Dr Arthur Clifton Mckinley Ctr
Inspection history, citations, penalties and survey trends for this long-term care facility in Brookville, Pennsylvania.
- Location
- 133 Laurelbrooke Drive, Brookville, Pennsylvania 15825
- CMS Provider Number
- 395550
- Inspections on file
- 37
- Latest survey
- December 4, 2025
- Citations (last 12 mo.)
- 4
Citation history
Health deficiencies cited at Dr Arthur Clifton Mckinley Ctr during CMS and state inspections, most recent first.
The facility failed to maintain documentation for the annual 90-minute load bank test of its emergency generator, as required by NFPA standards. An interview with the maintenance supervisor confirmed the absence of this documentation, indicating non-compliance with essential maintenance protocols.
The facility did not maintain proper documentation for a 90-minute annual emergency lighting test, as required by regulations. This deficiency was confirmed during a document review and an interview with the maintenance supervisor.
A facility failed to document a physician's order for a resident's code status, leaving it unclear whether the resident was Full Code or DNR. The resident, with chronic respiratory failure and other conditions, had an EMR indicating DNI, but this was not supported by a formal order. This deficiency was confirmed by both an LPN and the DON.
A facility failed to document attempts of non-pharmacological interventions before administering PRN Lorazepam to a resident with anxiety and depression. Despite the facility's policy requiring such interventions, the resident's records showed repeated use of the medication without evidence of alternative approaches being tried first. The DON confirmed the lack of documentation for these interventions.
The facility did not discard a Tubersol PPD vial in a timely manner, as required by both facility policy and manufacturer's instructions. An LPN confirmed the vial was past its 30-day discard date during an observation in the 1st floor medication room.
The facility did not post the required contact information for the State Survey Agency, Pennsylvania Department of Health, on the Ground and First floors, making it inaccessible to residents. This was confirmed by the DON during an interview.
The facility failed to provide accessible Department of Health Survey results for residents and visitors. Observations revealed that survey binders on the ground and first floors lacked the two most recent survey results. The DON confirmed the absence of these results, indicating non-compliance with regulations.
Failure to Maintain Emergency Generator Documentation
Penalty
Summary
The facility failed to maintain proper documentation for the maintenance and testing of its emergency generator, which is a critical component of the essential electrical system. During a document review on December 23, 2024, it was discovered that the facility did not have the required documentation for the annual 90-minute load bank test of the emergency generator. This test is crucial to ensure that the generator can supply power within 10 seconds during an emergency, as stipulated by NFPA 101 and related standards. An interview with the maintenance supervisor on the same day confirmed that the documentation for the emergency generator testing was unavailable at the time of the survey. This lack of documentation indicates a failure to comply with the necessary maintenance and testing protocols outlined in NFPA 110 and NFPA 111, which are designed to ensure the reliability and readiness of emergency power systems in the facility.
Plan Of Correction
1. Maintenance Director completed and properly documented the required 90 minute annual load bank testing for the generator on 1-2-5. 2. Education will be provided to maintenance staff regarding the required testing and documentation for the yearly 90 minute load bank testing for the generator by 2-10-25. 3. From this point forward, the yearly emergency generator testing will be completed and properly documented every January. 4. Process will be monitored in QAPI meeting to ensure this process is sustained.
Failure to Maintain Emergency Lighting Documentation
Penalty
Summary
The facility failed to maintain emergency lighting in accordance with regulations, affecting the entire facility. During a document review on December 23, 2024, at 10:00 a.m., it was revealed that the facility could not provide documentation for a 90-minute annual emergency lighting test over the past 12 months. An interview with the maintenance supervisor at the same time confirmed the absence of this documentation.
Plan Of Correction
1. Maintenance Director completed and properly documented the required 90 minute annually emergency lighting test on 1-2-25. 2. Education will be provided to maintenance staff regarding the required testing and documentation for the yearly 90 minute emergency lighting test by 2-10-25. 3. From this point forward, the yearly emergency lighting testing will be completed and properly documented every January. 4. Process will be monitored in QAPI meeting to ensure this process is sustained.
