21, 2025; -Albuterol from November 18, 2025 (PM) to November 21, 2025 (AM); -Ondansetron from November 18, 2025 (PM) to November 21, 2025 (AM); -Mirtazapine from November 19, 2025 to November 20, 2025; and -Gabapentin from November 18, 2025 (12 PM and 4 PM) to November 21, 2025 (8 AM). 3 . A review of R5's medical record revealed a signed medication order list for the following medications: -Ferrous Sulfate 325 MG 1 tablet daily; -Aripiprazole 5 MG 1 tablet daily; -Glipizide 5 MG once daily; -Omeprazole 20 MG once daily; -Apixaban 5 MG 1 tablet twice a day; -Gabapentin 300 MG 2 capsules three times a day; -Furosemide 40 MG 1 tablet twice a day; -Oxybutynin 5 MG three times daily; -Citalopram 10 MG 1 tablet daily; and -Metoprolol 25 MG 1 tablet twice a day. However, the following medication was not documented as administered on the following dates: -Ferrous Sulfate from November 19, 2025 to November 21, 2025; -Aripiprazole from November 19, 2025 to November 21, 2025; -Glipizide from November 19, 2025 to November 21, 2025; -Omeprazole from November 19, 2025 to November 21, 2025; -Apixaban from November 18, 2025 (PM) to November 21, 2025 (AM); -Gabapentin from November 18, 2025 (12 PM and 4 PM) to November 21, 2025 (8 AM); -Furosemide from November 18, 2025 (PM) to November 21, 2025 (AM); -Oxybutynin from November 18, 2025 (12 PM and 8 PM) to November 21, 2025 (8 AM); -Citalopram from November 19, 2025 to November 21, 2025; and -Metoprolol from November 18, 2025 (PM) to November 21, 2025 (AM). 4 . A review of R6's medical record revealed a signed medication order list for the following medications: -Famotidine 20 Mg 1 tablet a day; -Bupropion 150 Mg 1 tablet a day; -Docusate 100 MG 1 caplet a day; -Duloxetine 60 MG 1 capsule twice a day; -Trazodone 50 MG 1 tablet a day; -Gabapentin 300 MG 1 tablet three times a day; -Methocarbamol 500 MG 1 tablet three times a day; and -Seroquel 25 mg 1 tablet a day. However, the following medication was not documented as administered on the following dates: -Famotidine from November 19, 2025 to November 21, 2025; -Bupropion from November 19, 2025 to November 21, 2025; -Docusate from November 19, 2025 to November 21, 2025; -Duloxetine from November 18, 2025 (PM) to November 21, 2025 (AM); -Trazodone from November 19, 2025 to November 20, 2025; -Gabapentin from November 18, 2025 (12 AM and 4 PM) to November 21, 2025 (8 AM); -Methocarbamol from November 18, 2025 (12 AM and 4 PM) to November 21, 2025 (8 AM); and -Seroquel from November 19, 2025 to November 20, 2025. 5 . In an interview, E1 confirmed the resident had received their medications as scheduled; however, the medication administration had not been marked on the medication administration record for some reason. In an exit interview, the findings were discussed with E1 and no additional information was provided.”

“Based on documentation review, observation and interview, the manager failed to ensure a bell, intercom, or other mechanical means to alert employees to a resident's needs or emergencies was available in a bedroom. The deficient practice posed a risk if residents were unable to summon help from personnel members Findings include: 1. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. The Compliance Officer observed no bell, intercom, or other mechanical means to alert employees to a resident's needs or emergencies in one resident bedroom. 3. In an interview, E2 reported no bell, intercom, or other mechanical means to alert employees to a resident's needs or emergencies was available in the bedroom because R4 did not know how to use it and R1 had moved it out of the room. 4. In an interview, E2 acknowledged the resident bedroom had not included a bell, intercom, or other mechanical means to alert employees to a resident's needs or emergencies.”

“Based on observation and interview, the manager failed to ensure poisonous or toxic materials stored by the facility were stored in a locked area and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of residents with access to the materials. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed a bottle of "Xtra plus Oxi Clean" detergent sitting on a washer in the backyard of the facility. The area was accessible by residents. 2. In an interview, E2 acknowledged the aforementioned poisonous or toxic materials were not stored in a locked location and inaccessible to residents.”