4orc."

VERMONT

AGENCY OF HUMAN SERVICES

DEPARTMENT OF DISABILITIES, AGING AND INDEPENDENT LIVING

Division of Licensing and Protection
HC 2 South, 280 State Drive
Waterbury, VT 05671-2060
http://www.dail.vermont.gov
Survey and Certification Voice/TTY (802) 241-0480
Survey and Certification Fax (802) 241-0343
Survey and Certification Reporting Line: (888) 700-5330
To Report Adult Abuse: (800) 564-1612
September 12, 2018

Ms. Brenda Scalabrini, Administrator
Lincoln House
120 Hill Street
Barre, VT 05641-3915

Dear Ms. Scalabrini:
Enclosed is a copy of your acceptable plans of correction for the survey conducted on July
17, 2018. Please post this document in a prominent place in your facility.
We may follow-up to verify that substantial compliance has been achieved and maintained. If
we find that your facility has failed to achieve or maintain substantial compliance, remedies
may be imposed.
Sincerely,

e_v„Laviiet4o3
Pamela M. Cota, RN
Licensing Chief

Disability and Aging Services
Licensing and Protection

Blind and Visually Imparied
Vocational Rehabilitation

 130/141P2018 16: 00
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 07/30/2018 12:02

802-476-3349

LINCOLN HOUSE

PRINTED: 07/25/2018
FORM APPROVED

Division of Licensing and Protection
sTATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION

(Xi) PROVIDER/SUPPLIER/CUR
IDENTIFICATION NUMBER:

1X2) MULTIPLE CONSTRUCTION
A. BUILDING:

0175
NAME OF PROVIDER OR

SUPPLIER

LINCOLN HOUSE
(X4) ID
PREFIX
TAG ,

PAGE 05/13

tX3) DATE SURVEY
COMPLETED

C
07/17/2018

B. WING
STREET ADDRESS, CITY, STATE, ZIP

CODE

120 HILL STREET
BARRE, VT 05641

SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY MUST BE PRECEDED BY FULL
REGULATORY OR LSO IDENTIFYING INFORMATION)

ID
PREFIX

TAG

8145 Continued From page 1

PROVIDER'S PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE
CROSS•. REFERENCED TO THE. APPROPRIATE
ORFICIqNCY) •

(X5)
COMPLETE
• OATS

R145

will be provided if prescribed by your physician
and/ or when diagnosis indicates this".
The inconsistency between Resident #2's Care
Plan and recorded dietary restriction was
reviewed with the Residence Administrator on the
afternoon of 7/17/4)18.
R18$ V, RESIDENT CARE AND HOME SERVICES
SS=0

f R168

5.10 Medication Management
5,10.d If a resident requires medication
administration, unlicensed staff may administer
medications under the following conditions:
(6) Insulin. Staff other than a nurse may
administer insulin injections only when:
The diabetic resident's condition and
medication regimen is considered stable by the
registered nurse who is responsible for
delegating the administration; and
ii, The designated staff to administer insulin to
the resident have received additional training in
the administration of insulin, including return
demonstration, and the registered nurse has
deemed them competent and documented that
assessment; and
The registered nurse monitors the resident's
condition regularly and is• available when changes
in condition or medication might Occur,

This REQUIREMENT is not met as evidenced
by:
Based on staff interview and record review, the
oluieinn of I

ICAA..:■ :j

STATE FORM

and Protectlan
60to

OTP P 11.

1r conlIquallorkOeCt 2 Of 9

 07/30/2018 12:02

LINCOLN HOUSE

802 -476 -3349

PRINTED: 07/25/2018
FORM APPROVED

Division of Licensing and Protection
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION

(Xi) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:

(X2) MULTIPI,E CONSTRUCTION
A. BUILDING:

0 175

07/17/2018

STREETAD MESS, CITY, STATE. ZIP CODE

U NCOLN HOUSE

120 HILL STREET
BARRE, VT 05641

SUMMARY STATEMENT OF DEFICIENCIES
.
(EACH DEFICIENCY MUST BE PRECEDED. BY FuLL
REGULATORY OR LSO IDENTIFYING INFORMATION)

R168 Continued From page 2

1

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COMPLETED

C

B. WING

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PAGE 06/13

.1
I

PROVIDER'S PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE
CROSS-REFERENCED TO THE APPROPRIATE
DEFICIENCY)

