LIFESTREAM AT YOUNGTOWN

Based on documentation review, record review, and interview, the manager failed to ensure a caregiver provided documentation of completing a caregiver training program approved by the Department or the Board of Examiners for Nursing Care Institution Administrators and Assisted Living Facility Managers (NCIA Board), for one of three caregivers reviewed. The deficient practice posed a risk if the individual was not qualified to provide the required services.

Findings include:

1. Review of the February 2024 personnel schedule revealed E6 worked the 2pm - 10pm shift February 2nd - 6th.

2. Review of E6's personnel record revealed no documentation that showed E6 completed a caregiver training program approved by the Department or the NCIA Board. In addition, E6's record did not include documentation that showed an administrator's license, a nursing license, or employment as a caregiver prior to November 1, 1998. Therefore, E6 was not qualified to be left alone with the residents based on the lack of caregiver training.

3. Review of the az.tmuniverse.com website on February 7, 2024 revealed no documentation of a caregiver training certificate for E6.

4. In an interview, E2 reported E6 worked as a caregiver. E1, E2, E3, and E4 acknowledged documentation was not available that showed E6 completed a caregiver training program approved by the Department or the NCIA Board.

Based on documentation review, record review, and interview, the manager failed to ensure a caregiver provided current documentation of first aid and cardiopulmonary resuscitation (CPR) training, before providing assisted living services, for one of three caregivers reviewed. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency.

Findings include:

1. Review of the facility's policies and procedures revealed a policy titled "Cardiopulmonary Resuscitation and First Aid Training" that stated "...3. Staff will provide proof of training in CPR/First Aid in the form of an unexpired card...4. HR will set up a tracking sheet as a reminder for expiration date of the card to ensure a timely retraining..."

2. Review of E5's personnel record revealed E5 worked as a caregiver. The personnel record revealed a first aid and CPR card with an expiration date of December 10, 2021. There was no other current documentation of first aid and CPR training in E5's record.

3. Review of the February 2024 personnel schedule revealed E5 worked the 6am - 2pm shift February 5th.

4. In an interview, E1, E2, E3, and E4 acknowledged E5 did not have current documentation of first aid and CPR training.

Based on record review and interview, the manager failed to ensure a resident accepted by the assisted living facility submitted documentation signed by a medical practitioner or a registered nurse that stated whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, for two of two residents reviewed accepted by the assisted living facility on or after October 1, 2013. The deficient practice posed a risk if the facility was unable to meet a resident's needs.

Findings include:

1. Review of R1's medical record revealed documentation that stated R1 did not require continuous medical services, continuous or intermittent nursing services, or restraints. However, this document was not signed by a medical practitioner or a registered nurse. Based on R1's acceptance date, this documentation was required.

2. Review of R2's medical record revealed documentation that stated R2 did not require continuous medical services, continuous or intermittent nursing services, or restraints. However, this document was not signed by a medical practitioner or a registered nurse. Based on R2's acceptance date, this documentation was required.

3. In an interview, E1, E2, E3, and E4 acknowledged R1 and R2 did not provide documentation signed by a medical practitioner or a registered nurse that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints.

Based on documentation review, record review, and interview, the health care institution failed to establish, document, and implement tuberculosis (TB) infection control activities as specified in R9-10-113. The deficient practice posed a risk as the caregiver received no organized instruction or information related to TB surveillance and posed a TB exposure risk to residents and staff.

Findings include:

1. R9-10-113.A states "If a health care institution is subject to the requirements of this Section, as specified in an Article in this Chapter, the health care institution's chief administrative officer shall ensure that the health care institution establishes, documents, and implements tuberculosis infection control activities that...2. Include: a. For each individual who is employed by the health care institution, provides volunteer services for the health care institution, or is admitted to the health care institution and who is subject to the requirements of this Section, screening, on or before the date specified in the applicable Article of this Chapter, that consists of: i. Assessing risks of prior exposure to infectious tuberculosis, ii. Determining if the individual has signs or symptoms of tuberculosis, and iii. Obtaining documentation of the individual's freedom from infectious tuberculosis according to subsection (B)(1)...c. Annually providing training and education related to recognizing the signs and symptoms of tuberculosis to individuals employed by or providing volunteer services for the health care institution; d. Annually assessing the health care institution's risk of exposure to infectious tuberculosis..."

