TOUCHMARK AT THE RANCH, LLC

<p>Based on documentation review and interview, the manager failed to develop a training program for all staff regarding fall prevention and fall recovery, including initial and continued training.</p><p><br></p><p><br></p><p><br></p><p>Findings include:</p><p><br></p><p><br></p><p><br></p><p>1 . A review of facility documentation revealed a written program which stated when personnel received initial training and continued competency training for fall prevention and fall recovery was not available for review at the time of inspection.</p><p><br></p><p><br></p><p><br></p><p>2 . In an exit interview, the findings were discussed with E1 and no additional information was provided.</p><p><br></p><p><br></p><p><br></p><p>3. This is a repeat deficiency from the compliance inspection conducted September 12, 2023.</p>

<p>Based on observation and interview, the manager failed to ensure p<span style="background-color: rgb(255, 255, 255);">oisonous or toxic materials stored by the assisted living facility were inaccessible to residents.</span></p><p><br></p><p><br></p><p><br></p><p><span style="background-color: rgb(255, 255, 255);">Findings include:</span></p><p><br></p><p><br></p><p><br></p><p><span style="background-color: rgb(255, 255, 255);">1 . During an environmental inspection of the facility, the Compliance Officers observed a "Supply" room with the door open. Inside the room was an unlocked cabinet with the following chemicals:</span></p><p><span style="background-color: rgb(255, 255, 255);">-A bottle of "Pill Disposal XL";</span></p><p><span style="background-color: rgb(255, 255, 255);">-A bottle of laundry stain remover;</span></p><p><span style="background-color: rgb(255, 255, 255);">-A bottle of "Great Value" low splash bleach;</span></p><p><span style="background-color: rgb(255, 255, 255);">-A bottle of "Top Clean"; and </span></p><p><span style="background-color: rgb(255, 255, 255);">-A bottle of "Expo" whiteboard cleaning spray.</span></p><p><br></p><p><br></p><p><br></p><p><span style="background-color: rgb(255, 255, 255);">2 . During an environmental inspection of the facility, the Compliance Officers observed an unlocked laundry room in the memory care unit. The room had an "AccuMax 4P" dispensing system with an open tube, which included bathroom cleaner and disinfectant options. </span></p><p><br></p><p><br></p><p><br></p><p><span style="background-color: rgb(255, 255, 255);">3 . During an environmental inspection of the facility, the Compliance Officers observed an unlocked cabinet under a sink in the memory care unit common area kitchen. The cabinet contained the following chemicals:</span></p><p><span style="background-color: rgb(255, 255, 255);">-A bottle of "Butler" disinfectant spray;</span></p><p><span style="background-color: rgb(255, 255, 255);">-A bottle of "Suprox-D"; and </span></p><p>-A bottle of "Take Down."</p><p><br></p><p><br></p><p><br></p><p>4 . <span style="background-color: rgb(255, 255, 255);">During an environmental inspection of the facility, the Compliance Officers observed an unlocked cabinet under a sink in a common area kitchen. The cabinet contained the following chemicals:</span></p><p><span style="background-color: rgb(255, 255, 255);">-A bottle of "Suprox-D";</span></p><p><span style="background-color: rgb(255, 255, 255);">-A can of stainless steel cleaner and polish; and</span></p><p><span style="background-color: rgb(255, 255, 255);">-A bottle of "Super Shine-All."</span></p><p><br></p><p><br></p><p><br></p><p><span style="background-color: rgb(255, 255, 255);">5 . In an exit interview, the findings were discussed with E1 and no additional information was provided. </span></p>

Based on record review and interview, the Manager failed to ensure that a resident was treated with dignity, respect and consideration.

Findings include:
1. Review of the record for E2 revealed a "Written Disciplinary Warning" dated April 2, 2024 that indicated E2 had been involved in an incident with R1 on March 27, 2024 where E2 had not treated R1 with "respect".
2. During an interview, E1 stated, "I listened to the video and I didn't like his tone of voice, it was unkind."
3. During an interview, E1 acknowledged E2 failed to treat R1 with dignity, respect and consideration.