(X3
COMPLETE
DATE

I R168

residence failed to ensure that all Residential
Care Home Regulation requirements were met
prior to the administration of insulin by unlicensed •
staff for one out of two residents in the sample
(Resident #1) Findings include:
Resident #1 was admitted to the residence in
April 2018, Per physician summary note dated
2/15/2018, "control of his/her blood sugars has
been problematic for a long time". Upon review
of medication orders, Resident #1's order for
Lantus (insulin) was changed by the physician
three times between 6/8/2018 and 7/12/2018.
Resident #1 has physician orders for blood
glucose monitoring twice a day. Per review of the
blood glucose monitoring log, there were 12
blood glucose measurements In the high range of
300-400 mg/d1 between 6/24/2018 and
7/14/2018. While the Personal Care Attendants
were obtaining and documenting blood glucose
measurements, and administrating daily insulin,
there was no evidence that an assessment by the
Registered Nurse had been completed after
Resident #1's medication changes. There was
no evidence of an-assessment by the Registered
Nurse reflecting the resident's condition and
diabetes care, or a determination of Resident #1's 1
condition to be stable. Resident #1's care plan
states s/her is on a Consistent Carbohydrate
Diet, however there was no evidence in the
record that this diet was being implemented:
The lack of an assessment by a Registered
Nurse for a resident with diabetes prior to the.
administration of insulin by unlicensed staff was
reviewed with the Residence Administrator on the
afternoon of 7/17/2018.

Division of Licensing and Protection
STATE FORM

OTPP 11

IT continuation sneel 3 of 9

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802-476-3349

PRINTED: 07/25/2018
FORM APPROVED

Division of Licensing and Protection
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER;

0175

(X2) MULTIPLE! CONSTRUCTION
A: BUILDING:

07/17/2018

STREET ADDRESS, CITY, STATE, ZIP CODE

LINCOLN HOUSE

120 HILL STREET.
BARRE, VI 056a1

(X4) ID

TAG

SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY MUST BE PRECEDED BY FULL
REGULATORY OR 1.80 IDENTIFYING INFORMATION)

ID
PREFIX i
TAG

R181 I Continued From page 3

R181

R181 V RESIDENT CARE AND HOME SERVICES
SS=E

R181

P:31 DATE SURVEY. .
COMPLETED
C

B. WING

NAME OF PROVIDER OR SUPPLIER

PREFIX

PAGE 07/13

. PROVIDER'S PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE
CROSS-REFERENCED TO. THE APPROPRIATE
DEFICIENCY)

i

(XS)
COMPLETE
DATE

5.11 Staff Services
5.11.d The licensee shall not have on staff a
person who has had a charge of abuse, neglect
or'exploitation substantiated against him or her,
as defined in 33 V.S.A. Chapters 49 and 69, or
one who has been convicted of an offense for
actions related to bodily injury, theft or misuse of
funds or property, or other crimes inimical to the
public welfare, in any jurisdiction whether within
or outside of the State of Vermont. This provision
shall apply to the manager of the home as well,
regardless of whether the manager is the
licensee or 'not. The licensee shall take all
reasonable steps to comply with this requirement,
including, but not limited to, obtaining and
checking personal and work references and
contacting the Division of Licensing and
Protection in accordance with 33 V.S.A. §6911 tO
see if prospective employees are on the abuse
registry or have a record of convictions.
This REQUIREMENT is rennet as evidenced .
by:
Based on observation and staff interview, the
residence failed to ensure that the conditions of a
variance-for an employee with convictions of
crimes inimical to the public welfare were met,
This has the potential to effect all residents,
Findings include:
During an environmental tour on 7117/2018, Staff
#1 was observed to be in the kitchen preparing
and providing meal service while residents were
in the adjoining dining room. Per record review,
Staff #1 has a variance requiring direct
of Licensing and. Protection
STATE PORN,

imp

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i__Division of Licensing and FrotectiOn
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION

PAGE 08/13

(X1) PROVIDER/SUPPLIER/WA
IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION
A. BUILDING:

