Based on observation, interview, and record review the facility failed to be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident for one of one facility reviewed. The facility failed to have sufficient resources to satisfy (pay) debts timely and when they come due. The phone and internet were disconnected, service repair bills/vendors were not paid, and the facility van did not have insurance or current registration tags. The facility failed to provide enough money to purchase the food necessary to follow the menus and to purchase printer supplies. An Immediate Jeopardy was identified on 03/14/25 at 3:52 pm. The IJ template was provided to the facility on 3/14/25 at 3:52pm. While the Immediate Jeopardy was removed on 03/19/25 at 4:36 pm, the facility remained out of compliance at scope of widespread and a severity level of no actual harm with potential for more than minimal harm because the facility needs to take action to ensure there is a plan for vendors to be paid timely, so services are not rescinded, and the residents have the services required for the highest practicable physical, mental, and psychosocial well-being of each resident. These failures could place residents at risk of not receiving essential care and services that the facility is responsible for providing. Findings included: During an interview on 02/22/25 at 9:30 am, the DON said the facility had not had an Administrator since December 20, 2024. She said: the facility had not been paying vendors. The phones/fax were not working. The staff had to utilize their own cell phones to conduct facility business. The facility is not able to send or receive faxes. A staff member bought a pre-paid cell phone, so the residents were able to call their family and vice versa. The staff went and bought milk, coffee, and hot chocolate for the residents, yesterday 02/21/25, due to the facility not having any for the residents. The ice machine was rented and was scheduled for repossession next Wednesday, 02/23/25 for non-payment. The nurses had purchased ink cartridges and paper so they could print out packets that needed to be sent with the residents when they go out of the facility. Staff have purchased soap, bodywash, lotion, laundry soap, bleach, bread, gas for the van, and incontinent briefs for the residents. Record review of invoices provided by the Human Resource Director indicated unpaid balances for the following: 1. Telephone and internet vendor invoice dated 2/7/25- Past due balance of $16,985.35. The phone was disconnected on 02/07/25. Internet was disconnected on 03/03/25. 2. Energy vendor invoice dated 2/6/25 - Past due balance of $41,159.61 with a due date of 02/21/25. 3. Water vendor invoice undated - Past due balance of $5292.92 with a due date of 03/10/25. 4. Fire and Security vendor - Past due balance of $11,497.06 as of 03/12/25 - a total of 11 invoices dated 12/26/24 - 3/3/25. Account was suspended on 03/12/25 and 10-day termination notice was to be given. 5. Ice machine vendor invoice dated 2/1/25- Past due balance of $137.12 with a due date of 2/11/25 and ice machine to be picked up on 02/26/25 if not paid. 6. Milk vendor invoice dates from 8/7/24-12/31/24 (22 invoices)- Past due balance of $1,360.59. Delivery of milk stopped 01/07/25. 7. Garbage and waste vendor invoice dated 1/20/25- Past due balance of $1,141.08. Subject to service suspension and/or container removal. 9. Pharmacy Consultant invoice dated 1/27/25- Past due balance (not disclosed on invoice). Pharmacy services to be terminated on 02/24/25. 10. Insurance vendor for van undated- Policy cancelled effective date on 02/09/25 for non-payment. Amount unknown. In an interview on 02/22/25 at 11:15 am, [NAME] B said the facility had to substitute meals due to not having the required food for the menu. She said they attempt to make sure the residents were receiving the correct nutritional value. She said at times, the facility does not have milk, bread, coffee, artificial sweetener. [NAME] B said she had purchased ketchup, mustard, and artificial sweetener for the residents. In an interview on 02/22/25 at 11:30 am, the Maintenance Director stated he could not purchase supplies to fix things at the facility due to the facility having a past due balance at a local hardware store, approximately $7000. The facility had a past due balance with the vendor who serviced the dishwasher, washing machines and dryers and could not get maintenance services. He said the hot water heater for the laundry did not work and could not get it fixed. He stated that he purchased supplies out of his own pocket to fix things at the facility for the residents. He said the facility owed him $125 for supplies he recently purchased, and they have never paid him. In an interview on 02/22/25 at 01:45 PM with the Human Resource Director, she stated the facility phone was cut off on 02/07/25 and had never been turned back on. She said an anonymous staff member purchased a prepaid cell phone out of their own pocket on 02/10/25 so that the residents and their families could communicate with each other. She said the facility could not send or receive faxes. The staff had to use their personal cell phones to conduct facility business. In an interview on 02/22/25 at 02:10 PM, Housekeeper C stated there was no hot water in the laundry and all laundry was being washed in cold water. She said the washing machine had no chemicals and needed to be serviced. She said staff purchased bleach and laundry soap as the facility had not been purchasing those items due to not paying their bill. In an interview on 02/23/25 at 10:10 am, LVN D said that she bought out of her pocket soap, bodywash, lotion, ink, and paper for the printer. She said if she did not purchase these things the residents would go without. In an interview on 02/23/25 at 10:15 am, LVN E said that she purchased ink and paper for the printer. She said when a resident was sent out of the facility, they have to print a paper packet to go with them. She said due to the facility not having phone or fax services, she had to use her own cell phone to conduct facility business. She said the facility was unable to receive faxes from doctors and hospitals. She said the residents' families have expressed to her their frustration about not being able to contact the facility or their loved ones. In an interview on 02/23/25 at 10:50 am, the DON said she was aware the facility did not have hot water for the laundry. She said when a resident goes out of the facility, they had to print out a packet concerning the resident's information to be sent with them and the nurses had been buying the ink and paper for that. If they did not purchase the items, they would not be able to send out a packet the receiving facility was requesting. In an interview with DON on 2/24/25 at 10:00am and a record review of an e-mail dated 02/17/25 at 11:05 am from the Director of Nursing to the CEO, the DON requested Supplies and Payments: We are nearly out of essential supplies, including toilet paper. Could you confirm when the outstanding bills will be settled so that we can restock as needed? Petty Cash: Do we have an estimated timeline for the release of petty cash? Several team members have been using funds to address immediate building needs. Could you advise on the status of these items? The DON said the CEO never responded to the e-mail. In an interview on 02/24/25 at 10:45 am, the Dietary Manager stated the residents were budgeted $6 a day for breakfast, lunch, and dinner. She said that amount was not enough to purchase all the food items for the menus. As a result, the facility had to substitute items on the menu. An example for today at lunch, it called for hamburger meat but there wasn't enough money to purchase that, so it was substituted with another item on the menu that was chicken. She said she had purchased coffee, milk, artificial sweetener, and tea