Based on documentation review and interview, the manager failed to ensure that a fire inspection was conducted by the local fire department or the State Fire Marshal according to the time-frame established by the local fire department or the State Fire Marshal.

Findings include:
1. Facility documentation indicated the last fire inspection was conducted by the local fire department on April 29, 2022.
2. During an interview with a representative from the local Fire Department it was determined that fire inspections are required on an annual basis.
3. During an interview, E1 stated, "We have a local fire protection company inspect us annually."
4. During an interview, E1 acknowledged that the required fire inspection was not conducted as required.

Based on record review and interview, the manager failed to ensure that the health care institution implemented tuberculosis infection control activities that included annually providing training and education related to recognizing the signs and symptoms of tuberculosis (TB) to individuals employed by the health care institution.

Findings include:
1. Review of the record for E1 indicated that the last documentation indicating that annual TB training had been conducted was on January 25, 2023.
2. Review of the record for E2 indicated that the last documentation indicating that annual TB training had been conducted was on June 5, 2023.
3. During an interview, E1 acknowledge that the required documentation was not available.

Based on record review and interview, the manager failed to ensure that medication administered to a resident was administered in compliance with a medication order.

Findings include:
1. Review of the record for R2 revealed that on September 26, 2023 at approximately 8pm, the resident failed to receive the following prescribed medications: Metoprolol 25mg, Potassium Chloride 20mEq, Warfarin 2.5mg, and Pravastatin 20mg. Instead the resident received the following medications prescribed to R4: Atorvastatin 40mg, Mirtazapine15mg, and Quetiapine 25mg.
2. During an interview, E1 stated, "The resident was given another resident's medications by mistake."
3. During an interview, E1 acknowledged that medication prescribed to the resident was not administered in compliance with the medication order.

Based on record review and interview the health care institution failed to develop and administer a training program for all staff regarding fall prevention and fall recovery as required in A.R.S. \'a7 36-420.01.

Findings include:
1. Review of the record for E1 (hired June 5, 2023), failed to reveal documentation of fall prevention and fall recovery training.
2. Review of the record for E2 (hired August 11, 2021), failed to reveal documentation of fall prevention and fall recovery training.
3. Review of the record for E3 (hired May 30, 2022), failed to reveal documentation of fall prevention and fall recovery training.
4. During an interview, E1 indicated that training for fall prevention and fall recovery had not been developed and administered to all staff.

This is a repeat deficiency from the complaint investigation conducted on August 11, 2022.

Based on record review and interview, the manager failed to ensure that one of three sample personnel records, for personnel who work more than 8 hours per week, contained evidence of freedom from infectious tuberculosis (TB), on or before the date the individual began providing services to residents as specified in R9-10-113.

Findings include:
1. The record for E1 (Manager, hired June 5, 2023) contained documentation indicating that a TB test with negative results was administered on July 22, 2023. No other TB test documentation conducted within the past 13 months was provided for review.
2. During an interview, E1 acknowledged that the required documentation was not available for review.

Based on record review, observation and interview, the manager failed to ensure that one of two sample service plans for residents who were storing medication in their bedrooms, included how the medication would be stored and controlled.

Findings include:
1. During an interview, E1 indicated that R3 self-administered their own medications and stored the medications in their room.
2. The record for R3 contained a service plan dated July 12, 2023 that did not include how the resident's medication would be stored and controlled.
3. During an interview, E1, acknowledged the service plan did not indicate how the resident's medication would be stored and controlled in their room.

Based on record review and interview the manager failed to ensure that three of four sample resident records contained a service plan that when updated, was signed and dated by the resident or resident's representative.

Findings include:
1. The record for R1, contained service plans dated April 25, 2023 and January 24, 2023 that did not contain the dated signature of the resident or the resident's representative.
2. The record for R2, contained service plans dated March 1, 2023 and February 3, 2023 that did not contain the dated signature of the resident or the resident's representative.
3. The record for R4, contained a service plan dated April 23, 2023 that did not contain the dated signature of the resident or the resident's representative.
4. During an interview, E1 acknowledged that the service plans did not reflect the required dated signature.

