LEONA HOUSE.

AN ADMINISTRATOR SIGNATURE COULD NOT BE OBTAINED. PRINTED: 07/23/2024 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 07/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 5000 NW OLD TRAIL ROAD KANSAS CITY, MO 64151 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) LEONA HOUSE 19 CSR 30-86.022(3)(D) Fire Extinguishers UL/FM, Maintain/Check Fire Extinguishers. (D) All fire extinguishers shall bear the label of the Underwriters ' Laboratories (UL) or the Factory Mutual (FM) Laboratories and shall be installed and maintained in accordance with NFPA 10, 1998 edition. This includes the documentation and dating of a monthly pressure check. II/III This regulation is not met as evidenced by: Class Ill Based on observations and an interview on 7/10/24 the facility failed to maintain all their fire extinguishers in accordance with NFPA 10, 1998; sections 4-4.1 and 4-4.3. The facility census was 6. This potentially affected 6 of 6 residents. Observation on 7/10/24 at 12:06 P.M. showed a fire extinguisher by Room 3 that had been discharged and had lost all pressure. Observation on 7/10/24 at 12:13 P.M. showed a fire extinguisher in Room 2 that had lost all pressure, but showed no evidence of being discharged. During an Interview on 7/10/24 at 1:43 P.M. with the house manager he/she said he/she looks at the extinguishers monthly, but did not know they were discharged. 19 CSR 30-86.022(9)(D) Fire Alarm System Inspections/Certifications Complete Fire Alarm Systems. (D) All facilities shall have inspections and written certifications of the complete fire alarm system Missouri Department of Health and Senior Services LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 YNO511 If continuation sheet 1 of 3 PRINTED: 07/23/2024 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 07/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 5000 NW OLD TRAIL ROAD KANSAS CITY, MO 64151 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) LEONA HOUSE Continued From page 1 completed by an approved qualified service representative in accordance with NFPA 72, 1999 edition, at least annually. I/II This regulation is not met as evidenced by: Class II Based on observation and an interview on 7/10/24 the facility failed to have the fire alarm system inspected and tested at least annually in accordance with NFPA 72, 1999 edition by an approved qualified service person. The facility census was 6. This potentially affected 6 of 6 residents. Observation on 7/10/24 at 12:21 P.M. showed an inspection tag dated 5/23/23 on the main alarm panel in the basement. Record review on 7/10/24 at 1:33 P.M. showed the last annual fire alarm system inspection report on file dated 5/23/23. During an Interview on 7/10/24 at 1:43 P.M. with the house manager he/she said he/she would let the owner know. 19 CSR 30-86.022(11)(A) Complete Sprinkler System-NFPA 13 Sprinkler Systems. (A) Facilities licensed on or after August 28, 2007, or any section of a facility in which a major renovation has been completed on or after August 28, 2007, shall install and maintain a complete sprinkler system in accordance with NFPA 13, 1999 edition. I/II This regulation is not met as evidenced by: Missouri Department of Health and Senior Services STATE FORM 6899 YNO511 If continuation sheet 2 of 3 Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: NAME OF PROVIDER OR SUPPLIER 5000 NW OLD TRAIL ROAD LEONA HOUSE KANSAS CITY, MO 64151 SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) (x4) ID PREFIX TAG Continued From page 2 Class II Based on observations, interviews and record review on 7/10/24 the facility failed to have the sprinkler system inspected and tested annually by a qualified person and to insure the monthly pressure gage readings and valve position checks of the sprinkler system was done as required in accordance with NFPA 13, 1999 edition. The facility census was 6. This potentially affected 6 of 6 residents. Observation on 7/10/24 at 12:20 P.M. showed no monthly sprinkler valve position and pressure gage check records by the sprinkler riser. Record review on 7/10/24 at 1:33 