bags for the residents. In an interview on 02/24/25 at 11:00 am, the Laundry Supervisor stated there was no hot water for the laundry. The resident's laundry was being washed in cold water. She said the hot water heater had been out for over a month. She said the washing machine did not have the correct chemicals to sanitize the resident's laundry properly. She said the washing machine had an error code and needed to be serviced. She said the facility had not paid the bill to the servicer and they would not come to fix it. She said staff purchased bleach and laundry detergent as the facility did not provide laundry soap or bleach. She said she had purchased laundry supplies for the residents out of her own pocket. She stated it had been reported, and maintenance was aware. In an interview on 02/24/25 at 2:00 pm, the local Ombudsman reported it was difficult to contact the facility due to having no phone service. Individual facility staff had to be contacted. The ombudsman said she was made aware of the communication with the owner because staff had been forwarding emails from the owner and it is very demeaning, and negative. In an interview on 02/24/25 at 2:54 pm, the Maintenance Director stated the facility needed a new hot water heater for the laundry. He said the facility could not get anyone to come out and look at the hot water heater due to the facility owing everyone money. He said the washing machine could not be serviced due to an unpaid bill. He said the facility could not order the proper chemicals for the washing machine due to an unpaid bill. He said the CEO was aware. In an interview on 02/25/25 at 9:30 am, Resident #1's POA expressed her concern about the facility not having an Administrator in the building and questioned as if this was causing a delay of Resident #1 being placed on hospice care requested on 02/16/25. In an interview on 02/25/25 at 11:23 am with the Activity Director, she stated she was purchasing blow-up calendars for the activity bulletin board out of her own pocket and the facility would reimburse her. She said she purchased a calendar for January and the facility did not reimburse her. She said the facility owed her $30. She said she purchased BINGO winnings for the residents such as coke, candy, and popcorn out of her own pocket. If she did not, the residents would not have any BINGO winnings. In an interview on 02/25/25 at 12:00 pm, Facility Physician A said she was aware the facility was not paying its bills. She said it makes communication very difficult as she could not send or receive faxes with the facility. She had to conduct business on staff's individual cell phones. In an interview on 02/25/25 at 1:35 pm, CNA F stated she had purchased soap and body wash for the residents so they could have a bath. In an interview with the CEO on 02/25/25 at 4:20 pm, he said don't worry about the utilities, they will not get shut off. I will not be able to keep up 30-day payments due to all the Medicaid in the facility and them not paying that much. He said he purchased the facility 6 months ago and it takes time to get everything switched over to a new account. He stated he was not going to pay any back service because he was not responsible for anything before he bought the facility. He said the facility staff had not communicated to him about the food or lack of food, and the best he could do was contact his purchase person. He said he was not aware the washing machine did not have hot water and needed to be serviced. CEO stated there was no Interim Administrator, and the position was posted on job website and no one licensed had applied. In an interview with the CEO on 02/25/25 at 4:55 pm, he stated he signed a new contract for the electric vendor. He said the water bill was only 2 months behind and that it was not late enough to be shut off so that was fine. He said the Fire and Security vendor were still within terms and would complete repairs. He said he would get payment sent out tomorrow for the ice machine vendor. He said they had a new pharmacy consultant to start 02/26/25. In an interview with the Social Worker on 02/26/25 at 1:00 pm, she stated for the last 3 to 4 weeks, she had received calls from family members 2 to 3 times per week on her personal cell phone upset and worried due to the facility phone number not working. In an interview on 03/07/25 at 10:00 am, the Human Resource Director said the internet was disconnected on 03/03/25 in the afternoon for non-payment. The facility did not have any internet service from 03/03/25 to the morning of 03/06/25. She stated the facility had insurance on the van and provided an invoice. In an interview on 03/07/25 at 11:25 am, the Activity Director said she was responsible for taking residents to doctor's appointments but had not taken them in February or March due to the van not having insurance or current tags. In an interview on 03/09/25 at 12:55 pm, the Dietary Manager said she had to substitute pot roast that was on the menu for chicken due to pot roast being over $200. She said she did not have enough money to purchase the required food items on the menu. In an interview on 03/09/25 at 1:00 pm, LVN D and LVN E stated due to the internet being down, the nurses were not able to access the computer for medication administration. They stated the residents on the Yellow [NAME] Hallway did not have TV service due to the internet being out and the facility did not purchase a hot spot for that hallway. They reported the residents did not have any coffee today and they were going to go purchase some. In an observation on 03/09/25 at 1:15 pm, the facility van's tag displayed on the front windshield expired on 11/24. In an interview on 03/10/25 at 1:30 pm, the DON said due to the facility having no insurance on the van, 3 residents (Resident #2, Resident #9, and Resident #11) had missed their doctors' appointments. One resident missed a cardiology and nephrology appointment; two residents missed an appointment with their primary doctor and 2 residents have been taken to their appointments by their family. The DON said a potential negative outcome would be the residents would not receive the proper treatment they needed. In an interview on 03/10/25 at 10:16 am, this writer contacted the van insurance company from the invoice provided by the Human Resource Director and was informed the policy had been cancelled and was not active. In an interview on 03/10/25 at 10:45 am, the Dietician said she was concerned about the food budget and not enough money to cover the menu. She said she was not aware the facility had been substituting the menu as frequently as they were doing. She said the facility should not be having to substitute more than 2 meals a week. In an interview on 03/11/25 at 1:15 pm, the laundry supervisor said the facility was not using the recommended bleach or detergent for the laundry, and no alkaline is being used. One washing machine is not equipped anymore to receive chemicals and they wash items in that one that doesn't require bleach. She said it had been over 2 years since the washing machines had been serviced. She said as a result the laundry had the potential to not be sanitized properly. In an interview on 03/11/25 at 8:24 am, Physician B stated it was very difficult to communicate with the facility due to no phone or fax service. He said a resident had an appointment with him yesterday, but it was cancelled. He was not aware it was cancelled due to the facility not being able to transport residents due to having no insurance on the facility van. In an interview on 3/12/25 at 12:00 pm, Facility Physician A said she was not aware residents missed doctor's appointments. She said the resident that missed his cardiology and nephrology appointments were considered important appointments. She said the facility called her about Resident #2 that was having slight bleeding from her vaginal