Failure to Document Code Status for a Resident
Penalty
Summary
The facility failed to ensure that a physician's order was completed to indicate the code status for a resident, identified as Resident R26. The resident's electronic medical record (EMR) did not contain a physician's order specifying whether the resident was Full Code (CPR/Attempt Resuscitation) or Do Not Resuscitate (DNR/Do Not Attempt Resuscitation-Allow Natural Death). This deficiency was identified during a review of the facility's policy, clinical records, and staff interviews. The absence of a physician's order for code status was confirmed by both a Licensed Practical Nurse (LPN) and the Director of Nursing. Resident R26 was admitted with several diagnoses, including chronic respiratory failure with hypoxia, cardiac heart failure, diabetes mellitus type one, and constipation. Despite these significant health conditions, the EMR lacked a clear directive regarding the resident's code status. During interviews, it was noted that the EMR header indicated a status of DNI (Do Not Initiate), but this was not supported by a formal physician's order. The deficiency was noted under several Pennsylvania Code regulations related to management, resident rights, and medical records.
Plan Of Correction
1. Proper order for R26's code status was obtained and written on 12-19-24. 2. Facility reviewed all orders for all code status and any other issues were corrected on 12-19-24. 3. Education will be provided to nursing staff regarding obtaining the proper orders for code status. 4. Audits will be completed by Director of nursing or designee with all admits and any code status changes as the admits enter the building or code statuses are changed to ensure that facility has obtained the proper order for that code status. 5. Process will be monitored in QAPI meeting to ensure this process is sustained.
Failure to Attempt Non-Pharmacological Interventions Before PRN Medication
Penalty
Summary
The facility failed to provide evidence that non-pharmacological interventions were attempted prior to administering PRN psychotropic medication to a resident. The facility's policy on Behavioral Assessment, Intervention, and Monitoring mandates the use of non-pharmacological approaches to manage behavioral symptoms before resorting to antipsychotic medications. However, for a resident with diagnoses including COPD, anxiety, and depression, there was no documentation of such interventions being attempted before administering Lorazepam, an anti-anxiety medication, on multiple occasions. The resident's clinical records showed repeated use of PRN Lorazepam in November and December 2024, with no evidence of non-pharmacological interventions being tried first. The Director of Nursing confirmed the absence of documentation for these interventions prior to the administration of the medication. This deficiency was identified during a review of the facility's policy, clinical records, and staff interviews.
Plan Of Correction
1. Facility assessed resident 24 and no ill side effects noted. 2. Facility will review all residents with PRN psychotropic medication orders to ensure orders contain directions for non-pharmacological approaches are in place by 2-10-25. 3. Education will be provided to nursing staff regarding attempting and charting non-pharmacological approaches prior to giving any PRN psychotropic medication by 2-10-25. 4. Audits will be completed by the Director of Nursing or designee on all PRN psychotropic meds given weekly for 4 weeks to ensure that non-pharmacological approaches are attempted and documented prior to medication being given. After audits are complete, charting will be reviewed with the morning meeting for ongoing compliance. 5. Process will be monitored in the Quality Assurance and Improvement meeting to ensure this process is sustained.
Medication Disposal Non-Compliance
Penalty
Summary
The facility failed to ensure that medications were discarded in a timely manner, as observed in the 1st floor medication room. The facility's policy on Medication Labeling and Storage, dated 11/02/24, requires that multi-dose vials that have been opened or accessed be dated and discarded within 28 days unless the manufacturer specifies a different timeframe. The manufacturer's instructions for Tubersol PPD, a solution used for tuberculosis testing, specify that vials in use for 30 days should be discarded. During an observation on 12/18/24, a vial of Tubersol PPD with an open date of 11/15/2024 was found in the medication storage room refrigerator, indicating it was past the 30-day discard date. An LPN confirmed that the vial was past its discard date and should have been discarded.
Plan Of Correction
1. Expired TB solution was discarded in the appropriate container on 12-18-24. 2. Facility checked all medication refrigerators on 12-18-24 for any other expired meds and none were found. 3. Education will be provided to the licensed nursing staff regarding monitoring open medication for expiration dates. 4. Audits will be completed by Director of Nursing or designee weekly x 4 weeks of all medication refrigerators for expired medications. Refrigerators will then be checked monthly by RN supervisors for expired meds. 5. Process will be monitored in Quality Assurance and Improvement meeting to ensure this process is sustained.
