SPLENDIDO AT RANCHO VISTOSO

Based on observation, clinical record, staff interviews and facility policy, the facility failed to ensure that medications were administered as ordered by the physician for 1 resident (#21). Findings include: Resident #21 was admitted on April 26, 2023 with diagnose of personal history of transient ischemic attack, cerebral infarction, and cardiac septal defect. A care plan dated April 14, 2023 included that the resident has Cerebral Vascular Accident and history of transient ischemic attack with an intervention of giving medications as ordered by the physician. A physician's order dated June 24, 2023 included Aspirin Oral Tablet Chewable (Aspirin), Give 81 mg by mouth one time a day for deep vein thrombosis prophylaxis. An observation was conducted on October 19, 2023 at 7:32 AM of a Registered Nurse (RN/staff #32) administering a 81mg enteric coated aspirin to resident #21 An interview was conducted on October 19, 2023 at 10:41 a.m. with the RN (staff #32) who said that she gave him an enteric coated aspirin. She checked the orders and said it should have been a chewable aspirin. She said that was the card that was missing so she just used house supply, but the house supply was enteric coated. An interview conducted on October 20, 2023 at 10:28 AM with the Director of Nursing (DON/staff #44) said that her expectation for provider orders is that they be followed. She said that enteric coated aspirin does not meet the order and that the administration did not meet her expectation. A policy titled 6.0 General Dose Preparation and Medication Administration revised January 1, 2013 revealed that facility staff should verify that the medication name and dose are correct.

Based on record review, staff interviews, and policy review, the facility failed to ensure a background check was completed prior to an employee working onsite. Findings include: A review of employee personnel files, on October 19th, 2023, indicated staff # 85 did not have a valid fingerprint card. In place of a fingerprint card, a photocopy of staff's previous employment as a security guard was on file. An interview was conducted on October 19th, 2023 at 1:27 PM with Human Resources (Staff #111). Staff #111 stated they were new to the State of Arizona and upon their hire, they did an audit on employee files and found several employees with recently expired fingerprint clearance. HR stated In employee's case, they discovered there was no fingerprint card on file so they requested that staff #85 apply for a fingerprint card. When asked for the copy of the application, it was discovered the application did not have an application number so there was no way for the facility to confirm the status of the application. When asked if the staff #85 is still currently working onsite, HR confirmed they were as of today but they would remove staff #85 immediately until his background check is fully completed. An interview was conducted on October 20th, 2023 AT 8:08 AM with the facility administrator (staff #121) in their office. When asked what their expectation was in regards to background checks for new employees, they stated that a new hire should have a copy of the fingerprint card on file or an application pending prior to working at the facility. Staff #121 stated they had assumed that staff #85's background check was done correctly because they observed a checkmark next to the fingerprint box without looking at the employee personnel file. A review of the policy titled, "Pre-Employment Screening" with an effective date of June 14, 2007, indicated the Human Resources representative will be responsible to ensure the background check form is completed. It also indicates that if any applicant is not able to complete a background check they will not be hired by the company.

§483.45 Pharmacy Services The facility must provide routine and emergency drugs and biologicals to its residents, or obtain them under an agreement described in §483.70(g). The facility may permit unlicensed personnel to administer drugs if State law permits, but only under the general supervision of a licensed nurse. §483.45(a) Procedures. A facility must provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident. §483.45(b) Service Consultation. The facility must employ or obtain the services of a licensed pharmacist who- §483.45(b)(1) Provides consultation on all aspects of the provision of pharmacy services in the facility. §483.45(b)(2) Establishes a system of records of receipt and disposition of all controlled drugs in sufficient detail to enable an accurate reconciliation; and §483.45(b)(3) Determines that drug records are in order and that an account of all controlled drugs is maintained and periodically reconciled.

Based on observation, clinical record, staff interviews and facility policy, the facility failed to ensure that medications were administered as ordered by the physician for 1 resident (#21). This practice could result in decreased deep vein thrombosis prophylaxis. Findings include: Resident #21 was admitted on April 26, 2023 with diagnose of personal history of transient ischemic attack, cerebral infarction, and cardiac septal defect. A care plan dated April 14, 2023 included that the resident has Cerebral Vascular Accident and history of transient ischemic attack with an intervention of giving medications as ordered by the physician. A physician's order dated June 24, 2023 included Aspirin Oral Tablet Chewable (Aspirin), Give 81 mg by mouth one time a day for deep vein thrombosis prophylaxis. An observation was conducted on October 19, 2023 at 7:32 AM of a Registered Nurse (RN/staff #32) administering a 81mg enteric coated aspirin to resident #21 An interview was conducted on October 19, 2023 at 10:41 a.m. with the RN (staff #32) who said that she gave him an enteric coated aspirin. She checked the orders and said it should have been a chewable aspirin. She said that was the card that was missing so she just used house supply, but the house supply was enteric coated. An interview conducted on October 20, 2023 at 10:28 AM with the Director of Nursing (DON/staff #44) said that her expectation for provider orders is that they be followed. She said that enteric coated aspirin does not meet the order and that the administration did not meet her expectation. A policy titled 6.0 General Dose Preparation and Medication Administration revised January 1, 2013 revealed that facility staff should verify that the medication name and dose are correct.