area; She said she asked the facility to bring the resident to her office, but was informed they could not due to no insurance on the van. She said as a result, she was going to go to the facility to evaluate her. In an interview and record review on 3/12/25 at 10:10 am, the DON provided documentation the van insurance policy was cancelled on 02/09/25. She said on 03/08/25, Resident #3 sustained a fall. The family requested her to be sent to the ER. DON stated the family took her to the ER and left. The facility had to use the facility van to pick her up from the ER, although there was no insurance on the van. In an interview on 3/13/25 at 11:35 am, the DON said Resident #2 was being sent to the ER, via ambulance for a change in condition. She said Facility Physician A did not get to see her prior to being sent. This was determined to be an Immediate Jeopardy (IJ) on 03/14/25 at 3:52 pm. The DON and Human Resource Director were notified. The DON was provided with the IJ template on 03/14/25 at 3:52 pm. The following Plan of Removal was submitted by the facility and accepted on 03/17/25 at 12:47 pm and included: The facility needs to take immediate action to ensure there is a plan for vendors to be paid timely, so services are not rescinded, and residents have the services required for the highest practicable physical, mental, and psychosocial well-being of each resident. Plan of Removal 1). Action: The Chief Executive Officer (CEO) and Managing Partner re-educated the Chief Operating Officer (COO) on the governing board responsibility to ensure management and operation of the facility; emphasis was stressed on the importance of providing oversight of facility care and services in accordance with professional standards of practice and principles, to ensure there is a plan for vendors to be paid timely, so services are not rescinded and residents have the services required for the highest practicable physical, mental, and psychosocial well-being of each resident. The mode of education was in the form of a one-on-one meeting and memo - a copy of the Policy and Procedures entitled Administrative Management (Governing Board). The teach-back method was used to assess comprehension. Start Date: 03/14/2025 Completion Date: 03/14/2025 Responsible: Chief Executive Officer (CEO) and Managing Partner 2). Action: The Chief Executive Officer (CEO) and Chief Operating Officer (COO) will meet to review and make payments or payment arrangements for: 1. Telephone and internet vendor on 03/13/2025, $10,000.00 was paid, the remaining payment was made on 3/17/25 in the amount of $7987.28, the amount told to us from the company to activate service.; 2. Insurance vendor for the facility van has been paid in the amount of $141.99 on 3/11/25. 3. Registration tags for the facility van was paid on 3.17.25 in the amount of $74.00 to County Tax Office. 4. Fire and security vendor - have confirmed that we are not on hold and have sent an email confirming so on 3.14.25. If the internet is out, the emergency plan to ensure the staff have access to MARs and TARs will be to use the Hot spots for internet. Until Telephone and internet have been restored, while these are out, the facility will continue to use mobile phone and internet Hot Spots to communicate and document as required to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. If the hot spots are not working, the DON was educated on the need to obtain paper-printed MARs and TARs from the pharmacy to be delivered on the medication run if no internet is available and printing abilities are not available locally. The facility Social Worker will call each family to share the mobile phone number if/when needed. The Activity Director will complete resident interviews to identify residents affected by phone interruption and share with them the availability of mobile phone if needed to communicate to people outside the facility. The facility's Human Resource Director will contact the facility's vendors to share the phone number if/when required. To prevent future service interruptions, the Chief Executive Officer (CEO) and Chief Operating Officer (COO) will meet monthly to review the facility's outstanding invoices and ensure vendors to be paid timely, so services are not rescinded, and residents have the services required for the highest practicable physical, mental, and psychosocial well-being of each resident. Start Date: 03/14/2025 Completion Date: 03/17/2025 Responsible: Chief Executive Officer (CEO) and Chief Operating Officer (COO) 3). Action: The Director of Nursing (DON) will complete a Medication Error Form for each of the identified 11 residents in which medication were given at a different time or omission occurred; the form includes communicating with the medical provider, the responsible party, facility management and pharmacist consultant, in addition to type of error and reason for error (Examples of medications errors include: a. Omission - a drug is ordered but not administered; b. Unauthorized drug - a drug is administered without a physician's order; c. Wrong dose (e.g., Dilantin 12 mL ordered, Dilantin 2 mL given); d. Wrong route of administration (e.g., ear drops given in eye); e. Wrong dosage form (e.g., liquid ordered, capsule given); f. Wrong drug (e.g., vibramycin ordered, vancomycin given); g. Wrong time; and the corrective action taken and measures to prevent similar error(s) recurrence. The Director of Nursing reviewed the other resident's Medication Administration Records (MARs) and did not reveal further discrepancies or errors. The Chief Nursing Officer (CNO) will confirm completion of Medication Error Forms. Start Date: 03/14/2025 Completion Date: 03/17/2025 Responsible: Director of Nursing (DON), Chief Nursing Officer (CNO) 4). Action: The Director of Nursing (DON) will re-educate nurses (RN/s/LVNs) and certified medication aides (CMAs) on the facility's policies: Administering Medications and Medication Errors - the different types and immediate actions to take to prevent adverse consequences. The mode of education will be in the form of a one-on-one meeting and memo - a copy of the Policy and Procedures entitled Administering Medications and Adverse Consequences and Medications Errors. The teach-back method was used to assess comprehension. To evaluate further understanding, the Director of Nursing will complete a weekly Medication Pass Observation to each nurse and medication aide for the next 4 weeks and quarterly thereafter. Education is done as well regarding obtaining MARs and TARs from the pharmacy to be delivered on the medication run if no internet is available. Facility will have the hotspots that were purchased available to use if the main internet is to stop working until pharmacy deliver paper MARS and TARs. In the absence of the DON, the Chief Nursing Officer (CNO) will request paper-printed MARs and TARs from the pharmacy vendor. Start Date: 03/14/2025. Completion Date: 03/17/2025 Responsible: Director of Nursing (DON), Chief Nursing Officer (CNO) 5). Action: The Chief Executive Officer (CEO) and Chief Operating Officer (COO) will post the facility's administrator's vacant position and continue active recruitment to fill the facility administrator's vacant position. With a sign on bonus posted on 3.15.25. Until the position is filled, all items needed for resident care are to be communicated to the facility's Director of Nursing (DON), as for ancillary services, such as dietary and environmental services, are to be communicated to the facility's Human Resource Director, Both - DON and HR Director will participate in a conference call with the Chief Executive Officer (CEO) and Chief Operating Officer (COO) weekly on Thursdays at 11 am that arrangements can be made to ensure there is a plan for vendors to be paid timely, so services are not rescinded and residents have the services required for the highest practicable