ARCHSTONE CARE CENTER

Based on personnel record reviews, staff interviews, and policy and procedures, the facility failed to ensure that one out of two Certified Nursing Assistants, (CNA/#106), sampled received in-services and training for at least 12 hours per year. The deficient practice failed to ensure the continuing competence of the CNA. Based on personnel record reviews, staff interviews, and policy and procedures, the facility failed to ensure that one out of two Registered Nurses (RN/#33) sampled received in-services and training for at least 12 hours per year. The deficient practice failed to ensure the continuing competence of the RN. Findings include: Review of the personnel file for CNA, (staff #106), revealed a hire date of October 11, 2022. Further review of the training from October 2022 to October 2023, revealed no evidence of in-service training for Communication and Dementia. The review did reveal completed in-service training for Abuse and Neglect and Resident Rights. Review of the personnel file for RN, (staff #33), revealed a hire date of October 7, 2022. Further review of the training from October 2022 to October 2023 revealed no training had been completed. An interview was conducted on October 12, 2023 at 09:35 AM, with Director of Nursing, (DON staff #12). He stated that orientation and training for skills is provided upon hire. He also stated that in-services are provided monthly at staff meetings and that CNA (staff #106), did not have documentation that dementia training was completed since hire date. He did provide an in-service sign in sheet dated February 12, 2023, with CNA (staff #106) signature, but the in-service was for Abuse, Neglect, Misappropriation of Property, Elder Justice and Resident Rights. He stated he did not have documentation for any dementia in-service training for her. An interview was conducted on October 12, 2023 with DON (staff #12). He stated an employee audit revealed RN (staff #33), had not completed training, TB testing or fingerprint clearance. He stated he had a phone conversation with her on October 11, 2023. He stated she refused to obtain her fingerprint clearance card. As a direct result of this refusal, her employment was terminated on October 11, 2023. Review of the facility's Sufficient and Competent Nurse Staffing revealed licensed nurses and nursing assistants are trained and monitored by nursing leadership to ensure programming for staff training results in nursing competency and gaps in education are identified and addressed. Skills in the following areas but not limited to: Resident Rights, Behavioral Health, Psychosocial Care, Dementia Care, Person Centered Care, Communication, Basic Nursing Skills, Basic Restorative Services, Skin and Wound Care, Medication Management, Pain Management, Infection Control, Identification of Changes in Condition, and Cultural Competency.

Based on personnel record review, staff interviews, and policy review, the facility failed to provide evidence that two employees (staff #119 and staff #83) were free from infectious tuberculosis (TB). Findings include: Review of the personnel record for Licensed Practical Nurse (LPN/staff #119), on October 12, 2023, revealed a hire date of September 4, 2023. Review of the file did not include verification that the LPN had been screened and deemed free from infectious TB. Review of the file further showed that that the LPN was scheduled to have her screening done on October 12, 2023. Review of the personnel record for LPN (staff #83), on October 12, 2023, revealed a hire date of November 15,2018. Review of the file did not include verification that the LPN had been screened and deemed free from infectious TB. Review of the file further showed that the LPN was scheduled to have her screening done on October 10, 2023. An interview with Director of Nursing, (DON staff #12), was conducted on October 12, 2023 at 09:35 AM. He stated he is aware of the regulation that new employees need to have a baseline TB/two step test done, and an annual questionnaire. Previous to the change in January 2023, the facility's policy was to have the two step test completed before start date. However, he cannot explain why LPN (staff #119), had not had her testing completed previously. He also stated staff #119 is scheduled to have a blood draw on October 12, 2023. An interview was conducted with DON (staff #12) on October 12, 2023, He stated that LPN (staff #83) had stated she needs a chest x-ray for her TB screening. He knows she had an x-ray in the 1970's, but can't explain why other x-rays have not been completed. He stated they had scheduled her for a blood draw on October 10, 2023.

