GARDEN RIDGE

<p>Based on the documentation review and interview, the manager failed to ensure a resident was treated with dignity, respect, and consideration. The deficient practice posed a risk of physical and/or psychosocial harm.</p><p> </p><p><br></p><p>Findings include:</p><p> </p><p><br></p><p>1. In an internal investigation during facility interviews, R1 reported that E4 was on E4's cell phone. R1 asked E4 to put the phone away so that E4 could concentrate. It was reported that E4 told R1, "I know what I am doing." The resident was described as being "shocked."</p><p><br></p><p><br></p><p>2. In an internal investigation, E5 was interviewed regarding E4. E5 reported that "residents have told E5 that E4 was rude, short, and mean. I don't want E4 to be with me because E4 was mean."</p><p><br></p><p><br></p><p>3. In an internal investigation, E6 sent an email to E3, reporting that R6 reported R6 asked E4 for help with collapsing the legs of the wheelchair to fit under the table. R6 reported that E4 ignored R6 and was rude.</p><p><br></p><p> </p><p>4. In an interview, E1 and E2 reported that it was not witnessed; however, due to other write-ups, E4 was terminated.</p><p> </p><p><br></p><p>5. In an exit interview, the findings were reviewed with E1, and no additional information was provided.</p>

Based on documentation review, record 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 Board), for one of seven caregivers sampled. The deficient practice posed a risk if the individual was not qualified to provide the required services.

Findings include:

1. A review of facility documentation revealed a weekly staff schedule dated August 13, 2023 through August 19, 2023. The schedule revealed E3 was scheduled to work on August 13 and 16-19, 2023 from 2:00 PM to 10:30 PM.

2. A review of facility documentation revealed a weekly staff schedule dated October 8, 2023 through October 14, 2023. The schedule revealed E3 was scheduled to work on October 8 and 11, 2023 from 2:00 PM to 10:30 PM.

3. A review of R1's medical record revealed a document titled "Service Received". The document revealed E3 provided R1 with toileting assistance on September 24, 2023 at 10:38 PM, and provided R1 with a safety check on September 4, 2023 at 2:02 AM.

4. A review of E3's personnel record revealed no documentation of completion of a caregiver training program approved by the Department or the NCIA Board.

5. In an interview, E1 and E2 reviewed E3's personnel and acknowledged there was no documentation available for review to reflect E3 completed a caregiver training program approved by the Department or the NCIA Board.

Based on record review and interview, the manager failed to ensure a resident's medical record contained documentation of the resident's orientation to exits from the facility, for five of seven residents sampled. The deficient practice posed a risk if a resident was unaware of the route to be used to evacuate the facility in an emergency.

Findings include:

1. A review of R2's, R3's, R4's, R5's, and R7's medical records revealed no documentation of R2's, R3's, R4's, R5's and R7's orientation to the exits of the facility.

2. In an interview, E1 acknowledged R2's, R3's, R4's, R5's, and R7's medical records did not contain documentation of the residents' orientation to exits from the facility.

Based on observation, documentation review, and interview, the manager failed to ensure pets were licensed consistent with local ordinances. The deficient posed a risk if a pet allowed into the facility did not meet the Maricopa County licensing requirements.

Findings include:

1. During the inspection, the Compliance Officer observed various pets living in the facility with their owners.

2. A review of the facility's pet records revealed no documentation to indicate O1 was licensed consistent with local ordinances.

3. A review of the facility's pet records revealed O2's pet license expired June 9, 2023.

4. A review of the facility's pet records revealed O3's pet license expired September 12, 2023.

5. A review of the facility's pet records revealed O4's pet license expired September 14, 2023.

6. A review of the facility's pet records revealed O5's pet license expired August 7, 2023.

7. In an interview, E1 acknowledged there was no other documentation available for review to reflect the aforementioned pets were licensed consistent with local ordinances.

This is a repeat citation from the previous compliance inspection conducted on August 25, 2022.

Based on observation, documentation review, and interview, the manager failed to ensure a pet was vaccinated against rabies. The deficient practice posed a potential rabies infection risk to residents.

Findings include:

1. During the inspection, the Compliance Officer observed various pets living in the facility with their owners.

2. A review of facility documentation revealed O5's rabies vaccination expired June 17, 2023.

3. A review of facility documentation revealed O6's rabies vaccination expired October 12, 2023.

4. A review of facility documentation revealed O7's rabies vaccination expired August 18, 2023.

5. In an interview, E1 acknowledged there was no documentation available for review to reflect a current rabies vaccination for O5, O6, and O7.

This is a repeat citation from the previous compliance inspection conducted on August 25, 2022.

Based on documentation review and interview, the manager failed to ensure personnel provided appropriate first aid before the arrival of emergency medical services to a resident who had fallen, appeared to be uninjured, and was unable to recover independently.

Findings include:

1. A review of facility documentation revealed a fall prevention and fall recovery program titled "Relias Identifying Fall Risk in Assisted Living". The program did not cover fall recovery.

2. In an interview, R1 reported recently having a seizure and falling out of R1's wheelchair. R1 reported a personnel member entered R1's residential unit and observed R1 on the floor, and refused to help O1 retrieve R1 from the floor. R1 further reported the personnel member notified the local fire department to assist R1 off the floor.

3. In an interview, R2 reported R3 called the local fire department to assist R2 from the floor after a recent fall. R2 reported staff came to the room the day of the fall, after the fire department arrived.

4. In an interview, E2 was asked about the facility's fall recovery protocol. E2 reported the staff has been instructed to help the resident off the floor and take the resident's vitals. E2 reported if assistance is needed to help a resident an additional staff would be called.

5. In an interview, E3 was asked about the facility's fall recovery protocol. E3 reported if a resident falls and one staff isn't able to pick up the resident from the floor during the night, additional assistance could be called from another facility on the campus or the fire department is called for assistance.

Based on documentation review and interview, the health care institution failed to develop and administer a training program for all staff addressing fall recovery.

Findings include:

1. A review of the facility's fall prevention and fall recovery program titled "Relias Identifying Fall Risk in Assisted Living" revealed the program failed to cover fall recovery.

2. In an interview, R1 reported recently having a seizure and falling out of R1's wheelchair. R1 reported a personnel member entered R1's residential unit and observed R1 on the floor, and refused to help O1 retrieve R1 from the floor. R1 further reported the personnel member notified the local fire department to assist R1 off the floor.

3. In an interview, R2 reported R3 called the local fire department to assist R2 from the floor after a recent fall. R2 reported the staff came to the room the day of the fall, after the fire department arrived.

4. In an interview, E1 acknowledged the facility's fall prevention program was provided to the Compliance Officer for review. No further information was provided.

Based on documentation review and interview, the manager failed to ensure policies and procedures were established, documented, and implemented to ensure the safety of a resident who may wander.

Findings include:

1. A review of Department documentation revealed AL11479 was licensed to provide directed care services.

2. In an interview, E1 reported the facility only accepted residents who received supervisory care and personal care.

3. A review of the facility's policies and procedures revealed there was no policy established to cover the safety of a resident who may wander. The Compliance Officer was provided a document titled "Missing Resident Policy", however the policy did not include how the facility would ensure the safety of a resident who may wander.

4. In an interview, E1 acknowledged the "Missing Resident Policy" did not include how the facility would ensure the safety of a resident who may wander.