physical, mental, and psychosocial well-being of each resident. This conference call will continue weekly with the new administrator once onboarded and the weekly minutes reviewed monthly during the facility's monthly QAPI to determine if changes in needed supplies, their quantity and/or delivery dates are required in order to be altered to ensure timely ordering and delivery. Items to be reviewed weekly will include food needed for the menu, milk, coffee, tea, artificial sweetener, hot chocolate, snacks, condiments, soap, shampoo, conditioner, lotion, laundry soap, bleach, ink for printers, paper for printers, chemicals for laundry, and gas for the van, along with routine service needs/requests for the dishwasher, washing machine, and dryer. Staff will be educated on 3.17.25 by HR that when a facility or resident need related to supplies and vendor payments to communicate with HR who will review supply and ensure supply is replenished before the item runs out. Laundry staff were educated by HR that when chemical supply becomes low to notify HR who will ensure supply is replenished prior to running out. Maintenance director will be educated on 3.17.25 to monitor once a week the supply visually and discuss with staff on site the supply level to see if additional chemicals need to be ordered and will communicate to HR. Department heads will be educated on 3.17.25 by HR that each department head will monitor its supplies once a week and communicate to HR any items needed. Maintenance director will do housekeeping and laundry, DON will do nursing, HR will do office supplies. Start Date: 03/14/2025. Completion Date: 03/17/2025 Responsible: Chief Executive Officer (CEO) and Chief Operating Officer (COO), Director of Nursing (DON), Human Resource Director (HR), and Administrator (LNFA) 6). Action: Staff will be reimbursed for their out-of-pocket expenses per usual procedures, including submitting reimbursement requests and receipts. The Human Resource Director (HR) will instruct line staff not to purchase items for the facility in the absence of the facility administrator; all purchases will be made by the facility administrator and/or the HR Director after the weekly Thursday conference call. Start Date: 03/14/2025 Completion Date: 03/17/2025 Responsible: Chief Executive Officer (CEO) and Chief Operating Officer (COO), Director of Nursing (DON), Human Resource Director (HR), and Administrator (LNFA) 7). Action: Annual van registration and insurance will be added to the annual maintenance checklist to ensure timely registration renewal; The facility administrator will review the yearly checklist during QAPI to ensure timely review. Start Date: 03/14/2025 Completion Date: 03/17/2025 Responsible: Maintenance Director and Facility Administrator 8). Action: An ad-hoc QAPI meeting will be held, and the facility Medical Director will be notified of the deficient practice and the approved removal plan. Action items will be reviewed monthly during the QAPI meetings for the next 3 months and ongoing as needed. Meeting minutes will be taken and maintained for 12 months. Start Date: 03/14/2025 Completion Date: 03/17/2025 Responsible: Chief Executive Officer (CEO) and Chief Operating Officer (COO), Director of Nursing (DON), Human Resource Director (HR), and Administrator (LNFA). Verification: Record review of receipt payment dated 01/28/25 to Water Department dated 1/28/25 for $1,579.21. Record review of receipt payment dated 01/29/25 reflected $1,141.08 to garbage and waste. Record review of receipt payment dated 02/20/25 to Water Department for $1,579.21 Record review of receipt dated 02/25/25 reflected $286.86 for ice machine payment. Observation on 2/27/25 at 3:46 pm revealed the fire sprinkler system with tag noted to have been serviced and working. In an Interview on 3/7/25 at 11:20am, Resident #1 stated she gets all of her medications as far as she knows and had no concerns. She stated she has her own cell phone so not affected. In an Interview on 03/7/25 at 11:22am, Resident #9 stated he gets all of his medications and has no concerns with care. In an observation on 03/7/25 at 11:55am, 9 residents were in the dining room. The menu was followed, and no food concerns were noted. In an observation on 03/10/25 at 9:20am, the kitchen had 7 days of non-perishable food and 3 days of perishable and no concerns were noted. In an Interview on 03/14/25 at 3:17pm, Resident # 11 stated she has access to her visitors and them to her and no concerns of anything about her care at the facility. In an Interview on 03/14/25 at 3:27pm, Resident #13 and Resident #10 stated they have access to their visitors and have no issues or concerns with their care and get their doctor appointments. A record review of the in-service titled Governing Responsibility dated 03/15/25 and signed by the CEO and COO reflected the importance of paying bills timely and the expectation of them to meet weekly on Thursdays to ensure bills are paid timely. Observation on 03/15/25 at 12:23pm revealed 9 residents in the dining room with no portion concerns. Food appears palatable and displayed well. Record review of the maintenance checklist on 03/16/25 at 3:15 pm revealed vehicle registration and insurance renewal was added annually with a next review date of March 14th, 2025. Record review of Medication Pass Observations for 5 nurses dated 3/16/25-3/19/25 for med pass observation by DON reflected medication pass observations were completed by the DON of her nurses. In an interview on 03/16/25 at 12:16 pm, the COO confirmed she had been in-serviced concerning bills must be paid in a timely manner and she is to meet weekly with the CEO and Human Resource Director weekly to review. In an interview on 03/16/25 at 1:27 pm, LVN E stated she had received 1:1 instruction from the DON on how to administer medications during an internet outage and how to obtain a copy of the paper MAR if one is not available. She said she had completed 2 in-services regarding medication administration and medication errors. In an interview and record review on 03/16/25 at 1:59 pm, the Human Resource Director stated she purchased additional data for the hot spots early today and provided a copy of the receipt dated 03/16/25 that indicated additional data purchased. The Human Resource Director provided the training sheet that was completed with the department heads on the process of communicating supply needs to be completed weekly. Human Resource Director said that 1:1 training with the department heads had been completed and they reviewed the process of communication for supply needs. She said she is to have a meeting weekly, on Thursdays, with the CEO and COO concerning supply needs of the facility. In an interview on 03/16/25 at 2:13 pm, the Human Resource Director confirmed weekly meetings were to be held with the CEO and COO on Thursdays to discuss billing and concerns. Record review/Observation on 03/16/25 at 2:45 pm of job website revealed the Administrator's position was posted for a salary up to $50,000 yearly with a sign on bonus. In an interview on 03/16/25 at 3:37 pm, the Maintenance Director stated he was given the task of monitoring supplies for the laundry weekly. He created a spread sheet weekly for the laundry staff to review needed supplies. Maintenance Director said he had the vehicle insurance and registration task added to his annual checklist. In an interview on 03/16/25 at 4:00 pm, the DON reported all the resident's representatives had been contacted regarding the temporary phone number for the facility and documented in the electronic record. The task was completed by the nurses as the Social Worker was not available. The DON said she was given the weekly responsibility to monitor supplies for nursing and is to have a meeting weekly with the CEO and COO on Thursdays. [TRUNCATED]