Failure to Post State Survey Agency Contact Information
Penalty
Summary
The facility failed to comply with the requirement to post contact information for the State Survey Agency, specifically the Pennsylvania Department of Health, in areas accessible to residents on both the Ground and First floors of the nursing units. This deficiency was identified during observations conducted on December 19, 2024, at 10:15 a.m., where it was noted that the necessary contact information was not available on either floor. The Director of Nursing confirmed during an interview at 12:35 p.m. on the same day that the contact information was indeed not posted in areas accessible to residents and visitors.
Survey Results Not Accessible to Residents and Visitors
Penalty
Summary
The facility failed to ensure that the most recent Department of Health Survey results were accessible to residents and visitors. During observations conducted on December 19, 2024, it was found that the State Department of Health Survey binders on the nursing units of the ground and first floors did not contain information or results from the two most recent State Surveys conducted on January 12, 2024, and February 29, 2024. This deficiency was identified as the survey results were not available for examination by residents and visitors as required. An interview with the Director of Nursing on the same day confirmed the absence of the two most recent survey results in the binders. The Director acknowledged that the binders did not have the necessary survey results accessible for residents and visitors to review, which is a requirement under the regulations. This oversight indicates a failure in the facility's management to comply with the regulatory requirement to make survey results readily accessible.
Latest citations in Pennsylvania
Surveyors identified that a fire-rated separation door between building levels did not meet NFPA 101 multiple occupancy requirements. Initially, the basement separation door had holes where panic hardware had been removed and only a turning knob remained, compromising the door’s fire-rated function. On revisit, although panic hardware had been installed, the door still failed to latch properly in the frame due to friction. Facility leadership and maintenance staff acknowledged these door deficiencies.
Surveyors found that the facility’s Emergency Preparedness Plan was not compliant with regulatory requirements because it lacked a documented community-based all-hazards risk assessment and the facility-based hazard vulnerability analysis had not been updated on an annual basis. During document review and an interview with the Maintenance Director, it was confirmed that the community-based HVA was missing from the plan and that the existing facility-based assessment had last been updated in 2024, leaving the plan without current, comprehensive all-hazards risk assessments.
Surveyors observed that stair towers used as exits were not properly maintained, as multiple stair landings were being used for storage. Chairs were found stored on landings in several stairwells on one floor, and the Maintenance Director confirmed that these items were being kept within the stair towers.
Surveyors found that the common area soiled linen room on the second floor, classified as a hazardous area in a sprinklered location, had a door that failed to positively latch when tested. This door is required to self-close and latch to maintain proper separation for hazardous areas. The issue was confirmed with the Maintenance Director during the survey.
Surveyors found that oxygen storage requirements were not maintained when a freestanding oxygen cylinder was observed unsecured in a third-floor room and the C-Hall oxygen storage room door failed to close and latch due to a coordinator malfunction. The Maintenance Director confirmed these oxygen storage deficiencies during the survey exit interview.
Surveyors found that the facility failed to review and update its emergency preparedness policies and procedures on an annual basis. During document review, the facility could not provide a community-based HVA, which is required to inform updates to the emergency preparedness plan, and the facility-based HVA had not been updated as required. In an interview, the Maintenance Director confirmed both the missing community-based HVA and the lack of an annual update to the facility-based HVA.
Surveyors found that the facility’s Emergency Preparedness Plan lacked required policies and procedures for tracking the location of on-duty staff and sheltered patients during and after an emergency. The plan also did not include a method to document the specific name and location of any receiving facility or other site if staff and patients were relocated. During the exit interview, the Maintenance Director confirmed that these tracking and documentation procedures were not present in the plan, affecting the entire facility.
Surveyors found that the facility failed to develop and maintain required arrangements with other facilities and providers to receive patients if operations were limited or ceased. Document review showed that transfer agreements were missing, and this absence of formal arrangements to ensure continuity of services was confirmed by the Maintenance Director during the exit interview.
Surveyors determined that the facility’s emergency preparedness communication plan did not include any method for sharing appropriate information from the emergency plan with residents and their families or representatives. During document review and staff interviews, it was confirmed that the written plan lacked a defined process for communicating emergency planning information to residents and their representatives, and this omission affected the entire facility.