§483.60(i) Food safety requirements. The facility must - §483.60(i)(1) - Procure food from sources approved or considered satisfactory by federal, state or local authorities. (i) This may include food items obtained directly from local producers, subject to applicable State and local laws or regulations. (ii) This provision does not prohibit or prevent facilities from using produce grown in facility gardens, subject to compliance with applicable safe growing and food-handling practices. (iii) This provision does not preclude residents from consuming foods not procured by the facility. §483.60(i)(2) - Store, prepare, distribute and serve food in accordance with professional standards for food service safety.

Based on observations, staff interviews, and policy review, the facility failed to ensure that cleaning clothes were stored in accordance with professional standards and that a beard nets were worn by two staff member. The deficient practice could result in placing residents at risk for food-borne illnesses. Findings include: A kitchen observation was conducted on October 17, 2023 at 8:40 AM. The observation revealed a dry cleaning rag on the top shelf of the central food preparation area adjacent to the plating area. Two additional rags were observed on a shelf above the sink in the main kitchen area, directly on top of a sealed bag of pita pocket bread. The executive chef took pictures of each identified rag and its placement. An interview was conducted immediately thereafter with the executive chef, staff #110, who stated that the expectation was the cleaning rags are to be stored underneath the counters and not on food preparation or storage areas. He stated that the risk could include a potential for infection or foodborne illness. A kitchen observation was conducted on October 17, 2023 at 8:50 AM. Staff #90, cook and executive chef, staff #110, were both observed without a beard net in the kitchen area. Staff #110 had approximately 2 centimeters of facial hair present; whereas staff #90 had a full-grown beard approximately 6 centimeters in length. Both staff members were observed in the kitchen and neither had a beard net in place at the time. An interview was conducted on October 17, 2023 at 8:55 AM, with staff #110, executive chef. Staff #110 stated he understood that staff #90 should have been wearing a beard net; however, he stated that he was under the impression that he (staff #110) did not require a beard net because his beard was relatively short. He stated that he understood that the risk still existed for hair to fall into the food regardless of the length of the beard. A kitchen observation was conducted on October 18, 2023 at 10:47 AM. A stained cleaning rag was observed on the food preparation counter. The rag was observed for approximately 5 minutes while staff continued to walk past it. No one removed it. When the sous chef, staff #31 was asked about the cleaning rag, she stated that the rag should not be there and removed it. She stated it was left there earlier when she was transferring a hot tray. An interview was conducted on October 19, 2023 with server, staff #67, who stated that the expectation is that hair nets and beard nets are to be worn anytime that staff are in the kitchen. An interview was conducted on October 19, 2023 at 12:30 PM, with both the executive chef, staff #110 and sous chef, staff #31. Both stated that the expectation is that beard nets are worn when facial hair is present and that cleaning rags, either dry or wet, not be stored on food preparation or storage surfaces. An interview was conducted on October 19, 2023 at 12:42 PM, with the administrator, staff #121. Staff #121 stated that the expectations are that sanitary practices should be conducted properly and following procedures regarding the placement of cleaning rags. She stated that not storing the rags accordingly could result in an infection control risk. She further stated that both hair and beard nets are to be worn at all times in the kitchen. She stated that the risk could include getting hair into the food that is being served to residents and staff. A review of facility kitchen and cleaning related policies revealed the presence of the following policies: cleaning dishes/ dish machine, cleaning and sanitizing the dining room, food storage and refrigeration management policy, culinary experience center safety-noting that culinary team members receive routine training on safety topics, kitchen equipment cleaning and sanitizing, and food temperatures; however, none of these policies showed evidence that of the hair or beard net requirements. Additionally, the food storage and refrigeration management policy, revised March 2023, revealed that food, chemicals and supplies should be stored in a manner that protects quality and the safety of food.