Based on interview and record review the facility failed to ensure the governing body of the facility had appointed an administrator, who is licensed by the state, to be responsible for the management of the facility and reports to the governing body, in that: The facility had not had an administrator since 12/20/2024. The governing body failed to provide the facility with enough money to keep up services including telephone service, internet service, food services, van registration/insurance, laundry services, and fire and security services. An Immediate Jeopardy was identified on 03/14/25 at 3:52 pm. The IJ template was provided to the facility on 3/14/25 at 3:52pm. While the Immediate Jeopardy was removed on 03/19/25 at 4:36 pm, the facility remained out of compliance at a scope of widespread and a severity level of no actual harm with potential for more than minimal harm because of the facility's need to evaluate the effectiveness of the corrective systems that were put into place. This deficient practice could place residents at risk of decreased quality of life and quality of care due to a lack of staff oversight and monitoring of care. The findings included: During an interview on 02/22/25 at 9:30 am, the DON said the facility had not had an Administrator since December 20, 2024. She said the only administrative staff at the facility were the DON and Human Resource Director. She said the facility had not been paying vendors. The phones/fax were not working. The staff had to utilize their own cell phones to conduct facility business. The facility is not able to send or receive faxes. A staff member bought a pre-paid cell phone, so the residents were able to call their family and vice versa. The staff went and bought milk, coffee, and hot chocolate for the residents, yesterday 02/21/25, due to the facility not having any for the residents. The ice machine was rented and was scheduled for repossession next Wednesday, 02/23/25 for non-payment. The nurses had purchased ink cartridges and paper so they can print out packets that need to be sent with the residents when they go out of the facility. Staff had purchased soap, bodywash, lotion, laundry soap, bleach, bread, gas for the van, and incontinent briefs for the residents. Record review of invoices provided by the Human Resource Director indicated unpaid balances for the following: 1. Telephone and internet vendor invoice dated 2/7/25- Past due balance of $16,985.35. The phone was disconnected on 02/07/25. Internet was disconnected on 03/03/25. 2. Energy vendor invoice dated 2/6/25 - Past due balance of $41,159.61 with a due date of 02/21/25. 3. Water vendor invoice undated - Past due balance of $5292.92 with a due date of 03/10/25. 4. Fire and Security vendor - Past due balance of $11,497.06 as of 03/12/25 - a total of 11 invoices dated 12/26/24 - 3/3/25. Account was suspended on 03/12/25 and 10-day termination notice was to be given. 5. Ice machine vendor invoice dated 2/1/25- Past due balance of $137.12 with a due date of 2/11/25 and ice machine to be picked up on 02/26/25 if not paid. 6. Milk vendor invoice dates from 8/7/24-12/31/24 (22 invoices)- Past due balance of $1,360.59. Delivery of milk stopped 01/07/25. 7. Garbage and waste vendor invoice dated 1/20/25- Past due balance of $1,141.08. Subject to service suspension and/or container removal. 9. Pharmacy Consultant invoice dated 1/27/25- Past due balance (not disclosed on invoice). Pharmacy services to be terminated on 02/24/25. 10. Insurance vendor for van undated- Policy cancelled effective date on 02/09/25 for non-payment. Amount unknown. In an interview on 02/22/25 at 11:15 am, [NAME] B said the facility had to substitute meals due to not having the required food for the menu. She said they attempt to make sure the residents received the correct nutritional value. She said at times, the facility did not have milk, bread, coffee, artificial sweetener. She said she had purchased ketchup, mustard, and artificial sweetener for the residents. In an interview on 02/22/25 at 11:30 am, the Maintenance Director stated he could not purchase supplies to fix things at the facility due to the facility having a past due balance at a local hardware store, approximately $7000. The facility had a past due balance with the vendor who services the dishwasher, washing machines and dryers and could not get maintenance services. He said the hot water heater for the laundry did not work and could not get it fixed. He stated that he purchased supplies out of his own pocket to fix things at the facility for the residents. He said the facility currently owed him $125 for supplies he recently purchased, and they have never paid him. In an interview on 02/22/25 at 01:45 PM with the Human Resource Director, she stated the facility phone was cut off on 02/07/25 and had never been turned back on. She said an anonymous staff member purchased a prepaid cell phone out of their own pocket on 02/10/25 so that the residents and their families could communicate with each other. She said the facility could not send or receive faxes. The staff were having to use their personal cell phones to conduct facility business. She said there was no acting interim and that her and the DON were covering. In an interview on 02/22/25 at 02:10 PM, Housekeeper C stated there was no hot water in the laundry and all laundry was being washed in cold water. She said the washing machine had no chemicals and needed to be serviced. She said staff had purchased bleach and laundry soap as the facility had not been purchasing those items due to not paying their bill. In an interview on 02/23/25 at 10:10 am, LVN D said that she bought out of her pocket soap, bodywash, lotion, ink, and paper for the printer. She said if she did not purchase these things the residents would go without. In an interview on 02/23/25 at 10:15 am, LVN E said that she purchased ink and paper for the printer. She said when a resident was sent out of the facility, they had to print a paper packet to go with them. She said due to the facility not having phone or fax services, she had to use her own cell phone to conduct facility business. She said the facility was unable to receive faxes from doctors and hospitals. She said the residents' families had expressed to her their frustration about not being able to contact the facility or their loved ones. In an interview on 02/23/25 at 10:50 am, the DON said she was aware the facility did not have hot water for the laundry. She said when a resident goes out of the facility, they had to print out a packet concerning the resident's information to be sent with them and the nurses had been buying the ink and paper for that. If they did not purchase the items, they would not be able to send out a packet the receiving facility was requesting. In an interview with the DON on 02/24/25 at 10:00 am and a record review of an e-mail dated 02/17/25 at 11:05 am from the Director of Nursing to the CEO, the DON requested Supplies and Payments: We are nearly out of essential supplies, including toilet paper. Could you confirm when the outstanding bills will be settled so that we can restock as needed? Petty Cash: Do we have an estimated timeline for the release of petty cash? Several team members have been using funds to address immediate building needs. Could you advise on the status of these items? The DON said the CEO never responded to the e-mail. In an interview on 02/24/25 at 10:45 am, the Dietary Manager stated the residents were budgeted $6 a day for breakfast, lunch, and dinner. She said that amount was not enough to purchase all the food items for the menus. As a result, the facility had to substitute items on the menu. An example for today at lunch, it called for hamburger meat but there wasn't enough money to purchase that, so it was substituted with another item on the menu that was chicken. She said she had purchased coffee, milk, artificial sweetener, and tea bags for the