0175

(X3) DATE SURVEY
COMPLETED
C

B. WING

•

NAME OF PROVIDER OR SUPPLIER

STREET ADORES3, CITY, STATE, ZIP CODE

LINCOLN HOUSE

120 HILL STREET

07/17/2018

BARRE, VT 05641
(X4) ID
PREFIX
TAG

SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY MUST $E PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)

ID
PREFIX I
TAG
I

8181 Continued From page 4

PROVIDER'S PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE
CROSS-REFERENCED TO THE APPROPRIATE
DEFICIENCY)

(X5I
COMPLETE
DATE

R181

supervision by an employee with supervisory
'authority whenever Staff #1 has contact with
residents Of the home, The Residence
Administrator was unable to provide evidence on
7/17/2018 that the variance had been updated or
rescinded by the state licensing agency.
R213 VI. RESIDENTS' RIGHTS
SS=E

l R213

6.1 Every resident shall be treated with
Consideration, respect and full recognition of the
resident's dignity, individuality, and privacy, A
home may not ask a resident to waive the
resident's rights.

This REQUIREMENT is net met as evidenced
by:
Based on interviews, the residence failed to
ensure that all residents were treated with
consideration and respect for two applicable
residents (anonymous Resident A and
anonymous Resident 8). This has the potential to
effect all residents in the home. Findings include:
Anonymous Witness #A stated in a phone
interview on 7/16/2018 that Staff #1 had refused
to provide Resident A with an additional serving of.
food, which was being offered to other residents
during a meal. During an interview on 7/17/2018,
Resident A stated that on 7/15/2018 Staff#1
offered other residents at the table additional
servings of food without offering Resident A any.
Per interview, Resident A had stated, "You didn't
offer me any" and Staff #1 replied, "Not if I can
I help it" and turned and walked away from the
table to the kitchen.
vi clOn5uU y aI Iv nurct,on
STATE FORM

609!,

OTPP11

If contInuairon Sheet 5 of g

 @7/30/2018 12:02

LINCOLN HOUSE

802-476-3349

PRINTED; 07/25/2018
FORM APPROVED

Division of Licensing and Protection
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER;

(X2) MULTIPLE CONSTRUCTION
A. BUILDING:

LINCOLN HOUSE
01:0I0
PREFIX
TAG

(Xa) DATE SURVEY
COMPLETED

C
07/1712018

B. WING

0175
NAME OF PROVIDER OR SUPPLIER

PAGE 09/13

STREET AD TRESS, CITY, STATE, ZIP CODE

' 120 HILL STREET
BARRE, VT 05641

SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY MUST 13E PRECEDED 13), FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)

.

R213 Continued From page 5

ti)
PREFIX
TAG

f

PROVIDER'S PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE •
CROSS-REFERENCE0 TO THE APPROPRIATE
DEFICIENCY)

.(XS)
COMPL E TE .
DATE

R213

Per interview on 7/17/2018, Resident A Went to
the kitchen prior to breakfast service on the
morning of 7/6/2018 and requested a muffin from
Staff #1 due to their early departure for an
appointment. Per interview with Resident A,
Staff #1 "ignored and refused tb talk to me" in
response to the request. Anonymbus Witness #6
observed and confirmed the interactions between
Staff #1 and Resident A. Resident A stated the
interactions with Staff #1, "left me feeling angry, it
bothers me and other residents",
During interviews on 7/16/2018 and 7/17/2018,
anonymous Witness A and anonymous Witness
B stated that Staff #1 "doesn't like a few people
(residents)". Staff #1 behaves in ways that
appear, "spiteful toward certain residents". Per
witness interview, residents will receive different
portions of food from Stiff #1, and will receive a
smaller serving if Staff #1 knows it is a preferred'
food for a particular resident, Per interview,
Resident A states s/he "enjoys bacon on
Wednesdays" and receives smaller portions than
other residents at their table. Witnesses
confirmed Staff #1 gives Resident A fewer pieces
of bacon when served.
Witness A and Witness B stated in interviews on
7/16/2018 and 7/17/2018 that Staff #1 put
excessive amounts of condiments on Resident
B's sandwich when a sandwich is requested as
an alternative meal. Per interview, witnesses
have repeatedly observed Resident B requesting
a "small amount" of condiment on a sandwich, •
and Staff #1 will "put on so much mustard its
unappealing and inedible". Witnesses have
observed the resident scraping condiments off
their bread and onto their plate prior to eating.
After describing the above interactionS, Witness
Division of Licensing and Protection
STATE FORM