2. Review of the Centers for Disease Control and Prevention website revealed a web page titled "TB Screening and Testing of Health Care Personnel." The web page stated, "If the Mantoux tuberculin skin test (TST) is used to test health care personnel upon hire (preplacement), two-step testing should be used."

3. Review of facility documentation revealed a policy titled "TB Test Procedure". However, this policy did not address an annual training and education related to recognizing the signs and symptoms of TB to individuals employed by or providing volunteer services for the health care institution; or an annual assessment of the health care institution's risk of exposure to infectious TB.

4. Review of E5's personnel record revealed no documentation of training and education related to recognizing the signs and symptoms of TB.

5. Review of E6's personnel record revealed a negative TB skin test that was less than 12 months old, however no additional documentation of freedom from infectious TB was available for review. In addition, the personnel record did not include documentation of training and education related to recognizing the signs and symptoms of TB. Based on E6's hire date, this documentation was required.

6. Review of E7's personnel record revealed no documentation of training and education related to recognizing the signs and symptoms of TB.

7. Review of facility documentation revealed no documentation of an annual assessment of the health care institution's risk of exposure to infectious TB.

8. In an interview, E1, E2, E3, and E4 acknowledged the facility had not established, documented, and implemented a TB infection control program as specified in R9-10-113.

9. Technical assistance was provided on this Rule during the compliance inspection conducted March 30, 2023.

Based on record review, observation, and interview, the manager failed to ensure a medication was administered in compliance with a medication order, for one of three residents reviewed. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication.

Findings include:

1. Review of R2's medical record revealed a signed medication order dated September 20, 2023. This medication order stated "Carbidopa-Levodopa 25-100 take 1/2 tablet by mouth four times daily at 7am, 11:30am, 4pm, and 8:30pm".

2. Review of R2's medical record revealed a September 2023 medication administration record (MAR). This MAR stated "Carbidopa-Levo ER 50-200 TA take 1 tablet by mouth four times daily at 7am, 11:30am, 4pm, and 8:30pm" and indicated one tab was administered at 4pm and 8:30pm September 20th and one tab was administered at 7am, 11:30am, 4pm, and 8:30pm September 21st - present.

3. During an observation of R2's medications, Carbidopa-Levodopa 50-200mg was observed.

4. In an interview, E2 reported the medication was administered per the MAR and acknowledged R2's medication was not administered in compliance with the available medication order.

Based on record review and interview, the manager failed to ensure the health care institution developed and administered a training program for all staff regarding fall prevention and fall recovery that included initial training and continued competency. The deficient practice posed a risk to the physical health and safety of a resident.

Findings include:

1. Review of E5's personnel record revealed no documentation indicating E5 completed fall prevention and fall recovery training.

2. During an interview, E1, E2, and E3 acknowledged documentation was not available showing E5 had completed fall prevention and fall recovery training.

Based on record review, observation, and interview, the manager failed to ensure a written service plan was updated no later than 14 days after a significant change in a resident's physical, cognitive, or functional condition, for one of two residents reviewed. The deficient practice posed a health and safety risk to the resident if the caregivers did not know what services the resident needed.

Findings include:

1. Review of R1's medical record revealed a current written service plan dated September 28, 2022. This service plan stated "...has no open wounds..."

2. During an observation, the Compliance Officer observed R1's skin. R1's left and right lower legs were red with open blister like sores. Additionally, R1's left and right feet were red/purple and swollen.

3. During an interview, R1 reported R1 did R1's own skin care and put Cerave cream, Zinc Oxide ointment, and Campho Phenique on the lower legs and feet. R1 reported R1's skin issues have been occurring for at least one month.

4. During an interview, E2 acknowledged R1 had skin issues. E1, E2, and E3 acknowledged R1's service plan was not updated after a significant change of condition.

Based on documentation review and interview, the manager failed to ensure documentation of each evacuation drill included the identification of residents needing assistance for evacuation and the identification of residents who were not evacuated. The deficient practice posed a risk if employees were unable to implement the evacuation plan.

