· In response to past deficiencies, the facility has already made changes such as switching to a new electronic health record (EHR) system, increasing staff training, and enhancing call response times. These efforts will be built upon with increased management oversight and daily compliance checks, as well as the engagement of the Flores Consulting Group for additional expertise.

· To tackle the concerns regarding resident care and fall prevention, the facility will implement a robust fall prevention plan, ensuring that effective interventions are in place and adhered to. This includes introducing the "Life Enrichment" program and increasing staffing levels to support better resident engagement and activity participation. The facility will also integrate a new behavior initiative program that includes tailored activity programs and fall risk assessments.

· In addition, the facility will work on improving communication with emergency services to resolve resistance issues and clarify response protocols. They plan to engage in regular meetings with emergency services to ensure effective collaboration and response procedures.

· To manage residents whose needs exceed the facility’s capabilities, the facility will use defined criteria for relocation, collaborate closely with families and social workers, and address legal challenges associated with resident relocation.

· Finally, the facility will implement ongoing monitoring and compliance checks, including a follow-up meeting 2-3 months after the engagement of the new consultants, to assess progress and ensure continued improvements. The consultants will perform both regulatory and clinical audits, providing a broad overview to identify areas for further enhancement.

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