Based on record review and interview for two of two sample directed care resident records, the manager failed to obtain the following documentation: documentation reflecting that the resident or resident's representative requested that the resident remain in the facility and a signed and dated statement from a medical practitioner indicating that the resident's needs were being met by the facility as per their scope of services.

Findings include:
1. During an interview, E1 indicated that R1 was non-ambulatory, has not walked for more than 30 days and cannot walk even when assisted.
2. The resident's record did not contain a request from the resident or their representative to remain in the facility or a statement from the medical practitioner that the resident's needs were being met as per the facility's scope of services. Based on the resident's date of acceptance this documentation was required.
3. During an interview, E1 indicated that R2 was non-ambulatory, has not walked for more than 30 days and cannot walk even when assisted.
4. The resident's record did not contain a request from the resident or their representative to remain in the facility or a statement from the medical practitioner that the resident's needs were being met as per the facility's scope of services. Based on the resident's date of acceptance this documentation was required.
5. During an interview, E1 acknowledged that the required documentation was not in the resident's records.

Based on observation and interview, the manager failed to ensure that a current toxicology reference guide was available for use by personnel members.

Findings include:
1. The toxicology guide available for use by personnel members was the Toxicology Handbook, 3rd. edition.
2. The Internet web site for the toxicology guide revealed that a more current edition was available for distribution.
3. During an interview, E1 acknowledged that a current toxicology reference guide was not available for use by personnel members.

Based on documentation review and interview, the manager failed to ensure that a disaster drill for employees was conducted on each shift at least once every three months and documented.

Findings include:
1. Facility disaster drill documentation revealed that the last disaster drill was conducted on September 1, 2022. No other disaster drill documentation was available for review.
2. During an interview, E1 acknowledged that documentation failed to reflect that employee disaster drills were conducted on each shift, at least once every three months.

Based on documentation review and interview, the manager failed to ensure that an evacuation drill for employees and residents was conducted at least once every six months.

Findings include:
1. Evacuation drill documentation indicated that the last evacuation drill for employees and residents had been conducted on May 1, 2022. No additional evacuation drill documentation was available for review.
2. During an interview, E1 acknowledged the documentation failed to indicate that evacuation drills for employees and residents had been conducted at least once every six months.

Based on documentation review and interview, the manager failed to ensure that three of three pets or animals that reside at facility, were licensed consistent with local ordinances.

Findings include:
1. Documentation for O2, a dog allowed in the facility, failed to reflect that the dog had a current license.
2. Documentation for O5, a dog allowed in the facility, failed to reflect that the dog had a current license.
3. Documentation for O7, a dog allowed in the facility, failed to reflect that the dog had a current license.
4. During a telephone interview with the local authority it was determined that the dogs required a license.
5. During an interview, E1 acknowledged that facility documentation failed to indicate the dogs had a current license.

This is a repeat deficiency from the compliance inspection conducted on August 11, 2022.

Based on documentation review and interview, the manager failed to ensure that seven of seven pets that reside at the facility, were vaccinated against rabies.

Findings include:
1. Documentation for the dog O1 that resides in the facility failed to indicate that the dog was vaccinated for rabies.
2. Documentation for the dog O2 that resides in the facility failed to indicate that the dog was vaccinated for rabies.
3. Documentation for the dog O3 that resides in the facility failed to indicate that the dog was vaccinated for rabies.
4. Documentation for the dog O4 that resides in the facility failed to indicate that the dog was vaccinated for rabies.
5. Documentation for the dog O5 that resides in the facility failed to indicate that the dog was vaccinated for rabies.
6. Documentation for the dog O6 that resides in the facility failed to indicate that the dog was vaccinated for rabies.
7. Documentation for the dog O7 that resides in the facility failed to indicate that the dog was vaccinated for rabies.
8. During an interview, E1 acknowledged the documentation available for review failed to reflect the pets were currently vaccinated against rabies.

This is a repeat deficiency from the compliance inspection conducted on August 11, 2022.