VALENCIA CARE HOMES

Based on a documentation review and interview, the manger 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 training. The deficient practice posed a risk to the physical health and safety of a resident.

Findings include:

1. In record review, the facility had no documentation to indicate E6 (hired March 23, 2023, as a caregiver) received training on fall prevention and fall recovery.

2. During an interview, E1 and E2 reported E6 worked the night shift alone.

3. During an interview, E2 acknowledged the personnel record for E6 did not include the required training.

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

Findings include:

1. A review of E4's personnel record revealed E4 was hired as a caregiver on December 18, 2023. The record included a caregiver training certificate from Arizona Assisted Living Caregiver and Manager Training Programs, LLC., ALTP 0150, dated January 25, 2013.

2. A review of the NCIA verification of caregiver training portal revealed the training program was in operation from May 11, 2009 through July 31, 2012, which made E4's certificate invalid.

3. In an interview, E2 reported E4 worked as a caregiver three night shifts per week, alone, while employed at the facility, and acknowledged documentation was not available that showed E4 completed a caregiver training program approved by the Department or the NCIA Board.

Based on documentation review, observation, record review, and interview, the manager failed to ensure a caregiver's skills and knowledge were verified and documented before the caregiver or assistant caregiver provided physical health services, and according to policies and procedures, for one of five sampled caregivers. The deficient practice posed a risk if the employees did not have the skills and knowledge necessary to meet a resident's needs.

Findings include:

1. A review of the facility's policies and procedures revealed a policy that stated "The hiring person or manager will ensure, check and document that each caregiver or assistant caregiver providing physical health services or behavioral care services have the required skills and knowledge before providing any service."

2. The Compliance Officers observed E3 working at the facility.

3. A review of E3's personnel record revealed a hire date of May 28, 2024. E3's record revealed no documentation of verifying E3's skills and knowledge.

4. In an interview, E2 acknowledged documentation was not available showing E3's skills and knowledge were verified and documented.

Based on documentation review, record review, and interview, the manager failed to ensure that a caregiver provided evidence of freedom from infectious tuberculosis (TB) as specified in R9-10-113 for one of five personnel sampled. The deficient practice posed a potential illness risk to residents.

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)..."

2. A review of the Centers for Disease Control and Prevention website revealed a web page titled, "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005." The web page stated, "If TST (Mantoux Skin Test) is used for baseline testing, two-step testing is recommended for HCW's (Health Care Workers) whose initial TST results are negative. If the first-step TST result is negative, the second-step TST should be administered 1-3 weeks after the first TST result was read."

3. A review of E6's personnel record revealed a hire date of March 23, 2023. The personnel record did not include documentation of freedom from TB.

4. During an interview, E2 acknowledged E6 did not provide documentation of freedom from infectious TB as specified in R9-10-113.

Technical assistance was provided on this Rule during the compliance inspection conducted August 15, 2023.

Based on record review, documentation review, and interview, for one of five caregivers reviewed, the manager failed to ensure a caregiver provided documentation of cardiopulmonary resuscitation training (CPR) certification specific to adults which included a demonstration. The deficient practice posed a health and safety risk to residents if caregivers did not have CPR training which included a demonstration of the employee's ability to perform CPR.

Findings include:

1. In record review, E4's personnel record revealed a hire date of December 18, 2023, as a caregiver. The record included documentation of a CPR certification, dated September 11, 2022, from National CPR Foundation, which was an online training program, and did not include a demonstration.

2. In an interview, E2 reported E4 worked the night shift alone, at the facility, three days a week.

3. In documentation review, a facility policy, titled, "First Aid and CPR Training...," documented, "... 2. Method and content of CPR training which includes the ability to perform and demonstrate cardiopulmonary resuscitation... "

4. In an interview, E2 acknowledged E4 did not have current documentation of CPR training, that included a demonstration of the individual's ability to perform CPR.

Based on interview and record review, for one of five employees reviewed, the manager failed to have a personnel record for an employee, as required by this Article. The deficient practice posed a risk to resident health and safety if the facility did not obtain documentation showing an employee met the requirements to provide services for the residents.

Findings include:

1. In an interview, E2 reported E5 worked as a caregiver at the facility for approximately "two weeks to a month," (hire date unknown) and worked the night shift alone.

2. In record review, the facility did not have a personnel record for E5.

3. During an interview, E1 and E2 acknowledged having no personnel record for E5.

Based on documentation review, record review, and interview, the governing authority failed to notify the Department according to A.R.S. \'a7 36-425(I), when there is a change in the manager.

Findings include:

1. In record review, E1 was the facility manager.

2. A review of Department documentation revealed O1 was the manager. The Department was not notified of the change in the manager.

3. During an interview, E1 reported [E1] was the manager effective May 1, 2023.

Based on observation, and interview, the manager failed to ensure soiled linen and soiled clothing stored by the facility were stored in closed containers.

Findings include:

1. During an environmental inspection, the surveyor observed a container in the laundry room which was uncovered and filled with soiled linens.

2. During an interview, E1 and E2 acknowledged the soiled linen and clothing stored by the facility was not stored in a closed container.

Based on observation, interview, and documentation review, for three of three employees reviewed, the manager failed to have a personnel record for an employee as required by this Article. The deficient practice posed a risk to resident health and safety if the facility did not obtain documentation showing an employee met the requirements to provide services for the residents.

Findings include:

1. In observation, E2, E3, and E4 were observed working at the facility during the inspection.

2. On August 31, 2022, during the prior compliance inspection, E3 and E4 were observed by the compliance officer to be working at the facility.

