Inspection Details
Inspection #
INSP-0061334
Inspection Date(s)
8/25/2023
Status
Complete
Inspection Type
Complaint;Compliance (Annual)
Worksheet Type
Assisted Living Center
Certificate Number
AL11558C
Location Type
โ
Initial Comments
The following deficiencies were found during the on-site compliance inspection and investigation of complaint AZ00189288 conducted on August 25, 2023:
Statement of Deficiency
3 deficiencies found
Deficiency #1
✓ Plan Provided
▼
Rule
36-420.01. Health care institutions; fall prevention and fall recovery; training programs; definition A. Each health care institution shall develop and administer a training program for all staff regarding fall prevention and fall recovery. The training program shall include initial training and continued competency training in fall prevention and fall recovery. A health care institution may use information and training materials from the department's Arizona falls prevention coalition in developing the training program.
Evidence
Plan of Correction
Permanent Correction Date
2023-10-19
Deficiency #2
✓ Plan Provided
▼
Rule
C. A manager shall ensure that policies and procedures are: 1. Established, documented, and implemented to protect the health and safety of a resident that: b. Cover orientation and in-service education for employees and volunteers;
Evidence
Plan of Correction
Permanent Correction Date
2023-10-19
Deficiency #3
✓ Plan Provided
▼
Rule
C. A manager shall ensure that a personnel record for each employee or volunteer: 1. Includes: a. The individual's name, date of birth, and contact telephone number;
Evidence
Based on record review and interview, the manager failed to ensure a personnel record for each employee included the individual's contact telephone number, for one of five personnel members sampled. Findings include: 1. A review of E5's personnel record revealed a telephone number was not available for review. 2. In an interview, E1 reported E5 was a temporary caregiver. E1 did not have E5's telephone number because the temporary employment agency did not share this information. E1 reported to utilize the temporary agency when E1 needed to contact E5.
Plan of Correction
Permanent Correction Date
2023-10-19