residents. In an interview on 02/24/25 at 11:00 am, the Laundry Supervisor stated there was no hot water for the laundry. The resident's laundry was being washed in cold water. She said the hot water heater had been out for over a month. She said the washing machine did not have the correct chemicals to sanitize the resident's laundry properly. She said the washing machine had an error code and needed to be serviced. She said the facility had not paid the bill to the servicer and they would not come to fix it. She said staff purchased bleach and laundry detergent as the facility did not provide laundry soap or bleach. She said she had purchased laundry supplies for the residents out of her own pocket. She stated it had been reported, and maintenance was aware. In an interview on 02/24/25 at 2:00 pm, the local Ombudsman reported it was difficult to contact the facility due to having no phone service. Individual facility staff had to be contacted. The ombudsman stated the facility staff had forwarded emails from the CEO and she stated they appeared demeaning and negative, but no specifics were provided. In an interview on 02/24/25 at 2:54 pm, the Maintenance Director stated the facility needed a new hot water heater for the laundry. He said the facility could not get anyone to come out and look at the hot water heater due to the facility owing everyone money. He said the washing machine could not be serviced due to an unpaid bill. He said the facility could not order the proper chemicals for the washing machine due to an unpaid bill. He said the CEO was aware. In an interview on 02/25/25 at 9:30 am, Resident #1's POA expressed her concern about the facility not having an Administrator in the building and questioned as if this caused a delay of Resident #1 being placed on hospice care requested on 02/16/25. In an interview with the Activity Director, on 02/25/25 at 11:23 am, stated she had purchased blow-up calendars for the activity bulletin board out of her own pocket and the facility would reimburse her. She said she purchased a calendar for January and the facility would not reimburse her. She said the facility owed her $30. She said she purchased BINGO winnings for the residents such as coke, candy, and popcorn out of her own pocket. If she did not, the residents would not have any BINGO winnings. In an interview on 02/25/25 at 12:00 pm, Facility Physician A said she was aware the facility was not paying its bills. She said it made communication very difficult as she could not send or receive faxes from the facility. She had to conduct business on staff's individual cell phones. In an interview on 02/25/25 at 1:35 pm, CNA F stated she had purchased soap and body wash for the residents so they could have a bath. In an interview with the CEO on 02/25/25 at 4:20 pm, he said don't worry about the utilities, they will not get shut off. I will not be able to keep up 30-day payments due to all the Medicaid in the facility and them not paying that much. He said he purchased the facility 6 months ago and it takes time to get everything switched over to a new account. He stated he was not going to pay any back service because he was not responsible for anything before, he bought the facility. He said the facility staff had not communicated to him about the food or lack of food, the best he can do is contact his purchase person. He said he was not aware the washing machine did not have hot water and needed to be serviced. The CEO said the Administrator job was posted on a job website. He said no one that had a license has applied. He said there was no interim administrator at the facility. He said the DON and Human Resource Director were running the facility. In an interview with the CEO on 02/25/25 at 4:55 pm, he stated he signed a new contract for electric vendor. He said the water bill was only 2 months behind and that it is not late enough to be shut off so that was fine. He said the Fire and Security vendor were still within terms and would complete repairs. He said he would get payment sent out tomorrow for the ice machine vendor. He said they had a new pharmacy consultant to start 02/26/25. In an interview with the Social Worker on 02/26/25 at 1:00 pm, she stated for the last 3 to 4 weeks, she had received calls from family members 2 to 3 times per week on her personal cell phone upset and worried due to the facility phone number not working. In an interview on 02/28/25 at 12:30 pm, the DON said possible negative outcomes of not having an Administrator was the facility was not being run effectively, making sure there were supplies in the building, and QAPI was not being done. In an interview on 03/07/25 at 10:00 am, the Human Resource Director said the internet was disconnected on 03/03/25 in the afternoon for non-payment. The facility did not have any internet service from 03/03/25 to the morning of 03/06/25. She stated the facility had insurance on the van and provided an invoice. In an interview on 03/07/25 at 11:25 am, the Activity Director said she was responsible for taking residents to doctor's appointments but had not taken them in February or March due to the van not having insurance or current tags. In an interview on 03/09/25 at 12:55 pm, the Dietary Manager said she had to substitute pot roast that was on the menu for chicken due to post roast being over $200. She said she did not have enough money to purchase the required food items on the menu. In an interview on 03/09/25 at 1:00 pm, LVN D and LVN E stated due to the internet being down, the nurses were not able to access the computer for medication administration. They stated the residents on the Yellow [NAME] Hallway did not have TV service due to the internet being out and the facility did not purchase a hot spot for that hallway. They reported the residents did not have any coffee today and they were going to go purchase some. In an observation on 03/09/25 at 1:15 pm, the facility van's tag displayed on the front windshield expired on 11/24. In an interview on 03/10/25 at 1:30 pm, the DON said due to the facility having no insurance on the van, 3 residents had missed their doctors' appointments. One resident missed a cardiology and nephrology appointment; 2 residents missed an appointment with their primary doctor and 2 residents have been taken to their appointments by their family. The DON said a potential negative outcome would be the residents would not receive the proper treatment they needed. In an interview on 03/10/25 at 10:16 am, this writer contacted the van insurance company from the invoice provided by the Human Resource Director and was informed the policy had been cancelled and was not active. In an interview on 03/10/25 at 10:45 am, the Dietician said she was concerned about the food budget and not enough money to cover the menu. She said she was not aware the facility had been substituting the menu as frequently as they were doing. She said the facility should not be having to substitute more than 2 meals a week. In an interview on 03/11/25 at 1:15 pm, the laundry supervisor said the facility was not using the recommended bleach or detergent for the laundry, and no alkaline was being used. One washing machine was not equipped anymore to receive chemicals and they wash items in that one that doesn't require bleach. She said it had been over 2 years since the washing machines had been serviced. She said as a result the laundry had the potential to not be sanitized properly. In an interview on 03/11/25 at 8:24 am, Facility Physician B stated it was very difficult to communicate with the facility due to no phone or fax service. He said a resident had an appointment with him yesterday, but it was cancelled. He was not aware it was cancelled due to the facility not being able to transport residents due to having no insurance on the facility van. In an interview on 3/12/25 at 12:00 pm, Facility Physician A said