3. In an interview, E2 reported having been with the company since 2020; however, started working at the facility as the manager designee approximately two weeks prior.

4. In record review, the compliance officer requested to review the personnel records for E2, E3, and E4. The compliance officer was provided some documents for E2; however, was not provided documentation of: the individual's qualifications, including skills and knowledge applicable to the individual's job duties; the individual's education and experience applicable to the individual's job duties; the individual's completed orientation and in-service education required by policies and procedures. No personnel records were provided for E3 and E4.

5. In an interview, E1 reported having no personnel records for E3 and E4 because a prior employee had taken all of the personnel records when employment was terminated. E1 reported the facility is rebuilding the personnel records, and acknowledged the employees' personnel records were not maintained.

Based on record review and interview, for one of three residents reviewed, the manager failed to ensure a resident had a written service plan to include the level of service the resident was expected to receive. The deficient practice posed a risk as the service plan did not reinforce and clarify services to be provided to a resident.

Findings include:

A.R.S. \'a7 36-401.38 defines "Supervisory care services" to mean general supervision, including daily awareness of resident functioning and continuing needs, the ability to intervene in a crisis and assistance in the self-administration of prescribed medications.

A.R.S. \'a7 36-401.38 defines " Personal care services" to mean assistance with activities of daily living that can be performed by persons without professional skills or professional training and includes the coordination or provision of intermittent nursing services and the administration of medications and treatments by a nurse who is licensed pursuant to title 32, chapter 15 or as otherwise provided by law.

A.R.S. \'a7 36-401.38 defines "Directed care services" to mean programs and services, including supervisory and personal care services, that are provided to persons who are incapable of recognizing danger, summoning assistance, expressing need or making basic care decisions.

1. In record review, R1's medical record included a written service plan, dated September 22, 2022, which indicated R1 received directed care services; however, the service plan did not include documentation R1 was unable to recognize danger, summon assistance, or express needs or make basic care decisions.

2. In an interview, R1 was able to converse with the compliance officer and respond appropriately to all questions. R1 was observed to be able to make needs known. E3 reported R1 was able to make needs known and was capable of recognizing danger and summoning assistance. R1 was observed to have a call bell around the neck.

3. In an interview, E1 acknowledged R1 received personal care services, and that R1's service plan did not identify R1's correct level of care.

Based on record review, observation, and interview, for one of three residents reviewed, the manager failed to ensure a caregiver documented the services provided in the resident's medical record. The deficient practice posed a risk if services provided for residents could not be verified.

Findings include:

1. In record review, R1's medical record included a service plan for "Directed Care" services, dated September 22, 2022. The service plan indicated R1 had a stroke, used a wheelchair, was dependent for bed mobility, eating, toileting, and incontinence care. R1's medical record did not include documentation of the services provided for R1.

2. In observation, R1 was observed to be unable to walk and required full assistance with transfer from chair to bed, and with incontinence care.

3. In an interview, R1 reported being fully dependent on staff to assist with activities of daily living, due to having a stroke.

4. In an interview, E1 reported not having documentation of the services provided for the residents, and the facility's system for documenting the services provided to residents was being revised.

Based on record review and interview, for one of three residents reviewed, the manager failed to ensure the service plan for a resident receiving personal care services included skin maintenance to prevent and treat bruises, injuries, pressure sores, and infections.

Findings include:

1. In record review, R1's service plan dated September 22, 2022, documented R1 received Directed Care services; (however, this was inaccurate and R1 was observed and reported to be at the personal care level of services). The service plan indicated R1 had a stroke, used a wheelchair, was dependent for bed mobility, eating, toileting, and incontinence care. The service plan did not include documentation of skin maintenance services to be provided for R1.

2. In an interview, E2 and E3 reported skin maintenance services were provided for R1, including the application of cream following incontinence care to prevent skin breakdown. E1 acknowledged R2's service plan did not include skin maintenance for R1.

Based on observation, record review, and interview, for one resident reviewed who was unable to walk and receiving personal care services, the manager failed to ensure the resident's primary care provider (PCP) or other medical practitioner (MP) examined the resident at the onset of the condition and at least every six months throughout the duration of the resident's condition, reviewed the facility's scope of services, and signed and dated a determination stating the resident's needs were being met by the facility.

Findings include:

1. In observation, the surveyor observed R1 (received personal care services). R1 was observed to be confined to a bed or chair, and unable to walk even with assistance.

2. In an interview, R1 reported being accepted at the facility after having a stroke, and was unable to walk. E2 and E3 reported R1 was unable to walk even with assistance and was confined to a bed or chair.

3. In record review, R1's medical record did not include a signed and dated determination stating the residents needs could be met by the facility.

4. In an interview, E1 acknowledged R1's record did not include a signed and dated determination stating R1's needs could be met by the facility.

5. This is a repeat deficiency from the compliance inspection conducted on August 31, 2022, for which a plan of correction was submitted to the Department.

Based on observation and interview, the manager failed to ensure the food menu included substitutions.

Findings include:

1. The surveyor observed a menu posted in the facility. The menu documented the lunch meal to be shrimp fettuccine, broccoli and garlic bread.

2. In an interview, E3 reported lunch served to the residents was sauteed chicken, rice and green beans. E1 and E3 acknowledged the
posted menu did not include the food substitutions in the morning of the day of meal service, as required.

Based on observation and interview, the manager failed to ensure there were snacks documented on the posted food menu.

Findings include:

1. The surveyor observed the posted food menu did not include snacks to be served to the residents.

2. In an interview, E3 reported snacks were served to the residents; however, acknowledged the snacks were not on the food menu.