59!,

OTPPil

Ir continvotion she 5 or g

 07/30/2018 12:02

LINCOLN HOUSE

802-476-3349

PRINTED; 07/25/2018
FORM APPROVED

Division of Licensin• and Protection
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION

(XD PROMER/SUPPLIF.R/CLIA
IDENTIFICATION NUMBER:

0175

(X2) MULTIPLE CONSTRUCTION
A. BUILDING:

C
07/17/2018

STREET ADDRESS., CITY. STATE. ZIP CODE

LINCOLN HOUSE

120 HILL STREET
BARRE?,

R213

SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY MUST BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)

Continued From page 6

•
B stated the residents, "don't feet safe". Per
interview, Resident A described Staff #1's
behavior as, "unprofessional, abusive and
disrespectful", The Residence Administrator was
informed of the reported above interactions
between Resident A and Staff #1 on the afternoon
of 7/17/2018. The Residence Administrator
denied knowledge of unprofessional actions or
job performance issues with Staff #1.
R236
SS=A

(X3) DATE SURVEY
COMPLETED

B. WING

NAME OF PROVIDER OR SUPPLIER

(X4) 10
PREFIX
TAG

PAGE 10/13

VII. NUTRITION AND FOOD SERVICES

VT 05641
ID
PREFIX
TAG

PROVIDERS PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE
CROSS-REFERENCED TO THE APPROPRIATE
DEFICIENCY)

(X5)
COMPLETE
DATE

R213

i R230

7.1.a. (5) The home shall keep menus, including
any substitutions, for the previous month on file
and available for examination by the licensing
agency.
This REQUIREMENT is not met as evidenced
by:
Based on staff interview and documentation
review, the residence failed to keep menus for
the period of time required by the Residential
Care Home Regulations. Findings include;
The Residence Administrator stated that one
month of menus was not available when
requested by the Nurse Surveyor on 7/17/2018.
The Administrator provided only the menu for the
week of 7/16/2018-7/22/2018.
R247 VII, NUTRITION AND FOOD SERVICES

R247

7.2 Food Safety and Sanitation
7.2.b All perishable food and drink shall be
labeled, dated and held at proper temperatures:
(1) At or below 40 degrees Fahrenheit. (2) At or
rlIsphninn of Lice
I
nsing
STATE FORM

NI

Pr otection
.0TPP1I

if continuation .shest 7 of 9

 07/30/2018 12:02

802-476-3349

LINCOLN HOUSE

PRINTED: 07425/2018
FORM APPROVED

Division of Licensing and Protection
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPUER/CLIA
IDENTIFICATION NUMBER:

0(2) MULTIPLE CONSTRUCTION
A. BUILDING:

NAME OF PROVIDER OR SUPPLIER

STREET Aoorless, CITY, STATE, 21P CODE

LINCOLN HOUSE

120 HILL STREET

IBARRE, VT 05641
SUMMARY STATEMENT OP DEFICIENCIES '
ID
(EACH DEFICIENCY MUST BE PRECEDED BY FULL
PREFIX ;
REGULATORY OR LSC IDENTIFYING 'INFORMATION)
TAG
I

R247 Continued From page 7

(X3) DATE SURVEY
COMPLETED
C
07/17/2018

B, WING

0175

(X4)10
PREFIX
TAG

PAGE 11/13

PROVIDER'S PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD 8E
OROSS-REFERENCED TO THE APPROPRIATE
DEFICIENCY)

j COMPLETE
DATE
I

R247

above 140 degrees Fahrenheit when served or
heated prior to service.
This REQUIREMENT is not met as evidenced
by:
Based on observation and staff interview, the
residence failed to ensure that all perishable food
was labeled and dated consistent with safe food
storage practices_ This has the potential to effect
all residents, Findings include:
During observations of a Vvalk in refrigerator and
standing refrigerator at the residence on the
morning of 7/17/2018, the following unlabeled
and out of date food items were identified:
1.
-3 one gallon containers of milk were out of date,
6/30/2018
.-sour cream, out of date, 6/5/2018
-bag of dinner rolls, unlabeled with no date
-bag of shredded cheese, observed with the
packaging open and no data
-4 packages of loosely wrapped sliced cheese,
unlabeled with no date
-1 individual serving of yogurt, out of date,
7/2/2018
-7 individual servings of yogurt with no date
stamped on the label
-3 containers of buttermilk, out of date, 6/12/2018
-1 bowl of fruit Uncovered, unlabeled with no date
-2 containers of salad, unlabeled with no date
-1 container of grapes, unlabeled with no date
-4 small containers with chopped vegetables,
unlabeled with no date
.large bag of rolled oats, observed with the bag
open, no date
-2 partially consumed containers of ice cream, no
date
The Kitchen Manager confirmed s/he was
-6ivision of Licenpunn and faryNFA.,4 ■0,..
STATE FORM