she was not aware residents missed doctor's appointments. She said the resident that missed his cardiology and nephrology appointments, those appointments would be considered important. She said the facility called her about Resident #2 that was having slight bleeding from her vaginal area: She said she asked the facility to bring the resident to her office, but was informed they could not due to no insurance on the van. She said as a result, she was going to go to the facility to evaluate her. In an interview and record review on 3/12/25 at 10:10 am, the DON provided documentation the van insurance policy was cancelled on 02/09/25. She said on 03/08/25, Resident #3 sustained a fall. The family requested her to be sent to the ER. Stated the family took her to the ER and left. The facility had to use the facility van to pick her up from the ER, although there was no insurance on the van. In an interview on 3/13/25 at 11:35 am, the DON said Resident #2 was being sent to the ER, via ambulance for a change in condition. She said Facility Physician #1 did not get to see her prior to being sent. This was determined to be an Immediate Jeopardy (IJ) on 03/14/25 at 3:52 pm. The DON and Human Resource Director were notified. The DON was provided with the IJ template on 03/14/25 at 3:52 pm. The following Plan of Removal was submitted by the facility and accepted on 03/17/25 at 12:47 pm and included: The facility needs to take immediate action to ensure there is a plan for vendors to be paid timely, so services are not rescinded, and residents have the services required for the highest practicable physical, mental, and psychosocial well-being of each resident. Plan of Removal 1). Action: The Chief Executive Officer (CEO) and Managing Partner re-educated the Chief Operating Officer (COO) on the governing board responsibility to ensure management and operation of the facility; emphasis was stressed on the importance of providing oversight of facility care and services in accordance with professional standards of practice and principles, to ensure there is a plan for vendors to be paid timely, so services are not rescinded and residents have the services required for the highest practicable physical, mental, and psychosocial well-being of each resident. The mode of education was in the form of a one-on-one meeting and memo - a copy of the Policy and Procedures entitled Administrative Management (Governing Board). The teach-back method was used to assess comprehension. Start Date: 03/14/2025 Completion Date: 03/14/2025 Responsible: Chief Executive Officer (CEO) and Managing Partner 2). Action: The Chief Executive Officer (CEO) and Chief Operating Officer (COO) will meet to review and make payments or payment arrangements for: 1. Telephone and internet vendor on 03/13/2025, $10,000.00 was paid, the remaining payment was made on 3/17/25 in the amount of $7987.28, the amount told to us from the company to activate service.; 2. Insurance vendor for the facility van has been paid in the amount of $141.99 on 3/11/25. 3. Registration tags for the facility van was paid on 3.17.25 in the amount of $74.00 to County Tax Office. 4. Fire and security vendor - have confirmed that we are not on hold and have sent an email confirming so on 3.14.25. If the internet is out, the emergency plan to ensure the staff have access to MARs and TARs will be to use the Hot spots for internet. Until Telephone and internet have been restored, while these are out, the facility will continue to use mobile phone and internet Hot Spots to communicate and document as required to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. If the hot spots are not working, the DON was educated on the need to obtain paper-printed MARs and TARs from the pharmacy to be delivered on the medication run if no internet is available and printing abilities are not available locally. The facility Social Worker will call each family to share the mobile phone number if/when needed. The Activity Director will complete resident interviews to identify residents affected by phone interruption and share with them the availability of mobile phone if needed to communicate to people outside the facility. The facility's Human Resource Director will contact the facility's vendors to share the phone number if/when required. To prevent future service interruptions, the Chief Executive Officer (CEO) and Chief Operating Officer (COO) will meet monthly to review the facility's outstanding invoices and ensure vendors to be paid timely, so services are not rescinded, and residents have the services required for the highest practicable physical, mental, and psychosocial well-being of each resident. Start Date: 03/14/2025 Completion Date: 03/17/2025 Responsible: Chief Executive Officer (CEO) and Chief Operating Officer (COO) 3). Action: The Director of Nursing (DON) will complete a Medication Error Form for each of the identified 11 residents in which medication were given at a different time or omission occurred; the form includes communicating with the medical provider, the responsible party, facility management and pharmacist consultant, in addition to type of error and reason for error (Examples of medications errors include: a. Omission - a drug is ordered but not administered; b. Unauthorized drug - a drug is administered without a physician's order; c. Wrong dose (e.g., Dilantin 12 mL ordered, Dilantin 2 mL given); d. Wrong route of administration (e.g., ear drops given in eye); e. Wrong dosage form (e.g., liquid ordered, capsule given); f. Wrong drug (e.g., vibramycin ordered, vancomycin given); g. Wrong time; and the corrective action taken and measures to prevent similar error(s) recurrence. The Director of Nursing reviewed the other resident's Medication Administration Records (MARs) and did not reveal further discrepancies or errors. The Chief Nursing Officer (CNO) will confirm completion of Medication Error Forms. Start Date: 03/14/2025 Completion Date: 03/17/2025 Responsible: Director of Nursing (DON), Chief Nursing Officer (CNO) 4). Action: The Director of Nursing (DON) will re-educate nurses (RN/s/LVNs) and certified medication aides (CMAs) on the facility's policies: Administering Medications and Medication Errors - the different types and immediate actions to take to prevent adverse consequences. The mode of education will be in the form of a one-on-one meeting and memo - a copy of the Policy and Procedures entitled Administering Medications and Adverse Consequences and Medications Errors. The teach-back method was used to assess comprehension. To evaluate further understanding, the Director of Nursing will complete a weekly Medication Pass Observation to each nurse and medication aide for the next 4 weeks and quarterly thereafter. Education is done as well regarding obtaining MARs and TARs from the pharmacy to be delivered on the medication run if no internet is available. Facility will have the hotspots that were purchased available to use if the main internet is to stop working until pharmacy deliver paper MARS and TARs. In the absence of the DON, the Chief Nursing Officer (CNO) will request paper-printed MARs and TARs from the pharmacy vendor. Start Date: 03/14/2025. Completion Date: 03/17/2025 Responsible: Director of Nursing (DON), Chief Nursing Officer (CNO) 5). Action: The Chief Executive Officer (CEO) and Chief Operating Officer (COO) will post the facility's administrator's vacant position and continue active recruitment to fill the facility administrator's vacant position. With a sign on bonus posted on 3.15.25. Until the position is filled, all items needed for resident care are to be communicated to the facility's Director of Nursing (DON), as for ancillary services, such as dietary and environmental services, are to be communicated to the facility's Human Resource Director, Both - DON and HR Director will participate in a conference call