P.M. showed no documentation of monthly sprinkler valve position and pressure gage check records on file. Observation on 7/10/24 at 12:20 P.M. showed the last annual sprinkler system inspection recorded on the riser tag was 4/29/23. Record review on 7/10/24 at 1:33 P.M. showed the last annual sprinkler system inspection on record was 4/29/23. During an interview on 7/10/24 at 1:43 P.M. with the house manager he/she said he/she was not aware the sprinklers had to be checked monthly and he/she would let the owner know the annual inspection was just past due on the sprinkler system. Missouri Department of Health and Senior Services STATE FORM 6899 YNO511 (X2) MULTIPLE CONSTRUCTION PRINTED: 07/23/2024 FORM APPROVED (X3) DATE SURVEY COMPLETED 07/10/2024 STREET ADDRESS, CITY, STATE, ZIP CODE PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (x5) COMPLETE DATE If continuation sheet 3 of 3 THE FACILITY DID NOT RETURN A PLAN OF CORRECTION THEREFORE, NO POC IS INCLUDED WITH THE STATEMENT OF DEFICIENCIES (2567 FORM)

Jul 242024 11:04pm = Jhiggins1 O 190041 F 10 ' PRINTED: 07/10/2024 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES iX1} PROVIDERSUPPLIERJCLIA (X2) MULTIPLE COHSTRUCTION (X3) DATE SURVEY | AND: PLAN OF CORRECTION IGENTIFIDETION KUMBER: A BUILDING: CCMPLETED c B.WING O7G1/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 5000 NW OLD TRAIL ROAD KANSAS CITY,MO 64151 (4)io SUMMARY STATEMENT OF CEFICIENCIES PROVIDER'S PLAN OF CCRRECTION xs PREFIM | {EACH DEFICIENCY MUST BE PRECEDED BY FULL j {EACH CORRECTIVE ACTION SHOULD SE COMPLETE LEONA HOUSE ING i REGULATORY OF LSC IDENTIFYING INFORMATION} CROSS-REPERENCED TO THE APPROPRIATE DATE : i DEACIENCY) AABBO 19 CSR 30-86.047(65)(A) Safe Transfers Ad4BE0 Training Requiremenis 1 | Requirements for training retated to safely transferring residents. (A) The faciiity shall ensure that all staff responsible for transferring residents are appropriately tamed to transfer residents safely. | individuals authorizect to provide this training inciude 2 licensed nurse, a physical therapist, a | | physical therapy assistant, an occupational | therapist or a certified occupational therapy | assistant, The :ndividual who provides the transfer training shall observe the caregiver's | stills when checking competency in completing \ safe transfers, shall dacument the date(s) of training and competency and shall sign and maintain training documentation. tnitial training shalt include a minimum of two (2) classroam instruction hours in addition to the on-the-job training related to safely transferring residents , who need assistance with transfers. liflil et This reguiation is not met as evidenced by: Class * Based on observation, interview and record review, the facility failed to document and ensure that staff who were responsible for transferring residents using a mechanical "ft were appropriately trained. This affected one cf ane sampled residents (Resident #1}. The facility census was 7. transfers. 1. Review of Resident #1's medical file showed: | Admit date of 3/1/23: Diagnoses included: Lewy Body Dementia la disease of the brain that affects memory, The facitity did not provide a policy regarding safe | Missouri Depariment o° Health and Senior Services PFELIER REPRESENTATIVE'S SIGRATURE If continuation sheet 1 STATE F2RM g GLE LPRGSLA Lsuibsiur = wd: @ ze. zi tne PRINTED: 07/10/2024 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED Cc 07/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 5000 NW OLD TRAIL ROAD KANSAS CITY, MO 64151 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) LEONA HOUSE A4860 19 CSR 30-86.047(65)(A) Safe Transfers Training Requirements Requirements for training related to safely transferring residents. (A) The facility shall ensure that all staff responsible for transferring residents are appropriately trained to transfer residents safely. Individuals authorized to provide this training include a licensed nurse, a physical therapist, a physical therapy assistant, an occupational therapist or a certified occupational therapy assistant. The individual who provides the transfer training