0,195

OTPP11

If continuation Sheet 8 or 9

  

 

49?,

Junijh 

07/30/2018 12:02

802-476-3349

LINCOLN HOUSE

Division of Licensing and Protection
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION

(M) PRompERisupPumcua
IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION
A. @WANG:

LINCOLN HOUSE

(X3) DATE SURVEY
• COMPLETED
C
07/17/2018

9. WING

0175
NAME OF PROVIDER OR SUPPLIER

PAGE 12/13
PRINTED: 07/25/2018
FORM APPROVED

' STREET ADDRESS, CITY, STATE, ZIP CODE
120 HILL STREET
BARRE, VT 05641

(X4) ID
PREFIX
TAG

SUMMARY STATEMENT OF- DEFICIENCIES
(EACH DEFICIENCY MUST BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)

ID
I
PREFIX •
I
TAG

' R247 Continued From page 8 •

PROVIDER'S PLAN OF CORRECTION
(EACH CORRECTIVE ACTION SHOULD BE
OROSS•REFERENCED TO THE APPROPRIATEDEFICIENCY)

I
.

(x5)
COMPLETE
. DATE

.R247

responsible for the dating and labeling of
perishable food. The out of date and unlabeled
food was discussed with the Residence
Administrator and Kitchen Manager on the
morning of 7/17/2018.

Division of Liconsing and Protection
STATE FORM

OGN 1

OTProll

If continuation sheet 9 of S

 R145 V RESIDENT CARE AND HOME SERVICES
5.9c(2)
Oversee development of a written plans of care for each resident that is based on abilities and needs as
identified in the resident assessment A plan of care and services necessary to assist the resident to
maintain independence and well-being
Plan of correction (POC)
Care plans will be audit will be performed on a monthly basis to ensure that all information is up to date
and accurate. Staff has been hesitant to complete and update the care plans, even though during the
initial orientation this is discussed and they have been guided on the process.
Implementation will be immediate .Scheduled staff meeting on August 9, 2018 will be focused on
reviewing the care plans to ensure competency.
Administrator and the lead PCA wilt be responsible for ensuring the audit is done on a monthly basis
Lincoln House wilt be in compliance in 90 days

R 1681/, RESIDENTIAL CARE AND HOME SERVICES
510 Medication Management
(6) Insulin. Staff other than a nurse may administer insulin injections only when:
L The diabetic resident's condition and medication regimen is considered stable

by the registered nurse who is responsible for delegating the administration'
and
ii The designated staff to administer insulin to the resident have received
additional training in the administration of insulin including return
demonstration, and the registered nurse has deemed them competent and
documented that assessment; and
The registered nurse monitors the resident's condition regularly and is available
when changes in condition or medication might occur.
Plan of Correction (POC)
Each of the medication PCA (Personal Care Attendant) have successfully completed the Lincoln House
Educational process to be checked off to administer insulin. This is actively used at this time.
The Medication PCA contact the RN when the glucose levels are out of range. They are given instructions
to how to proceed on a 24/7 basis.
Unfortunately the documentation of these encounters has failed. There is an attached form that will be
implemented immediately to document the encounters with signature of the PCA and RN.
This form will be reviewed on August 9, 2018
Implementation on 08/10/2018 and 100% compliance within 30 days.
This form wilt be audited by the administrator, RN and the Medication PCA on weekly basis.

