FREEDOM OF INFORMATION REPORT Facility Information Permit: Audit Information CRC-1428 F a c i l i t y N a m e : SWEETGRASS COURT SENIOR LIVING COMMUNITY Address: 1010 ANNA KNAPP BLVD C i t y / S t a t e / Z i p : MOUNT PLEASANT, SC 29464-5400 Charleston Phone 1: 843-971-7756 Email: LICENSING@5SSL.COM Audit Name: CRC GENERAL ROV 20161020 Type: L07 Investigation Start Date: 11 Apr 2017 08:30 AM End Date: 11 Apr 2017 10:45 AM Inspector: Erika Edwards C o n t a c t N a m e : KELLY CARLETON C o n t a c t E m a i l : null C o n t a c t P h o n e : 843-556-4100                                                                            Overall Score 0.0%                                                                           Report Notice Question ID NOTICE01 Question Bureau of Health Facilities Licensing 2600 Bull St Columbia SC 29201-1708 Answer Report Notice REPORT NOTICE: If applicable, this Report of Visit includes a detailed description of the conditions, conduct or practices that were found to be in violation of requirements. This inspection or investigation is not to be construed as a check of every condition that may exist, nor does it relieve the licensee (owner) from the need to meet all applicable standards, regulations and laws. The South Carolina Code of Laws requires this Department to establish and enforce basic standards for the licensure (permitting), maintenance, and operation of health facilities and services to ensure the safe and adequate treatment of persons served in this State. It also empowers the Department to require reports and make inspections and investigations as considered necessary. Furthermore, the Code authorizes the Department to deny, suspend, or revoke licenses (permits) or to assess a monetary penalty against a person or facility for (among other reasons), violating a provision of law or departmental regulations or conduct or practices detrimental to the health or safety of patients, residents, clients, or employees of a facility or service. If applicable to the type of report being made, the signature of the activity representative indicates that all of the items cited were reviewed during the exit discussion. If this Report of Visit is required by regulation to be made available in a conspicuous place in a public area within the facility, redaction of the names of those individuals in the report is required as provided by Sections 44-7-310 and 44-7-315 of the S.C. Code of Laws, 1976, as amended. Administrator's Signature - Plan of Correction Question ID SIGN01 Question PLAN OF CORRECTION - Administrators Certification: I certify that the attached plan of correction describes: (1) the actions taken to correct each cited deficiency, (2) the actions taken to prevent similar recurrences, and Answer POC REQUIRED (3) the actual or expected completion dates of those actions. PRINT NAME:__________________________________________________________________________ TITLE:_______________________________________________________________________________ SIGNATURE:___________________________________________________________________________ DATE:________________________________________ Any violations cited in this report of visit were observed at the time of the inspection. The Administrator submits an electronic plan of correction by visiting the website http://www.scdhec.gov/Health /FHPF/HealthFacilityRegulationsLicensing/HealthcareFacilityLicensing/CorrectionPlan/ and following the instructions online. Or the Administrator returns a copy of this report (original signature required) with description of corrective actions to: SCDHEC, Bureau of Health Facilities Licensing, 2600 Bull St, Columbia, SC, 29201 Your response to this report must be received in our office by close of business (5:00 p.m.) no later than the date listed below: Comments     •   The Plan of Correction (POC) is due 15 days from receipt of this Report of Visit (ROV). Inspection Information Question ID COMBO-LIC Question Inspection Includes Licensing: Answer YES COMBO-FOOD Inspection Includes Food/Sanitation: NO COMBO-FLSC Inspection Includes Fire & Life Safety: NO ONSITE Is this an On-Site Visit? YES INSP Select the Type of Inspection to be Performed: COMPL-01 Section Team Log Number: Comments     •   C04005-17 COMPL-03 Reason for Investigation: Comments     •   CRCF Investigation Section Team Log Number Reason for Investigation: A complaint (#C04005-17) was received by the Department on 4/4/17. The complaint alleged that: 1. A incident of verbal abuse was reported. It was further reported that a video tape was circulating capturing this abuse. Verbal abuse happen on between midnight and 2:00 am. The administrator admitted the incident, saying that a video tape of