Findings include:

1. Review of the evacuation drill documentation revealed an evacuation drill conducted November 30, 2022, December 31, 2022, January 31, 2023, and February 28, 2023.

2. During an interview, E6 reported not all the residents participated in the evacuation drills due to refusal.

3. During an interview, E3 reported some residents would need assistance during an evacuation.

4. Review of the evacuation drill documentation revealed no documentation of the identification of residents needing assistance for evacuation and the identification of residents who were not evacuated.

5. During an interview, E1, E2, and E3 acknowledged the evacuation drills did not include the identification of residents needing assistance for evacuation and the identification of residents who were not evacuated.

Based on record review and interview, the manager failed to ensure a resident received orientation to the exits from the assisted living facility and the route to be used when evacuating the assisted living facility within 24 hours of acceptance, for one of two residents reviewed. The deficient practice posed a health and safety risk if the resident needed to exit the facility in an emergency.

Findings include:

1. Review of R1's medical record revealed an evacuation plan orientation. However, this evacuation plan orientation was from R1's previous facility. Documentation of orientation to the exits from the current assisted living facility and the route to be used when evacuating the current assisted living facility within 24 hours of acceptance was not available for review. Based on the resident's date of acceptance, this documentation was required.

2. During an interview, E1, E2, and E3 acknowledged documentation was not available showing R1 was oriented to the current facility's evacuation plan within 24 hours of acceptance.

Based on observation and interview, the manager failed to ensure toxic materials stored by the facility were stored in a locked area and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident.

Findings include:

1. During the facility tour with E3, the Compliance Officer observed Raid, Extra Strength CSP cleaner, Arsenal Heavy Duty Floor Cleaner, Arsenal QT.3, Arsenal Restroom Cleaner, and Robusto Multi Purpose Cleaner unlocked in a closet on the east side of the facility. This closet had a locking device, however the device was not locked.

2. During an observation, the employees were not accessing the toxic materials at the time of the facility tour.

3. During an interview, E1, E2, and E3 acknowledged toxic materials were stored unlocked.

Based on documentation review, record review, observation, and interview, the manager failed to ensure an individual authorized by policies and procedures to administer an opioid, documented in the resident's medical record the identification of the resident's need for the opioid and the effect of the opioid administered, for one of two residents reviewed. The deficient practice posed a risk to the physical health and safety of a resident.

Findings include:

1. Review of the facility's policies and procedures revealed a policy titled "Opioid Administration" that stated "...2. When administering an opioid the authorized caregiver shall include the following: a. A pain scale assessment is entered before each dose and the effectiveness of the drug documented within an appropriate interval. b. Monitor the patient's response to the opioid and
c. Document in the patient's medical record: i. An identification of the patients pain before the opioid was administered and ii. The effect of the opioid administered..."

2. Review of R1's medical record revealed signed medication orders dated January 25, 2023. These medication orders stated the following:
"Morphine Sulf ER 15mg Tabl Take 1 tablet by mouth every 12 hours"
"Oxycodone HCL (IR) 10mg Tab Take 1 tablet by mouth every 6 hours"

3. Review of R1's medical record revealed a March 2023 medication administration record (MAR). This MAR stated the following:
"Morphine Sulf ER 15mg Tabl Take 1 tablet by mouth every 12 hours" and indicated 1 tab was administered at 8am and 8pm March 1st - present.
"Oxycodone HCL (IR) 10mg Tab Take 1 tablet by mouth every 6 hours" and indicated 1 tab was administered at 12am, 6am, 12pm, and 6pm March 1st - present.
However, documentation was not available showing the identification of R1's need for the opioids and the effect of the opioids administered.

4. During an observation of R1's medications the following was observed:
-Morphine Sulfate ER 15mg was available.
-Oxycodone HCL IR 10mg was available.

5. Review of R1's medical record revealed no documentation stating R1 had an end of life condition or an active malignancy.

6. During an interview, E1, E2, and E3 acknowledged the caregivers did not document in R1's medical record the identification of R1's need for the opioids and the effect of the opioids administered.