shall observe the caregiver's skills when checking competency in completing safe transfers, shall document the date(s) of training and competency and shall sign and maintain training documentation. Initial training shall include a minimum of two (2) classroom instruction hours in addition to the on-the-job training related to safely transferring residents who need assistance with transfers. II/III This regulation is not met as evidenced by: Class II* Based on observation, interview and record review, the facility failed to document and ensure that staff who were responsible for transferring residents using a mechanical lift were appropriately trained. This affected one of one sampled residents (Resident #1). The facility census was 7. The facility did not provide a policy regarding safe transfers. 1. Review of Resident #1's medical file showed: -Admit date of 3/1/23: -Diagnoses included: Lewy Body Dementia (a disease of the brain that affects memory, Missouri Department of Health and Senior Services LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 VXS811 If continuation sheet 1 of 3 Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA AND PLAN OF CORRECTION IDENTIFICATION NUMBER: NAME OF PROVIDER OR SUPPLIER (X2) MULTIPLE CONSTRUCTION A. BUILDING: 5000 NW OLD TRAIL ROAD KANSAS CITY, MO 64151 LEONA HOUSE (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL TAG REGULATORY OR LSC IDENTIFYING INFORMATION) Continued From page 1 reasoning and function), Parkinson's Disease (a disease that affects the nervous system causing function loss), and unsteady gait. Review of the resident's care plan dated 6/1/24 showed: -The resident was partial weight bearing; -Transferred via sit to stand mechanical lift. Review of an Unusual Occurrence Report dated 6/17/24 showed: -The resident had a witnessed fall on 6/17/24 at 6:15 A.M.; -The fall was reported to the Nurse Practitioner and the resident's responsible party. Review of the resident's nurse's notes showed: - On 6/18/24, staff was transferring the resident from bed to wheel chair when the resident's shoe fell off, staff stumbled over it and lost their balance and the resident fell on top of staff; -On 6/18/24 at 8:45 P.M., Nurse A assessed the resident after a mild head injury. Review of a letter dated 6/26/24 signed by Physician A showed: -He saw the resident in his office on 6/26/24: -The resident had a black eye on the left side but did not know how it happened. Observation of Resident #1 on 7/1/24 at approximately 2:20 P.M. showed: -Resident #1 was in his/her room in the sit-to-stand mechanical lift; -The resident was not bearing an weight on his/her legs; -Level One Medication Aide (LIMA) C was approximately ten feet away from the resident making the bed. Missouri Department of Health and Senior Services STATE FORM 6899 VXS811 PRINTED: 07/10/2024 FORM APPROVED (X3) DATE SURVEY COMPLETED Cc 07/01/2024 STREET ADDRESS, CITY, STATE, ZIP CODE PROVIDER'S PLAN OF CORRECTION (X5) (EACH CORRECTIVE ACTION SHOULD BE COMPLETE CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) If continuation sheet 2 of 3 Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA AND PLAN OF CORRECTION IDENTIFICATION NUMBER: NAME OF PROVIDER OR SUPPLIER (X2) MULTIPLE CONSTRUCTION A. BUILDING: 5000 NW OLD TRAIL ROAD KANSAS CITY, MO 64151 LEONA HOUSE (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL TAG REGULATORY OR LSC IDENTIFYING INFORMATION) Continued From page 2 During an interview on 7/1/24 at 2:56 P.M., LIMA C said: -He/She did not received transfer training; -Did not know that the resident should not be left unattended while in a mechanical lift. During an interview on 7/1/24 at 3:00 P.M., Nurse A said: -She had not done transfer training; -She did instruct all staff to watch a video on safe transfers and sign a document stating they watched and understood the video; -The training did not require staff to demonstrate their ability to do a safe transfer. During an interview on 7/1/24 at 1:30 P.M., the Owner/Administrator said: -On 6/17/24, LIMAA attempted to transfer the resident by him/herself using the "bearhug" method; -LIMAA