Monte Cristo 1 Alh LLC.

“Based on record review and interview, the manager failed to ensure that before or at the time of acceptance of an individual, the individual submitted documentation that was dated within 90 calendar days before the individual was accepted by an assisted living facility which included if the individual was expected to receive supervisory care services, personal care services, or directed care services, and included whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; and was dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant, for one of nine residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1 . A review of R2's medical record revealed documentation that was dated within 90 calendar days before the individual was accepted by the assisted living facility which included if the individual was expected to receive supervisory care services, personal care services, or directed care services, and included whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; and was dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant was completed after admission of R2. 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 a caregiver documented the services provided in the resident's medical record, for nine of nine residents sampled. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1 . The Compliance Officers requested the resident's Activities of Daily Living (ADL) sheets at approximately 9:30 AM. 2 . A review of the ADL binder revealed documentation of Activities of Daily Living (ADL) sheets for the month of April, 2026 for R1, R2, R3, R4, R5, R6, R7, R8, or R9 was not available for review at the time of inspection. 3 . In an interview, E1 reported E1 was unsure why the ADL sheets were not prepped for April. 4 . In an exit interview, the findings were discussed with E1 and no additional information was provided.”

“Based on observation and interview, the manager failed to ensure there was a means of exiting the facility for a resident that allowed the resident to exit to a location at least 30 feet away from the facility that was secure. Findings include: 1 . During an environmental inspection of the facility, the Compliance Officer observed a door from the side of the house leading to the backyard with an alert. However, the alert was not functioning at the time of inspection. 2 . In an exit interview, the findings were reported to E1 and no additional information was provided.”

“Based on observation and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were inaccessible to residents. Findings include: 1 . During an environmental inspection of the facility, the Compliance Officers observed a laundry room accessible from the backyard of the facility. The door to the laundry room was unlocked at the time of inspection, and the following was accessible: -A jug of "Xtra" detergent; -A jug of "Fabuloso" multi-purpose cleaner; -A bottle of "Lysol" toilet bowl cleaner; and -A bottle of "Winco" bleach. 2 . In an exit interview, the findings were discussed with E1 and no additional information was provided.”

“Based on the record review and interview, the manager failed to ensure that a caregiver provides documentation of completion of a caregiver training program approved by the Department or the Board of Examiners for Nursing Care Institution Administrators and Assisted Living Facility Managers. Findings Include: R9-10-806. Personnel A. A manager shall ensure that: 1. A caregiver: b. Provides documentation of: i. Completion of a caregiver training program approved by the Department or the Board of Examiners for Nursing Care Institution Administrators and Assisted Living Facility Managers; 1. A review of E2's personnel record revealed a caregiver certificate that the Compliance Officer was not able to verify. 2. In an interview, E1 acknowledged E2 did not have documentation of completion of a caregiver training program approved by the Department or the Board of Examiners for Nursing Care Institution Administrators and Assisted Living Facility Managers.”

“Based on observation, record review, 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 and accessible in a bedroom being used by a resident receiving personal care services. Findings include: 1. The Compliance Officers observed R3's bedroom did not have a bell, intercom, or other mechanical means to alert the employees to a resident's needs or emergencies. 2. A review of R3's medical record revealed a service plan for personal care services. 3. In an interview, E1 and E2 acknowledged R3's bedroom did not have a bell, intercom, or other mechanical means to alert the employees to a resident's needs or emergencies. .”

“Based on record review and interview, the manager failed to ensure a medication was administered in compliance with a medication order, for one of three residents reviewed. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. A review of R2's medical record revealed a signed medication list dated September 5, 2023 that included the following medication and instructions: -Lantus 100 Unit. Inject before meals as per sliding scale: 61-200=0 201-250=2 units 251-300=4 units 301-350=8 units 351-400=10 units Greater than 400=12 units and call Doctor. 2. A review of R2's medication administration record (MAR) revealed on November 13, 2023 at 4:00 pm, R2's blood glucose level was recorded as 239. The MAR documentation revealed four units of Lantus was given, however, only two units should have been given per sliding scale. Additionally, on November 14, 2023 for 12:00 pm, R2's blood glucose level was recorded as 329. The MAR documentation revealed ten units of Lantus was given, however, only eight units should have been given per the sliding scale. 3. In an interview, E1 and E2 acknowledged R2 did not receive medication administration for the aforementioned medication in compliance with a medication order.”

“Based on record review, observation, and interview, the manager failed to ensure a medication administered to a resident was documented in the resident's medical record, for two of three residents reviewed. The deficient practice posed a risk as medication could not be verified as administered against a medication order. Findings include: 1. A review of R1's (received medication administration) medical record revealed a signed medication order dated October 2023, for the following medications: -Quetiapine 100 mg take one tablet daily - Levothyroxine 75 mcg take one tablet daily -Metformin 300 mg take one tablet twice a day 2. A review of R1's medication administration record (MAR) for November 2023, listed the aforementioned medications. However, the MAR did not contain the name and signature of the individual administering the medication for the 5:00 PM administration on November 15, 2023. 3. A review of R2's (received medication administration) medical record revealed a signed medication order dated September 2023, for the following medications: -Tamsulosin 4 mg take one tablet twice a day -Furosemide 80 mg take one tablet once a day -Carvedilol 3.125 mg take one tablet once a day 4. A review of R2's medication administration record (MAR) for November 2023, listed the aforementioned medications. However, the MAR did not contain the name and signature of the individual administering the medication for the 5:00 PM administration on November 15, 2023. 5. In an interview, E1 reported the medications were administered per the medication order and acknowledged R1's and R2's medical records did not include documentation the medications were administered on the above listed days.”

“Based on observation and interview, the manager failed to ensure a smoke detector was installed in each bedroom. The deficient practice posed a health and safety risk if a smoke detector was needed during an emergency. Findings include: 1. During the facility tour with E1 and E2, the compliance officers observed the smoke detector was missing and had connector wires hanging down from the ceiling in R3's bedroom. 2. During an interview, E1 and E2 acknowledged R3's bedroom did not contain a smoke detector at the time of the survey.”