 R 181 V.RESIDENTIL CARE AND SERVICES
5.11 Staff Services
5.11. d The licensee shall not have on staff a person who has had a charge of abuse, neglect or
exploitation substantiated against him or her, as defined in 33 V.S.A. Chapters 49 and 69, or one who has
been convicted of an offense for actions related to bodily injury, theft or misuse of funds or property, or
other crimes inimical to the public welfare, in anyjurisdiction whether within or outside of the State of
Vermont. This provision shall apply to the manager of the home as well, regardless of whether the
manager is the licensee or not The licensee shall take all reasonable steps to comply with this
requirement including, but not limited to, obtaining and checking personal and work references and
contacting the DiVision of Licensing and Protection in accordance with 33 VS.A. §6911 to see if
prospective: employees are on the abuse registry or have a record of convictions

Plan of Correction (POC)
In reference to the employee in question, there was no indication that the variance needed to be updated
on a regular basis. In fact the employee was expunged from the criminal charges. Attached is the
documentation from the initial variance. There is no indication of needing to renew. Instructions in
reference to the variance process would have been helpful in preventing this issue.
Lincoln House will seek clarification of the expectation of the State Regulatory Process as welt as the
statures of the Vermont Legal System in reference to expungement. Lincoln House strives to be in
compliance with the State of Vermont Regulatory and Legal Systems.
Immediate consult with legal counsel in reference to the attached documentation in reference to the
employee of question
Lincoln House will seek legal counsel within the next 30 days in reference to the expungement and the
most recent registry check done by the Vermont Agency of Human Services.
The response will be forwarded to your department after Lincoln House has received the
recommendations of legal counsel.
Attached are the forms that were provided for the surveyor on 7/17/2018. In addition the report from the
Vermont Agency of Human Services. Dated 7/20/2018 (this had been requested by the surveyor on
07/17/2018
ire teat.
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R213 VI RESIDENT'S RIGHTS
6.1 Every resident shall be treated with consideration, respect and full recognition of the resident's
dignity, individuality and [privacy. A home may not ask a resident to waive the resident's rights.

Plan of Correction (POC)
Resident Rights is a discussion that is addressed at almost every staff meetings.
On a yearly basis there is an educational opportunity to review the Resident Rights with the employee
signing an agreement to abide by this code of ethics at Lincoln House.
The yearly educational opportunity is being offered in the next 30 days and the staff meeting in
September will be reviewing the rights and code of conduct here at Lincoln House. Staff will then sign the
agreement which is available in their individual files.
To address individual complaint by resident, family or staff.

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The incident will be internally investigated by the Administrator and Medical Administrator.
This investigation will include, speaking to the complaint, staff, and any observers of incident.
Consideration in reference to medical, emotional, dietary components will be reviewed in
reference to the incident.
Plan of Action will include documentation of incident, with discussion with resident family and
staff.
If it is an issue with inappropriate staff intervention, the staff member will be counseled, a plan of
action will be developed and signed by the staff member and the administrators.
If there is a reassurance, the staff member will be required to review and retest on the educational
offering for the Rights of the Resident.
The member will be counseled and forewarned that if there is another incident, it will be
immediate dismissal of employment from Lincoln House.

R 236 NUTRITION AIVD FOOD SERVICES
71. a (5) The hOrneshall keep menus, including any substitutions, for the previous month on file and
available for examination by the licensing agency.

Plan of Correction (POC)
All menus will be kept in a file on a monthly and yearly basis. These will be accessible for staff, family
resident and regulatory surveyors.
This has been implemented as of 08/0112018

R247 VII NUTRITION AND FOOD SERVICES

Z2. b All perishable food and drink shall be labeled, dated and held at proper temperatures:
(1) At or below 40 degrees Fahrenheit
(2) At or above 140 degrees Fahrenheit when served or heated prior to service.

Plan of Correction (POC)
Again seek clarification in reference to outdated foods, Administrator had beenin contact with the
Department of Licensing and Protection. (She had been told that as long as the food in question was
sealed and consistently at the required temperature that the food in question was good for '1 week after
the expiration date).
Implementation of this has been implemented by present kitchen staff.
Reeducation of all kitchen staff that prepares and stores food that dates are required on any food in the
freezer/refrigerator.
Implementation was immediate.
Administrator and RN will do surprise audits on a monthly basis to ensure compliance within 90 days.

 Date

Resident Name
DOB

This is to be used when PCA reports and elevated glucose reading greater than 250

`Glucose reading

RN Instructions

Follow up

PCA Signature

RN Signature

(Please put this form in RN's mail box.)