CASAS ADOBES ASSISTED LIVING

<p>Based on documentation review, record review, and interview, the health care institution's chief administrative officer failed to ensure the health care institution documented, and implemented tuberculosis infection control activities required in R9-10-113.A.2.a-f.</p><p><br></p><p> </p><p><br></p><p>Findings include:</p><p><br></p><p> </p><p><br></p><p>1. A review of E2’s personnel record revealed a negative TB blood test, however, E2’s personnel record did not include a baseline screening questionnaire to include an assessment of E2’s risks of prior exposure to infectious tuberculosis and a determination if E2 had signs or symptoms of tuberculosis.</p><p>  </p><p><br></p><p>2. A review of R2’s medical record revealed a baseline screening. However, documentation of a Mantoux skin test or other test for TB was not available. A document titled, “Initial Medication/Treatment Plan of Care,” included the entry, “Tb Skin Test/Chest X-ray:  Date 2/1/24 Results: Negative.” However, this documentation did not specify if the negative test was a TB Skin Test or Chest X-ray, and did not include an attachment with the actual test result.</p><p><br></p><p><br></p><p>3 In an interview, E1 acknowledged the health care institution had not documented, and implemented tuberculosis infection control activities as required in R9-10-113.A.2.a-f.</p><p><br></p><p><br></p><p>Technical assistance for this rule was provided during the on-site compliance inspection conducted on May 1, 2024.</p>

Based on observation, documentation review, record review, and interview, the manager failed to implement policies and procedures to protect the health and safety of a resident to cover cardiopulmonary resuscitation (CPR) training for applicable employees to include the method and content of cardiopulmonary resuscitation training, to include a demonstration of the employee's ability to perform cardiopulmonary resuscitation, for one of four personnel records reviewed. The deficient practice posed a risk if the employee was unable to meet a resident's needs during an emergency.

Findings include:

1. A review of E3's personnel record revealed E3 had been hired in October of 2024 as a caregiver.

2. A review of E3's personnel record revealed a CPR and First Aid training certification card from "NationalCPRFoundation," an online only provider for which the training had not included a hands on demonstration of E3's ability to perform CPR.

3. In an interview, E1 acknowledged E3's CPR training had not included a demonstration of E3's ability to perform CPR. E1 reported E3 had given notice and had already worked their last day at the facility.

Based on record review, documentation review, and interview, the manager failed to ensure a caregiver provided documentation of completing 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 three caregivers reviewed. The deficient practice posed a health and safety risk to the residents if the employee was not trained.

Findings include:

1. A review of E3's personnel record revealed a certificate issued by "Assisted Living Trainers Curriculum", ALTP #0050, instructed by "Tami's Personalized Care", and signed by O1, dated June 13, 2012. However, E3's personnel record did not include documentation of verification of this qualification.

2. A review of the NCIA verification of caregiver training portal (https://nciaboard.az.gov/news/caregiver-certificate-verification/) revealed the training program number, ALTP# 50, was for a school named "SDL Enterprises Assisted Living Trainers," however this information did not match the school information on E3's certificate.

3. A review of Department records revealed ALTP# 50, Tami's Personalized Care Training Program, a contract training program, had expired on January 31, 2011.

4. In an interview, E1 reported being unaware that the document was not a valid caregiver certificate. E1 acknowledged E3's certificate could not be verified as valid on the NCIA board website.

Based on documentation review, record review, and interview, the manager failed to ensure an assistant caregiver interacted with residents under the supervision of a manager or caregiver. The deficient practice posed a risk as E5 was not qualified to provide the required services unsupervised.

Findings include:

1. Arizona Revised Statutes (A.R.S.) \'a7 36-401(A)(49) states "[s]upervision" means "directly overseeing and inspecting the act of accomplishing a function or activity."

2. A documentation review of the facility work schedule revealed E5 worked alone in the facility on the following dates:
- October 24, 2024 between 4 PM and 7 PM;
- October 25, 2024 between 4 PM and 7 PM;
- October 30, 2024 between 4 PM and 7 PM;
- November 1, 2024 between 4 PM and 7 PM;
- November 6, 2024 between 4 PM and 7 PM;
- November 7, 2024 between 4 PM and 7 PM;
- November 8, 2024 between 4 PM and 7 PM;
- November 13, 2024 between 4 PM and 7 PM;
- November 14, 2024 between 4 PM and 7 PM; and
- November 15, 2024 between 4 PM and 7 PM.

3. A review of E5's personnel record revealed E5 was an assistant caregiver.

4. In an interview, E1 acknowledged E5 was hired as an assistant caregiver and had worked alone at the facility without being under the direct supervision of a caregiver or manager.

Based on documentation review, record review and interview, the manager failed to ensure a caregiver's or assistant caregiver's skills and knowledge were verified and documented before providing physical health services and according to policies and procedures, for one of one assistant caregivers sampled. The deficient practice posed a health and safety risk to residents if an assistant caregiver did not have the documented skills and knowledge to provide services for residents.