should have waited for LIMA B to assist him/her; -Not all staff used the sit to stand lift when transferring the resident; -Nurse A did transfer training with staff a month or two prior; -He expected staff to use which ever method they felt most comfortable with as long as the transfers are done safely. *Higher classification merited due to the extent of the violation. MO238254 Missouri Department of Health and Senior Services STATE FORM 6899 VXS811 PRINTED: 07/10/2024 FORM APPROVED (X3) DATE SURVEY COMPLETED Cc 07/01/2024 STREET ADDRESS, CITY, STATE, ZIP CODE PROVIDER'S PLAN OF CORRECTION (X5) (EACH CORRECTIVE ACTION SHOULD BE COMPLETE CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) If continuation sheet 3 of 3 PLAN OF CORRECTION Provider/Suppl Leona House ier Name: Street Address, 5000 NW Old Trail Rd. Kansas City, MO 64151 City, Zip: Date of Survey: 7/1/2024 PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER COMPLETI ON DATE ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION: (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) All current staff and new hires will undergo at least the 8/1/24 minimum 2 hour transfer classroom training by either a Physicial therapist or Licensed Nurse. PT or Licensed nurse will observe all staff transfer to ensure competency. All current staff training will be completed by August 15th, and all new hire transfer training will be completed within 2 weeks of hire. The Administrator signing and dating the first page of the CMS-2567/State Form is indicating their approval of the plan of correction being submitted on this form.

PRINTED: 08/04/2023 ; FORM APPROVED Missouri Department of Health and Senlor Services STATEMENT OF DEFICIENCIES 4X1) PROVIDERJBUPPLIER/OLIA {X2) MULTIPLE CONSTRUCTION (3) OATE SURVEY AND PLAN OF CORRECTION IDENTIFIOATION NUMBER: COMPLETED 4, BUILDING: 24749 5. WING NAME OF PROVIDER OR SUPPLIER STREET ADORESE, CITY, STATE, ZF GODE 5000 NW OLO TRAIL ROAD LEONA HOUSE KANSAS CITY, MO 84161 07/26/2023 {X4b ID GUMMARY STATEMENT OF DEFICIENCIES 1D | PROVIDER'S PLAN OF CORRECTION ry PREFIX {EACH DEFICIENCY MUST BE PRECEDED @Y FULL PREFIX | [EACH CORRECTIVE ACTION SHOULD 6g COMPLETE TAG i, CROSS-REFERENCED TO THE APPROPRIATE | pate REGULATORY OR LSC IDENTIFYING INFORMATION} DEFKENCY) 19 CSR 30-86.047(13)(A) Criminal Background AAT it Check Requiremants | Prior to allowing any person who has been hired in & full-time, part-time, or temporary position to have contact with any resident, the facility shall, | or in the oase of temporary employees hired ihrough or contracted from an employment | agency, the employment agency shall, prior to sending a temporary employee to a faoility: | (A) Request a criminal background cheok for tha person, a8 provided in section 660.317, RSMo. | Each facility shall maintein documents verifying that the background checks were requested, the | date of gach such request, and the nature of the response received for each auch request. Il | This regulation ie not met as evidenced by: | Clase I} | Based on interview and record review, facility | | | ataff faded to request 4 criminal background | | check (CBC) and document with the date of request, date recelved, and nature of the | Fesponge for two of two newly hired staff members, The facilily census wes 7. | Record review shawed the facility did not provide polley regarding completion of criminal background checks. 1. Record review of Level Gne Medication Aide (L1MA) B's parsonnel record shawed: -A hire date of 7-7-23 | -No CBC completed, | | 2. Record review of L1MAA's personnel record showed: | A hire date of 7/4 8/23; | No CAC completed. Missouri Department at Health and Senior Services J /| o— LABORATORY ORECTOR'S OR PROVIDERISUPPLIGA REPREGENTHIIVE'S Senate y TE iP Af paoate Ce Lok Sd mm STATE FORM o Bo WMT It continwistion shast t of 2 £/€ d DTLTPSSITE HIYON SANOH AWMTYD Hd 9T!