RAMBLEWOOD CARE HOME LLC

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with A.R.S \'a7 36-411, for one of three personnel sampled. The deficient practice posed a risk if E3 was a danger to a vulnerable population.

Findings include:

1. A.R.S \'a7 36-411 states, "A. Except as provided in subsection F of this section, as a condition of licensure or continued licensure of a residential care institution, a nursing care institution or a home health agency and as a condition of employment in a residential care institution, a nursing care institution or a home health agency, employees and owners of residential care institutions, nursing care institutions or home health agencies, contracted persons of residential care institutions, nursing care institutions or home health agencies or volunteers of residential care institutions, nursing care institutions or home health agencies who provide medical services, nursing services, behavioral health services, health-related services, home health services or direct supportive services and who have not been subject to the fingerprinting requirements of a health professional's regulatory board pursuant to title 32 shall have a valid fingerprint clearance card that is issued pursuant to title 41, chapter 12, article 3.1 or shall apply for a fingerprint clearance card within twenty working days after employment or beginning volunteer work or contracted work."

2. A review of E3's personnel record did not include documentation of a valid fingerprint clearance card. Given E3's hire date, this documentation was required.

3. In an interview, E1 acknowledged the governing authority failed to ensure compliance with A.R.S. \'a7 36-411 for E3.

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 three 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 T est) is used for baseline testing, two-step testing is recommended for HCWs (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 E3's personnel record revealed two negative TB skin tests; however, the tests were not completed within 12 months of each other. Based on E3's date of hire, this documentation was required.

4. In an interview, E1 acknowledged E3 did not provide evidence of freedom from infectious TB as specified in R9-10-113.

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

Findings include:

1. A review of R1's medical record revealed a service plan (dated June 22, 2024) that indicated, R1 would receive the following services:
- Fluids offered every 1-2 hours;
- Medication administration;
- Shower, twice weekly;
- Trim and file fingernails, as needed (PRN);
- Shave, PRN; and
- Skin care, daily (qd).

2. A review of R1's activities of daily living (ADL) documentation, for the month of January 2025, revealed missing documentation of all services provided to R1 January 9, 2025 - present.

3. A review of R2's medical record revealed a service plan (dated November 26, 2024) that indicated, R2 would receive the following services:
- Cut up meats and vegetables;
- Shower;
- Partial bath;
- Brush teeth, qd;
- Clean fingernails, qd;
- Trim and file fingernails, PRN;
- Shave, PRN;
- Monitor skin integrity, qd; and
- Assistance with ambulation.

4. A review of R2's ADL documentation, for the month of January 2025, revealed missing documentation of all services provided to R2 January 9, 2025 - present.

5. In an interview, E1 reported R1 and R2 received all aforementioned services in the month of January 2025. However, documentation of the services provided were not available for Compliance Officer review. E1 acknowledged a caregiver failed to document the services provided in R1's and R2's medical records.

Based on documentation review and interview, the manager failed to ensure that a medical record was maintained for each resident according to A.R.S. Title 12, Chapter 13, Article 7.1, for one of three residents sampled. The deficient practice posed a risk as the Department was unable to verify services were provided to the resident.

Findings include:

1. A.R.S. Title 12, Chapter 13, Article 7.1 states, "Unless otherwise required by statute or by federal law, a health care provider shall retain the original or copies of a patient's medical record as follows... If the patient is an adult, for at least six years after the last date the adult patient received medical or health care services from that provider."

2. The Compliance Officer requested to review R3's medical record. However the entirety of R3's medical record was unavailable for Compliance Officer review.

3. In an interview, E1 reported R3's family took R3's medical record upon the termination of R3's residency. E1 acknowledged R3's medical record was not maintained according to A.R.S. Title 12, Chapter 13, Article 7.1.

Based on record review and interview, the manager failed to ensure that the service plan for a resident receiving personal care services included incontinence care that ensured that a resident maintained the highest practicable level of independence when toileting, for one of three residents sampled.

Findings include:

1. A review of R2's service plan, dated November 26, 2024, did not include documentation of the incontinence care required by R2.

2. In an interview, E1 acknowledged that R2's service plan did not include incontinence care that ensured R2 maintained the highest practicable level of independence when toileting.