Findings include:

1. A documentation review of the facility work schedule revealed E5 worked alone in the facility on the following dates:
- October 24, 2024 between 4 PM and 7 PM;
- October 25, 2024 between 4 PM and 7 PM;
- October 30, 2024 between 4 PM and 7 PM;
- November 1, 2024 between 4 PM and 7 PM;
- November 6, 2024 between 4 PM and 7 PM;
- November 7, 2024 between 4 PM and 7 PM;
- November 8, 2024 between 4 PM and 7 PM;
- November 13, 2024 between 4 PM and 7 PM;
- November 14, 2024 between 4 PM and 7 PM; and
- November 15, 2024 between 4 PM and 7 PM.

2. A review of E5's personnel record revealed E5 was an assistant caregiver. E5's personnel record included a form titled, "Certified Caregiver Skills Checklist," however, the form was not dated to indicate when E5's skills had been verified.

3. In an interview, E1 acknowledged E5's personnel record did not contain completed documentation of verification of E5's skills and knowledge.

Based on record review and interview, the manager failed to ensure a caregiver and an assistant caregiver provided evidence of freedom from infectious tuberculosis, (TB) on or before the individual began providing services at or on behalf of the assisted living facility, and as specified in R9-10-113, for two of four personnel sampled.

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 Test) 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 E3 had been hired as a caregiver in October of 2024. E3's personnel record included a two-step skin test and baseline screening questionnaire, however, the second-step skin test and screening questionnaire were completed after E3 began working as a caregiver at the facility.

4. A review of E5's personnel record revealed E5 had been hired as an assistant caregiver in August of 2024. E5's personnel record included a blood test dated the same day as E5's hire date, however, a baseline screening questionnaire was not available for review.

5. In an interview, E1 acknowledged the personnel records provided for E3 and E5 had not included documentation of evidence of freedom from infectious TB as required by R9-10-113.

Based on observation and interview, the manager failed to ensure at least one manager or caregiver was present at the assisted living home when a resident was on the premises. The deficient practice posed a health and safety risk to residents who were on the premises with unqualified personnel.

Findings include:

1. A documentation review of the facility work schedule revealed E5 worked alone in the facility on the following dates:
- October 24, 2024 between 4 PM and 7 PM;
- October 25, 2024 between 4 PM and 7 PM;
- October 30, 2024 between 4 PM and 7 PM;
- November 1, 2024 between 4 PM and 7 PM;
- November 6, 2024 between 4 PM and 7 PM;
- November 7, 2024 between 4 PM and 7 PM;
- November 8, 2024 between 4 PM and 7 PM;
- November 13, 2024 between 4 PM and 7 PM;
- November 14, 2024 between 4 PM and 7 PM; and
- November 15, 2024 between 4 PM and 7 PM.

2. A review of E5's personnel record revealed E5 was an assistant caregiver.

3. In an interview, E1 acknowledged a manager or a caregiver had not been present in the facility at all times when a resident was present.

Based on record review and interview, the manager failed to ensure a personnel record included the individual's starting date of employment, for one of four personnel records sampled.

Findings include:

1. A review of E5's personnel record revealed a starting date of employment was not available for review. The personnel record included an orientation checklist and a skills verification checklist, which both included a space to document the employee's start date, however, both documents had not been completed.

2. In an interview, E1 acknowledged the personnel record provided for E5 did not include the E5's starting date of employment.

Based on record review and interview, the manager failed to ensure a resident had a written service plan completed no later than 14 calendar days after the resident's date of acceptance, for one of two residents sampled. The deficient practice posed a risk as there was no service plan to direct services to be provided to a resident.

Findings include:

1. A review of R2's medical record revealed a service plan was not available for review. Based on R2's admission date, a complete service plan was required.

2. In an interview, E1 acknowledged a service plan for R2 had not been provided for review. E1 reported E1 had contacted the service plan nurse during the on-site inspection to inquire about the status of the service plan.

Based on record review, and interview, the governing authority failed to ensure compliance with Arizona Revised Statutes (A.R.S.) \'a7 36-411(C), for one of two employees sampled.

A.R.S. \'a7 36-411(C) states:
C. Owners shall make documented, good faith efforts to:
"1. Contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in a residential care institution, nursing care institution or home health agency.
2. Verify the current status of a person's fingerprint clearance card."

Findings include:

1. A review of E3's personnel record revealed E3 had been hired in November of 2021 as a caregiver and had a valid fingerprint clearance card.

2. A review of E3's personnel record revealed an application which listed two previous employers. The application included a section to document efforts to contact the previous employers to obtain recommendations. However, this section had been left blank.

3. A review of E3's personnel record revealed documented, good faith efforts to contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in a residential care institution, nursing care institution were not available for review.

4. In an interview, E1 acknowledged the personnel record provided for E3 did not include documentation of compliance with A.R.S. \'a7 36-411(C)

Based on observation and interview, the manager failed to ensure poisonous or toxic materials were maintained in a locked area separate from food preparation and storage areas and were inaccessible to residents.

Findings include:

1. During an environmental inspection of the facility, the Compliance Officer observed a cabinet below the sink in the laundry room had a magnetic lock. However, the magnetic lock had been switched to the off position and the Compliance Officer was able to open the cabinet without the magnet. Inside the cabinet, the Compliance Officer observed a bottle of, "WD-40," and a can of, "Varathane Triple Thick Polyurethane."

2. In an interview, E1 acknowledged poisonous or toxic materials were not maintained in a locked area inaccessible to residents.