€O ezoe-o0 “Bry Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA AND PLAN OF CORRECTION IDENTIFICATION NUMBER: NAME OF PROVIDER OR SUPPLIER LEONA HOUSE (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL TAG REGULATORY OR LSC IDENTIFYING INFORMATION) PRINTED: 08/01/2023 FORM APPROVED (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY COMPLETED 07/25/2023 STREET ADDRESS, CITY, STATE, ZIP CODE 5000 NW OLD TRAIL ROAD KANSAS CITY, MO 64151 PROVIDER'S PLAN OF CORRECTION (X5) (EACH CORRECTIVE ACTION SHOULD BE COMPLETE CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) 19 CSR 30-86.047(13)(A) Criminal Background Check Requirements Prior to allowing any person who has been hired in a full-time, part-time, or temporary position to have contact with any resident, the facility shall, or in the case of temporary employees hired through or contracted from an employment agency, the employment agency shall, prior to sending a temporary employee to a facility: (A) Request a criminal background check for the person, as provided in section 660.317, RSMo. Each facility shall maintain documents verifying that the background checks were requested, the date of each such request, and the nature of the response received for each such request. II This regulation is not met as evidenced by: Class II Based on interview and record review, facility staff failed to request a criminal background check (CBC) and document with the date of request, date received, and nature of the response for two of two newly hired staff members. The facility census was 7. Record review showed the facility did not provide a policy regarding completion of criminal background checks. 1. Record review of Level One Medication Aide (L1MA) B's personnel record showed: -A hire date of 7-7-23 -No CBC completed. 2. Record review of L1MAA's personnel record showed: -A hire date of 7/18/23; -No CBC completed. Missouri Department of Health and Senior Services LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 W7MT11 If continuation sheet 1 of 2 Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 5000 NW OLD TRAIL ROAD LEONA HOUSE KANSAS CITY, MO 64151 PRINTED: 08/01/2023 FORM APPROVED (X3) DATE SURVEY COMPLETED 07/25/2023 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE A4711) Continued From page 1 During an interview on 7/25/23, at 3:47 P.M., the Administrator said: -CBC's should be completed for all employees prior to their start date; -He was not aware CBC's had not been done for all newly hired employees. Missouri Department of Health and Senior Services STATE FORM oeee W7MT11 DEFICIENCY) If continuation sheet 2 of 2 PLAN OF CORRECTION premien/ sapplier Leona House- Galway Homes Name: Street Address, Ci 7 5000 NW Old Trail Rd. Kansas City, MO 64151 ity, Zip: Date of Survey: 7/25/2023 PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION: (EACH CORRECTIVE ACTION COMPLETION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) DATE This plan of correction is submitted as required under State Law. The submission of this plan shall not constitute or be construed as an admission by Leona House of the allegations found by the surveyor(s) nor the conclusions drawn there from. This plan of correction shall serve as our credible letter alleging compliance, which will be effective by August 30, 2023. Compliance will be maintained as provided in the plan of correction. : 19 CSR 30-86.047(13)(A) Criminal Background Check requirements -Prior to allowing any person who has been hired to have contact with any resident, the DON or designee will request a criminal background check via FCSR. If an employee is not already registered, DON or designee will check the highway A4755 safety patrol website and run their social security number on the 8/30/2023 employee disqualification list, prior to employee having any resident contact. DON will keep a record of when the background check was requested as well as the information received for each request. Leona House will implement a Human Resources policy outlining these requirements for CBC’s by 8/30/2023. DON or designee will oversee these by reviewing all new hire files before allowing contact with a resident. The Administrator signing and dating the first page of the CMS-2567/State Form is indicating their approval of the plan of correction being submitted on this form.