Two residents receiving PRN anti‑anxiety medications were not protected from potential chemical restraints when PRN lorazepam/Ativan orders lacked required 14‑day stop dates and physician re‑evaluation. One resident with schizoaffective disorder, dementia, and anxiety had a PRN Ativan order without a stop date that was administered multiple times over several months. Another resident with metabolic encephalopathy, heart failure, and peripheral vascular disease had a PRN lorazepam order without a stop date that was still being administered weeks later, with no documented physician reassessment. The DON confirmed that these PRN psychotropic orders should have included 14‑day limitations but did not.
Noncompliant Fire-Rated Separation Door Between Multiple Occupancies
Penalty
Summary
The facility failed to meet NFPA 101 multiple occupancy construction type requirements by not maintaining a compliant fire-rated separation door between building levels. During an observation in the basement, surveyors found that the building separation door had holes where the fire exit (panic) hardware had been removed, and the only remaining hardware was a turning knob, compromising the integrity of the fire-rated door. In a subsequent onsite revisit, surveyors observed that although panic hardware had been installed on the same fire-rated door, the door failed to latch properly in the frame due to friction. The administrator and maintenance staff confirmed the presence of the holes in the fire-rated door and later confirmed that the door continued to have a deficiency because it did not latch.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State and Federal regulatory requirements. Please accept this plan of correction as the facility's written credible allegation of compliance such that all alleged deficiencies cited have been or will be corrected by the date or dates indicated. To remain in compliance with all federal and state regulations, the facility has taken or will take the actions set forth in the following plan of correction. 1. The correct fire rated hardware was ordered and will be installed on the basement building separation door. 2. Results will be shared with the Quality Assurance Performance Improvement Committee with corrections made as needed.
Failure to Maintain Current All-Hazards Emergency Preparedness Risk Assessments
Penalty
Summary
The deficiency involves the facility’s failure to maintain an Emergency Preparedness Plan that was based on and included both a documented facility-based and community-based risk assessment utilizing an all-hazards approach. During document review, surveyors found that the Emergency Preparedness Plan did not contain a documented community-based risk assessment. The plan therefore lacked the required community-based hazard vulnerability analysis (HVA) component that should identify and address community-level emergency events. Surveyors also determined that the facility-based risk assessment within the Emergency Preparedness Plan had not been updated annually as required. The last update to the facility-based HVA was documented in 2024, indicating that it was not current at the time of review. During the exit interview, the Maintenance Director confirmed both the absence of the community-based HVA and that the facility-based HVA had not received the required annual update.
Plan Of Correction
4.1. The facility will update the facility assessment to include the All Hazards Assessment annually. 4.2. The Director of Maintenance or designee Services will monitor bi-annually to meet compliance with E-006. Completion Date: 06/30/2026 Status: APPROVED Date: 06/09/2026
Improper Storage of Chairs in Exit Stair Towers
Penalty
Summary
Surveyors found that stairways and smokeproof enclosures used as exits were not properly maintained as required by NFPA 101. On one of five levels, multiple stair tower landings were being used for storage. During observations on May 4, 2026, chairs were stored on the landings of stair #2 on the third floor C-wing at 11:30 a.m., stair #3 on the third floor B-wing at 11:40 a.m., and stair #4 on the third floor A-wing at 11:50 a.m. In an exit interview on the same day at 1:30 p.m., the Maintenance Director confirmed the presence of this storage within the stair towers.
Plan Of Correction
4.1. The chairs were permanently removed from the third floor C-wing, stair # 2, the third floor B-wing, stair # 3, and the third floor A-wing, stair # 4 on Tuesday, May 5th, 2026. 4.2. The maintenance staff will be in-serviced on importance of verifying that stairwells are cleared Stairways and smokeproof enclosures used 4.3. The maintenance staff will perform monthly audits to confirm that stairwells are cleared. Audits will be completed for 6 months. 4.4. The maintenance director will monitor to meet the compliance
Soiled Linen Room Door Failed to Latch in Hazardous Area
Penalty
Summary
Surveyors identified a deficiency related to NFPA 101 hazardous area enclosure requirements when observing the soiled linen room on the second floor. During the survey, the common area soiled linen room door was tested and found to fail to positively latch. This room qualifies as a hazardous area in a sprinklered location, and the door is required to self-close and latch to maintain proper separation. The deficiency was confirmed during an exit interview with the Maintenance Director, who acknowledged the door problem. No residents or specific patient conditions were mentioned in the report, and no additional contributing actions or events beyond the failed latching mechanism of the soiled linen room door were described.