Based on employee personnel record review, staff interviews, and policy and procedures, the administrator failed to ensure that documentation of a fingerprint clearance card was maintained in the personnel record for two employees (staff #33 and staff # 106). Findings include: Review of the personnel file for a Registered Nurse, (RN staff # 33), revealed a hire date of October 7, 2022. Further review of the personnel file revealed no evidence of fingerprint clearance card. Review of the personnel file for a Certified Nursing Assistant, (CNA staff #106), revealed a hire date of October 11, 2022. Further review of the personnel file revealed no evidence of fingerprint clearance card. An interview was conducted on October 12, 2023, with Director of Nursing, (DON staff #12). He stated that staff who have direct contact with residents are required to have a fingerprint clearance. He stated that RN (staff #33) required a fingerprint clearance in her current position and she had refused. He stated that RN (staff #33) had been terminated on October 11, 2023 for refusal to complete fingerprint clearance. He stated regarding CNA (staff #106), he did not know why she did not have a fingerprint clearance card. He stated she loses things easily, so that could be the reason why, but he would follow up with her. The facility's policy, Background Screening Investigations, revised March 2019, stated the Director of Personnel, or other designee, will conduct background checks, reference checks and criminal conviction checks (including fingerprinting as may be required by state law) on all potential direct access employees and contractors. Background and criminal checks are initiated within two days of an offer of employment or contract agreement, and completed prior to employment.

§483.95(g) Required in-service training for nurse aides. In-service training must- §483.95(g)(1) Be sufficient to ensure the continuing competence of nurse aides, but must be no less than 12 hours per year. §483.95(g)(2) Include dementia management training and resident abuse prevention training. §483.95(g)(3) Address areas of weakness as determined in nurse aides' performance reviews and facility assessment at § 483.70(e) and may address the special needs of residents as determined by the facility staff. §483.95(g)(4) For nurse aides providing services to individuals with cognitive impairments, also address the care of the cognitively impaired.

Based on personnel record reviews, staff interviews, and policy and procedures, the facility failed to ensure that one out of two Certified Nursing Assistants, (CNA/#106), sampled received in-services and training for at least 12 hours per year. The deficient practice failed to ensure the continuing competence of the CNA. Based on personnel record reviews, staff interviews, and policy and procedures, the facility failed to ensure that one out of two Registered Nurses (RN/#33) sampled received in-services and training for at least 12 hours per year. The deficient practice failed to ensure the continuing competence of the RN. Findings include: Review of the personnel file for CNA, (staff #106), revealed a hire date of October 11, 2022. Further review of the training from October 2022 to October 2023, revealed no evidence of in-service training for Communication and Dementia. The review did reveal completed in-service training for Abuse and Neglect and Resident Rights. Review of the personnel file for RN, (staff #33), revealed a hire date of October 7, 2022. Further review of the training from October 2022 to October 2023 revealed no training had been completed. An interview was conducted on October 12, 2023 at 09:35 AM, with Director of Nursing, (DON staff #12). He stated that orientation and training for skills is provided upon hire. He also stated that in-services are provided monthly at staff meetings and that CNA (staff #106), did not have documentation that dementia training was completed since hire date. He did provide an in-service sign in sheet dated February 12, 2023, with CNA (staff #106) signature, but the in-service was for Abuse, Neglect, Misappropriation of Property, Elder Justice and Resident Rights. He stated he did not have documentation for any dementia in-service training for her. An interview was conducted on October 12, 2023 with DON (staff #12). He stated an employee audit revealed RN (staff #33), had not completed training, TB testing or fingerprint clearance. He stated he had a phone conversation with her on October 11, 2023. He stated she refused to obtain her fingerprint clearance card. As a direct result of this refusal, her employment was terminated on October 11, 2023. Review of the facility's Sufficient and Competent Nurse Staffing revealed licensed nurses and nursing assistants are trained and monitored by nursing leadership to ensure programming for staff training results in nursing competency and gaps in education are identified and addressed. Skills in the following areas but not limited to: Resident Rights, Behavioral Health, Psychosocial Care, Dementia Care, Person Centered Care, Communication, Basic Nursing Skills, Basic Restorative Services, Skin and Wound Care, Medication Management, Pain Management, Infection Control, Identification of Changes in Condition, and Cultural Competency.