the abuse was sent to a member of their Corporate Staff. The Administrator suspended the two alleged perpetrators on the spot. COMPL-04 What is the Source: SC Governor's Office of Ombudsman COMPL-10 Date Agency (DHEC) Notified: Comments Date Agency (DHEC) Notified:     •   4/4/17 COMPL-05 Detailed Results of this Investigation: Comments     •   Detailed Results To investigate this complaint, an unannounced on-site visit was made to the facility by a representative of the Department. The investigation consisted of the following: (1). A review of the facility's investigation of an abuse incident to include statements, incident reports, and employee disciplinary forms. As a result of this investigation, the following violations of S.C. Code Ann Regulation 61-84 (Supp. 2016), Standards for Licensing Residential Care Facilities, were cited. COMPL98 Is this an Unlicensed Facility/Activity Complaint? NO COMPL-06 Has the Initial QI Review Been Completed? NO VERIFY02 Is the Current Facility/Activity Administrator the same as the Administrator of Record? YES INSP04 Are there any other individuals accompanying the auditor for this visit? NO CRCF Regulation Sections 100-800 61-84 Question ID R-61-84-601.D Question Answer 601.D. A facility shall submit a written report of its investigation of every serious accident and/or incident to the Department within five (5) days of the serious accident and/or incident. A facility’s written report to the Department shall provide at a minimum: 1. Facility name; 2. License number; 3. Type of accident and/or incident; 4. Date accident and/or incident occurred; 5. Number of residents directly injured or affected; 6. Resident record number or last four (4) digits of Social Security Number; 7. Resident age and sex; 8. Number of staff directly injured or affected; 9. Number of visitors directly injured or affected; 10. Name(s) of witness(es); 11. Identified cause of accident and/or incident; 12. Internal investigation results if cause unknown; and 13. Brief description of the accident and/or incident including the location of occurrence and treatment of injuries. (Class III Violation) Comments OUT     •   The facility did not submit a written report of its investigation of a serious accident and/or incident to the Department within five (5) days of the occurrence of the serious accident and/or incident. Incident reports dated documented that around 12:30am staff members A and B were observed being verbally abusive towards Residents A and B. The verbal abuse was recorded and observed on social media (Snap Chat). Both staff members were immediately remove from the facility and terminated. R-61-84-601.H. 601.H. The administrator or his or her designee shall report abuse and suspected abuse, neglect, or exploitation of residents to the South Carolina Long-Term Care Ombudsman Program in accordance with 1976 Code Section 43-35-25. (Class III Violation) Comments     •   OUT The facility did not report confirmed verbal abuse to the South Carolina Long-term Care Ombudsman Program in accordance with 1976 Code Section 43-35-25. Incident reports dated documented that around 12:30am staff members A and B were observed being verbally abusive towards Residents A and B. The verbal abuse was recorded and observed on social media (Snap Chat). Both staff members were immediately remove from the facility and terminated. CRCF Regulation Sections 900-1800 61-84 Question ID Question Answer R-61-84-1001.A. 1001.A. The facility shall comply with all current Federal, State, and local laws and regulations concerning resident care, resident rights and protections, and privacy and disclosure requirements, e.g., 1976 Section 44-81-10, et seq., Resident’s Bill of Rights, Alzheimer’s Special Care Disclosure Act, and the Omnibus Adult Protection Act notice, 1976 Code Section 43-35-5, et seq. (Class I Violation) Comments     •   OUT The facility staff did not comply with current laws and reguations concerning resident care, resident rights and protections, and privacy and disclosure requirements, e.g., 1976 Section 44-81-10, et seq., Resident’s Bill of Rights; Section 44-81-40.(G) Each resident must be free from mental and physical abuse and free from chemical and physical restraints except those restraints ordered by a physician. An incident report dated documented that Staff members A and B were observed being verbally abusive to Residents A and B. An investigatory Interview Form dated documented that Staff member A stated that s/he uploaded the snapchat video on social media on between 1am and 2am for fun with another employee. Record Retention Question ID RETENTION Question DHEC 0282 (05/2010) AUDIT - [Records Retention Schedule #SBH-F&S-17] Answer Retention