Plan Of Correction
K 03214.1. On the second floor, the common area soiled utility room door latch was repaired on May 4th, 2026. 4.2. The maintenance staff will be in-serviced to meet compliance requirements of K-0321; NFPA 101 Hazardous areas - enclosures. 4.3. The maintenance staff will perform monthly audits to meet compliance requirements of K-0321 to November 30th, 2026. 4.4. The maintenance director will monitor to meet the compliance requirements of K-0225. Completion Date: 06/30/2026 Status: APPROVED Date: 06/09/2026
Failure to Maintain Required Oxygen Cylinder Storage and Secured Storage Room
Penalty
Summary
Surveyors identified deficiencies in the facility’s compliance with NFPA 101 and NFPA 99 requirements for gas equipment cylinder and container storage. During observation on the third floor, surveyors found a freestanding oxygen cylinder in room 5352 at 11:30 a.m. This cylinder was not described as being secured or stored in accordance with the specified oxygen storage requirements, which include proper enclosure and handling precautions for cylinders available for immediate use in patient care areas. Further observation at 11:40 a.m. revealed that the C-Hall oxygen storage room door failed to close and latch due to a malfunctioning door coordinator. This condition meant the designated oxygen storage room was not being properly secured as required. During the exit interview on the same day at 1:30 p.m., the Maintenance Director confirmed the oxygen storage deficiencies observed by the surveyors.
Plan Of Correction
Completion Date: 06/30/2026 Status: APPROVED Date: 06/09/2026 4.1. The empty freestanding oxygen cylinder on the 3rd floor rom 5352 was removed & placed into the proper oxygen storage room on May 4th, 2026. The corridor malfunction identified on the c hall oxygen storage door will be repaired to ensure proper closure. 4.2. The maintenance staff will be in-serviced to meet compliance requirements of K-0923; NFPA 101 Gas equipment - Cylinder & container storage. 4.3. The maintenance staff will perform monthly audits to meet compliance requirements of K-0923 to November 30th, 2026. 4.4. The maintenance director will monitor to meet the compliance requirements of K-0923.
Failure to Annually Update Emergency Preparedness Policies and Risk Assessments
Penalty
Summary
The deficiency involves the facility’s failure to ensure that its emergency preparedness policies and procedures were reviewed and updated at least annually, as required. Surveyors cited that the facility did not have an emergency preparedness plan community-based risk assessment available for review. This community-based Hazard Vulnerability Analysis (HVA) is one of the required components used to update the facility’s emergency preparedness policies and procedures each year. During document review, surveyors found that the facility could not provide the community-based HVA and also confirmed that the facility-based HVA had not been updated annually as required. In an exit interview, the Maintenance Director acknowledged the absence of the community-based HVA and the missing annual update to the facility-based HVA, confirming that the emergency preparedness policies and procedures were not properly updated based on the emergency plan and risk assessment.
Plan Of Correction
4.1. The facility will update the emergency preparedness to include the community based risk assessment 4.2. The Director of Maintenance or designee Services will monitor bi-annually to meet compliance with E-013.
Missing Emergency Tracking System for Staff and Patients
Penalty
Summary
Surveyors identified a deficiency related to the facility’s Emergency Preparedness Plan, specifically the absence of required policies and procedures for tracking on-duty staff and sheltered patients during an emergency. During document review, the surveyor examined the facility’s Emergency Preparedness Plan and found that it did not contain a system to track the location of on-duty staff and sheltered patients in the facility’s care during an emergency. The review further showed that the plan lacked provisions to document the specific name and location of any receiving facility or other location if on-duty staff and sheltered patients were relocated during an emergency. In an exit interview, the Maintenance Director confirmed that these policies and procedures were missing from the Emergency Preparedness Plan, affecting the entire facility.
Plan Of Correction
4.1. The facility will update the emergency preparedness plan to include a system to track the location of on-duty staff and sheltered patients in the facility's care during an emergency; the specific name and location of the receiving facility or other location of on-duty staff and sheltered patients are relocated during an emergency. 4.2. The Director of Maintenance or designee will monitor bi-annually to meet compliance with E-0018.