with the Chief Executive Officer (CEO) and Chief Operating Officer (COO) weekly on Thursdays at 11 am that arrangements can be made to ensure there is a plan for vendors to be paid timely, so services are not rescinded and residents have the services required for the highest practicable physical, mental, and psychosocial well-being of each resident. This conference call will continue weekly with the new administrator once onboarded and the weekly minutes reviewed monthly during the facility's monthly QAPI to determine if changes in needed supplies, their quantity and/or delivery dates are required in order to be altered to ensure timely ordering and delivery. Items to be reviewed weekly will include food needed for the menu, milk, coffee, tea, artificial sweetener, hot chocolate, snacks, condiments, soap, shampoo, conditioner, lotion, laundry soap, bleach, ink for printers, paper for printers, chemicals for laundry, and gas for the van, along with routine service needs/requests for the dishwasher, washing machine, and dryer. Staff will be educated on 3.17.25 by HR that when a facility or resident need related to supplies and vendor payments to communicate with HR who will review supply and ensure supply is replenished before the item runs out. Laundry staff were educated by HR that when chemical supply becomes low to notify HR who will ensure supply is replenished prior to running out. Maintenance director will be educated on 3.17.25 to monitor once a week the supply visually and discuss with staff on site the supply level to see if additional chemicals need to be ordered and will communicate to HR. Department heads will be educated on 3.17.25 by HR that each department head will monitor its supplies once a week and communicate to HR any items needed. Maintenance director will do housekeeping and laundry, DON will do nursing, HR will do office supplies. Start Date: 03/14/2025. Completion Date: 03/17/2025 Responsible: Chief Executive Officer (CEO) and Chief Operating Officer (COO), Director of Nursing (DON), Human Resource Director (HR), and Administrator (LNFA) 6). Action: Staff will be reimbursed for their out-of-pocket expenses per usual procedures, including submitting reimbursement requests and receipts. The Human Resource Director (HR) will instruct line staff not to purchase items for the facility in the absence of the facility administrator; all purchases will be made by the facility administrator and/or the HR Director after the weekly Thursday conference call. Start Date: 03/14/2025 Completion Date: 03/17/2025 Responsible: Chief Executive Officer (CEO) and Chief Operating Officer (COO), Director of Nursing (DON), Human Resource Director (HR), and Administrator (LNFA) 7). Action: Annual van registration and insurance will be added to the annual maintenance checklist to ensure timely registration renewal; The facility administrator will review the yearly checklist during QAPI to ensure timely review. Start Date: 03/14/2025 Completion Date: 03/17/2025 Responsible: Maintenance Director and Facility Administrator 8). Action: An ad-hoc QAPI meeting will be held, and the facility Medical Director will be notified of the deficient practice and the approved removal plan. Action items will be reviewed monthly during the QAPI meetings for the next 3 months and ongoing as needed. Meeting minutes will be taken and maintained for 12 months. Start Date: 03/14/2025 Completion Date: 03/17/2025 Responsible: Chief Executive Officer (CEO) and Chief Operating Officer (COO), Director of Nursing (DON), Human Resource Director (HR), and Administrator (LNFA). Verification: Record review of receipt payment dated 01/28/25 to Water Department dated 1/28/25 for $1,579.21. Record review of receipt payment dated 01/29/25 reflected $1,141.08 to garbage and waste. Record review of receipt payment dated 02/20/25 to Water Department for $1,579.21 Record review of receipt dated 02/25/25 reflected $286.86 for ice machine payment. Observation on 2/27/25 at 3:46 pm revealed the fire sprinkler system with tag noted to have been serviced and working. In an Interview on 3/7/25 at 11:20am, Resident #1 stated she gets all of her medications as far as she knows and had no concerns. She stated she has her own cell phone so not affected. In an Interview on 03/7/25 at 11:22am, Resident #9 stated he gets all of his medications and has no concerns with care. In an observation on 03/7/25 at 11:55am, 9 residents were in the dining room. The menu was followed, and no food concerns were noted. In an observation on 03/10/25 at 9:20am, the kitchen had 7 days of non-perishable food and 3 days of perishable and no concerns were noted. In an Interview on 03/14/25 at 3:17pm, Resident # 11 stated she has access to her visitors and them to her and no concerns of anything about her care at the facility. In an Interview on 03/14/25 at 3:27pm, Resident #13 and Resident #10 stated they have access to their visitors and have no issues or concerns with their care and get their doctor appointments. A record review of the in-service titled Governing Responsibility dated 03/15/25 and signed by the CEO and COO reflected the importance of paying bills timely and the expectation of them to meet weekly on Thursdays to ensure bills are paid timely. Observation on 03/15/25 at 12:23pm revealed 9 residents in the dining room with no portion concerns. Food appears palatable and displayed well. Record review of the maintenance checklist on 03/16/25 at 3:15 pm revealed vehicle registration and insurance renewal was added annually with a next review date of March 14th, 2025. Record review of Medication Pass Observations for 5 nurses dated 3/16/25-3/19/25 for med pass observation by DON reflected medication pass observations were completed by the DON of her nurses. In an interview on 03/16/25 at 12:16 pm, the COO confirmed she had been in-serviced concerning bills must be paid in a timely manner and she is to meet weekly with the CEO and Human Resource Director weekly to review. In an interview on 03/16/25 at 1:27 pm, LVN E stated she had received 1:1 instruction from the DON on how to administer medications during an internet outage and how to obtain a copy of the paper MAR if one is not available. She said she had completed 2 in-services regarding medication administration and medication errors. In an interview and record review on 03/16/25 at 1:59 pm, the Human Resource Director stated she purchased additional data for the hot spots early today and provided a copy of the receipt dated 03/16/25 that indicated additional data purchased. The Human Resource Director provided the training sheet that was completed with the department heads on the process of communicating supply needs to be completed weekly. Human Resource Director said that 1:1 training with the department heads had been completed and they reviewed the process of communication for supply needs. She said she is to have a meeting weekly, on Thursdays, with the CEO and COO concerning supply needs of the facility. In an interview on 03/16/25 at 2:13 pm, the Human Resource Director confirmed weekly meetings were to be held with the CEO and COO on Thursdays to discuss billing and concerns. Record review/Observation on 03/16/25 at 2:45 pm of job website revealed the Administrator's position was posted for a salary up to $50,000 yearly with a sign on bonus. In an interview on 03/16/25 at 3:37 pm, the Maintenance Director stated he was given the task of monitoring supplies for the laundry weekly. He created a spread sheet weekly for the laundry staff to review needed supplies. Maintenance Director said he had the vehicle insurance and registration task added to his annual checklist. In an interview on 03/16/25 at 4:00 pm, the DON reported all the resident's representatives had been contacted regarding the temporary phone number for the facility and documented in the electronic record. The task[TRUNCATED]