BELL ADULT CARE HOME

Based on record review and interview, the manager failed to ensure a manager and caregiver provided current documentation of first aid training and cardiopulmonary resuscitation training certification specific to adults for two of two managers or caregivers sampled. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency.

Findings include:

1. A review of E1's personnel record revealed documentation of first aid training and cardiopulmonary resuscitation training certification. However, the training certification expired on September 20, 2024. No more recent documentation of first aid training and cardiopulmonary resuscitation training certification was able for review for E1.

2. A review of E2's personnel record revealed documentation of first aid training and cardiopulmonary resuscitation training certification. However, the training certification expired on September 20, 2024. No more recent documentation of first aid training and cardiopulmonary resuscitation training certification was able for review for E2.

3. In an interview, E1 stated, "I have to renew it and I forgot to schedule the renewal training for myself and [E2]." E1 acknowledged E1's and E2's documentation of first aid training and cardiopulmonary resuscitation training certification had expired September 20, 2024.

Based on record review, documentation review, and interview, the manager failed to ensure before or at the time of acceptance of an individual, the individual submitted documentation dated within 90 calendar days before acceptance to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints. The deficient practice posed a risk if the facility was unable to meet a resident's needs.

Findings include:

1. A review of R1's medical record revealed no documentation that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints. Based on R1's acceptance date, this documentation was required.

2. A review of the facility's policy and procedures (revised June 2024) titled, "Scope of Services Provision of Assisted Living Services," revealed in section twelve, "The management will ensure that at the time of admission or earlier the resident or resident representative is required to provide the documentation no older than 90 days for the resident's need of continuous medical services, continuous or intermittent nursing services, restraints, or behavior care. Documentation provided has to be signed appropriately. This documentation will be maintained in the resident records."

3. In an interview, E1 acknowledged R1 did not provide documentation signed by a medical practitioner or a registered nurse that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints.

Based on documentation review, record review, and interview, the manager failed to ensure a resident medical record contained documentation of notification of the resident of the availability of vaccination for influenza (flu) and pneumonia, according to A.R.S. \'a7 36-406(1)(d), to one of two residents sampled. The deficient practice posed a potential illness risk to residents.

Findings include:

A.R.S. \'a7 36-406(1)(d) The department shall: Require as a condition of licensure that nursing care institutions and assisted living facilities make vaccinations for influenza and pneumonia available to residents on site on a yearly basis. The department shall prescribe the manner by which the institutions and facilities shall document compliance with this subdivision, including documenting residents who refuse to be immunized. The department shall not impose a violation on a licensee for not making a vaccination available if there is a shortage of that vaccination in this state as determined by the director.

1. A review of R1's medical record revealed R1 refused the flu and pneumonia vaccinations May 2023. However, current documentation was not available that showed the flu and pneumonia vaccinations were received or refused. Based on R1's acceptance date, this documentation was required.

2. A review of the facility's policy and procedures (revised June 2024) titled, "Scope of Services Provision of Assisted Living Services," revealed in section twenty-four, "The facility will make influenza and pneumonia available on site to residents, on an annual basis, through ancillary services or primary care providers. The facility will document compliance with this requirement, including documentation for the residents who refused to be immunized."

3. In an interview, E2 acknowledged R1's medical record did not include current documentation that showed the flu and pneumonia vaccinations were received or refused.

Based on documentation review, observation, and interview, the manager failed to ensure for a facility authorized to provide directed care services, there was a means of exiting the facility for a resident who does not have a key, special knowledge for egress, or the ability to expend increased physical effort and provided access to an outside area which allowed the resident to be at least 30 feet away from the facility and controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a risk if the facility was unaware of the general or specific whereabouts of a resident.

Findings include:

1. A review of Department documentation revealed the facility was authorized to provide directed care services.

2. The Compliance Officer observed ambulatory residents in the facility.

3. The Compliance Officer observed two sliding glass doors exiting to the backyard did not have a device that controlled or alerted employees of the egress of the residents.

4. The Compliance Officer observed another accessible door leading out to the backyard did not have a device that controlled or alerted employees of the egress of the residents.

5. A review of the facility's policy and procedures (revised June 2024) titled, "Environmental and Physical Plant Safety" revealed in section four, "Exit doors and windows to the outside that a wandering resident may exit through will be alarmed to alert employees in the event a resident is wandering".

6. In an interview, E1 reported E1 was not aware doors leading outside needed to have a device that controlled or alerted employees of the egress of the residents.

Based on observation, documentation review, and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were maintained in a locked area inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident.

Findings include:

1. The Compliance Officer observed a door that had a deadbolt lock facing towards the interior hallway. However the Compliance Officer was able to unlock the door without the assistance of a key. Inside the room the following was observed:
-A spray can of WD-40 was observed on top of a cabinet.
Inside of a cabinet the following toxic materials were observed:
- A 20 oz spray can of Raid bug spray
- A spray can of Hot Shot Flying Insect Killer
- A 32 oz spray bottle labeled, "Kills Ants"
- A spray bottle of ArmorAll Protectant
- A spray bottle of Cedarcide Scorpion Shield
- A bottle of Instant Power Main Line Cleaner

2. The Compliance Officer observed a box of Polident Antibacterial Denture Cleanser (had a caution warning) on top of a toilet tank in a shared resident bathroom. In a different shared resident bathroom Clorox disinfectant wipes were stored in an unlocked cabinet below the sink.

3. The Compliance Officer observed the following toxic materials stored unlocked below the kitchen sink:
- A spray can of Stainless Steel Polish & Cleaner
- Magic Stainless Steel wipes

4. A review of the facility's Policy and Procedures (revised June 2024) revealed a policy titled, "Environmental and Physical Plant Safety" stated in section fifteen, "Poisonous and toxic materials will be in labeled containers and stored in a locked area separate from food preparation areas, dining areas, and medications and are inaccessible to residents."

5. In an interview, E1 acknowledged toxic materials were stored unlocked.