ACOYA SCOTTSDALE AT TROON

Based on record review and interview, for three of five caregivers reviewed, the manager failed to ensure a caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services or behavioral health services. The deficient practice posed a health and safety risk to residents, if a caregiver did not have the documented skills and knowledge to provide care and services for a resident.

Findings include:

1. In record review, the personnel records for E4 (hired as a caregiver on January 21, 2024), E5 (hired as a caregiver on May 26, 2024), and E6 (hired as an assistant caregiver on August 10, 2024), did not include documentation the caregivers' and assistant caregiver's skills and knowledge were verified.

2. During an interview, E1 reported the caregivers and assistant caregiver shadowed a caregiver, and their skills and knowledge was normally documented on a skills checklist. E1 reported E4, E5 and E6, worked shifts at the facility, since their date of hire. E1 acknowledged the personnel records did not include documentation the caregivers' and assistant caregiver's skills and knowledge were verified and documented before the caregivers provided services.

Based on record review and interview, for two of five caregivers reviewed, the manager failed to ensure before providing assisted living services to a resident, a caregiver received orientation specific to the duties to be performed by the caregiver. The deficient practice posed a health and safety risk to residents if a caregiver was not oriented to the facility and the residents, as required.

Findings include:

1. In record review, the personnel records for E4 (hired as a caregiver on January 21, 2024), E5 (hired as a caregiver on May 26, 2024), and E6 (hired as an assistant caregiver on August 10, 2024), did not include documentation the caregivers and the assistant caregiver received orientation.

2. During an interview, E1 reported E4, E5 and E6, worked shifts at the facility, since their date of hire. E1 acknowledged the personnel records did not include documentation the caregivers and the assistant caregiver received orientation specific to the duties to be performed by the caregiver and assistant caregiver.

Based on record review, interview and documentation review, for one resident who received transportation coordinated by a caregiver or employee, the manager failed to ensure an evaluation of the resident was conducted before and after the transport, information from the resident's medical record was provided to a receiving health care institution, and if applicable, any communication with an individual at a receiving health care institution.

Findings include:

1. During an interview, R1 reported being transported by Go Go Grandparent to an urgent care facility, after requesting transport from the facility, per a physician's recommendation.

2. In record review, R1's medical record included documentation (date and time) R1 was transported to an urgent care facility; however, the record did not include an evaluation of the resident before and after the transport, information from the resident's medical record provided to the receiving health care institution, and any communication with an individual at the receiving health care institution.

3. During an interview, E1 reported the facility coordinated transport for R1, to an urgent care facility, per the resident's request. E1 acknowledged R1's medical record did not include an evaluation of the resident before and after the transport, information from the resident's medial record provided to a receiving health care institution, and any communication with an individual at the receiving health care institution. E1 acknowledged the documentation was required when the facility coordinated a resident transport to another licensed health care institution.

Based on documentation review, and interview, for one resident reviewed, who reported missing property, the manager failed to ensure a resident was not subjected to misappropriation of personal and private property by the assisted living facility's caregiver.

Findings:

1. During an interview, R1 reported having purchased new chairs, which were stolen by a facility employee. R1 reported the chairs were recovered; however, were damaged so the facility reimbursed the resident for the chairs.

2. The Compliance Officer requested to review documentation relevant to R1's complaint about the missing chairs. No documentation was available for review.

3. During an interview, E1 reported R1 purchased new chairs, which were put together by staff, and then stored in a corner in the parking garage, because the chairs couldn't be delivered immediately to R1. E1 reported the chairs were later found to be missing, and a review of video footage revealed the chairs were taken by E10. E1 reported that upon request E10 returned the chairs, and reported that [E10] didn't think the chairs belonged to anyone. E1 reimbursed R1 for the cost of the chairs, after R1 reported the chairs were returned with scratches. E1 acknowledged R1's property was taken by a caregiver.

Based on observation, record review and interview, for one resident who was unable to walk, even with assistance, 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, or within 30 calendar days before acceptance, and at least once 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 could be met by the facility within the facility's scope of services.

Findings include:

1. During an environmental inspection, the Compliance Officer met R6, who was observed in a wheelchair.

2. During an interview, R6 reported being unable to walk.

3. In record review, R6's medical record included a service plan, dated November 2, 2023, which documented, "Mobility/Ambulation... Extensive. Resident requires hands on assistance by staff members..."Wheelchair (electric, manual)... Resident has enabling device(s) used for mobility/ambulation... Requires frequent hands on assistance with transfers and/or change in position..." R6's medical record did not include a signed and dated determination from the PCP or MP, as required.

4. During an interview, E1 reported R6 was unable to walk, even with assistance, and the resident's PCP or MP did not sign and date the required determination on acceptance, and every six months while the condition persisted.

Based on observation, record review, documentation review, and interview, for one resident reviewed receiving opioid medication without an active malignancy or an end of life condition, the manager failed to ensure an individual authorized to administer opioids documented in the resident's medical record an identification of the resident's need for the opioid before the opioid was administered and the monitoring of the effect of the opioid administered. The deficient practice posed a risk to a resident if a resident's pain was not identified, monitored, and documented, as required.

Findings include:

1. In observation, R2 had Tramadol 50mg medication, (a schedule IV controlled substance), take one tablet three times daily. The package indicated 90 tablets were dispensed on June 21, 2023, with 80 tablets remaining.

2. In record review, R2's medical record (received personal care and medication administration services) included documentation R2 received the opioid medication as ordered; however, the record did not include documentation of an identification of the resident's need for the opioid, and the monitoring of the effect of the opioid administered. R2's medical record did not include documentation R2 had an active malignancy or an end of life condition.

3. In documentation review, a facility policy, titled "... Pain Management and Opioid Medications, on page 289, documented, Opioid Administration... must include 1. Identification and documentation of the resident's pain level prior to medication using the pain scale... ii. Monitoring resident's response to medicaiton. iii. Documenting the effectiveness of medication forty-five minutes after administration in resident's record. Document on the MAR the resident's need, monitoring, and response to the medication... The name of the staff member responsible for administering/assisting the resident with the opioid medication... The resident's level of pain prior to administering the medication... How the ... level of pain was assessed... How the resident's response was monitored including the time and person(s) responsible for monitoring... The resulting effect of the medication on the resident."

4. During an interview, E1 and E2 reported R2 received an opioid medication, and acknowledged the facility did not identify and document the residents' need for the opioid before the opioid was administered, and monitor and document the effect of the opioid administered, according to the facility's policies and procedures.