Lack of Emergency Transfer Arrangements With Other Facilities
Penalty
Summary
The deficiency involves the facility’s failure to develop and maintain arrangements with other facilities and providers to receive patients if the facility experiences limitations or cessation of operations. During document review, surveyors determined that the facility did not have the required transfer agreements or documented arrangements in place as mandated under the emergency preparedness regulations, which require policies and procedures to ensure continuity of services to patients. On the date of the survey, at a specified time in the morning, the surveyor’s review of facility documentation showed that these arrangements were missing. In an exit interview later that day, the Maintenance Director confirmed that the transfer agreements were not in place, corroborating the surveyor’s findings that the facility lacked the necessary arrangements to ensure continuity of services in an emergency situation.
Plan Of Correction
4.1. The facility will update the emergency preparedness plan to provide arrangements with other facilities and other providers to receive patients in the event of limitations or cessation of operations to maintain the continuity of services to facility patients. 4.2. The Director of Maintenance or designee will monitor bi-annually to meet compliance with E-0025. Completion Date: 07/07/2026 Status: APPROVED Date: 06/09/2026
Failure to Include Resident/Family Communication Method in Emergency Plan
Penalty
Summary
Surveyors found that the facility failed to maintain and update an emergency preparedness communication plan that included a method for sharing information from the emergency plan with residents and their families or representatives. During document review and interview on May 4, 2026, at 8:30 a.m., the surveyor determined that the written emergency communications plan lacked any described process or method for communicating appropriate portions of the emergency plan to residents and their families or representatives, affecting the entire facility. In an exit interview with the Maintenance Director on the same day at 1:30 p.m., the Maintenance Director confirmed that the emergency communications plan did not include such a method for sharing information from the emergency plan with residents and their families or representatives. No specific residents, medical histories, or clinical conditions were identified in the report, and the deficiency pertained to the facility-wide emergency preparedness communication plan documentation and content.
Plan Of Correction
4.1. The facility will update the emergency communications plan to include a method of sharing information from the emergency plan with the residents and their families or representatives, affecting the entire facility. 4.2. The Director of Maintenance or designee will monitor bi-annually to meet compliance with E-0035.
Failure to Limit and Re‑Evaluate PRN Psychotropic Medications
Penalty
Summary
The deficiency involves the facility’s failure to ensure that residents were free from potential chemical restraints by not complying with federal requirements for PRN psychotropic medications. For one resident with schizoaffective disorder bipolar type, dementia, and anxiety disorder, the MDS showed cognitive impairment and the care plan identified mood problems, yelling out, and anxiety/restlessness. A physician ordered PRN Ativan for anxiety with no stop date specified. The MAR showed the PRN Ativan was administered multiple times over several months, including in January, March, and April 2026, without a 14‑day limitation or documented stop date. The DON stated that the PRN order was supposed to have a 14‑day stop date, confirming that the order did not meet regulatory requirements. For another resident with metabolic encephalopathy, heart failure, and peripheral vascular disease, a physician ordered PRN lorazepam every four hours for anxiety, again without a specified stop date. The MAR documented administration of lorazepam nearly a month after the order was written, with no evidence that the physician had re‑evaluated the continued use of the PRN anti‑anxiety medication beyond 14 days. The DON confirmed that no stop date had been added to this order. These omissions resulted in PRN psychotropic medications being available and used beyond 14 days without required time limitations or documented physician re‑evaluation, constituting a failure to ensure residents were free from potential chemical restraints and unnecessary drugs.
Plan Of Correction
Pharmacist will send out a re-education to all the providers regarding PRN psychotropics and end dates by May 4, 2026. Resident records for all residents receiving psychotropics were checked on April 30, 2026- no other orders were missing stop dates. New psychotropic orders added to Point Click Care dashboard on May 1, 2026- listing shows new orders and stop dates. Interdisciplinary team will review dashboard during clinical meeting for stop dates- any missing stop dates will be added. Charge nurses will audit order listing report for new psychotropic orders- 5 residents will be audited x 4 weeks, then 2 residents per week for 4 weeks, then random residents monthly. Audits will be added to quality indicators and reviewed at QAPI.
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