GARDENS OF SCOTTSDALE, THE

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with Arizona Revised Statutes (A.R.S.) \'a7 36-411(C)(2), for one of five personnel members sampled. The deficient practice posed a risk if the personnel member was a danger to a vulnerable population.

Findings include:

1. A.R.S. \'a7 36-411(C)(2) states: "C. Owners shall make documented, good faith efforts to: 2. Verify the current status of a person's fingerprint clearance card."

2. A review of E4's personnel record revealed a photocopy of E4's fingerprint clearance card. However, the review revealed no documentation demonstrating compliance with A.R.S. \'a7 36-411(C)(2).

3. A review of the Department of Public Safety website revealed E4's fingerprint clearance card was valid.

4. In an interview, E1 reported E4 was hired as a caregiver. E1 acknowledged the governing authority did not verify the status of E4's fingerprint clearance card.

Technical assistance was provided on this rule during the compliance and complaint inspection conducted on September 26, 2023.

Based on documentation review, record review, and interview, the manager failed to ensure a personnel record for each employee included documentation of the individual's education and experience applicable to the individual's job duties, for four of five caregiver records sampled.

Findings include:

1. A review of facility policies and procedures revealed a policy titled "Medication Aid, Review Process Summary Form" which stated, "Education and/or Experience: High school diploma or general education degree (GED), or one to three months related experience and/or training or equivalent combination of education and experience preferred."

2. A review of E6's personnel record revealed E6 was hired as a "Medication Aid." E6's personnel record also contained a caregiver certificate. However, no documentation of education or experience applicable to E6's job duties was available for review.

3. A review of E7's personnel record revealed E7 was hired as a "Medication Aid." E7's personnel record also contained a caregiver certificate. However, no documentation of education or experience applicable to E7's job duties was available for review.

4. Further review of facility policies and procedures revealed a policy titled "Resident Assistant, Review Process Summary Form" which stated, "Education and/or Experience: High school diploma or general education degree (GED), or three-six months related experience and/or training or equivalent combination of education and experience desired."

5. A review of E3's personnel record revealed E3 was hired as a "Resident Assistant." E3's personnel record also contained a caregiver certificate. However, no documentation of education or experience applicable to E3's job duties was available for review.

6. A review of E8's personnel record revealed E8 was hired as a "Resident Assistant." E8's personnel record also contained a caregiver certificate. However, no documentation of education or experience applicable to E8's job duties was available for review.

7. In an interview, E10 reported the facility verified all employee's education and experience during the hiring process. However, E10 acknowledged documentation of education and experience applicable to E3's, E6's, E7's, and E8's job duties was not available for review.

Technical assistance was provided on this rule during the previous compliance inspection conducted on September 21, 2022.

Based on record review and interview, the manager failed to ensure a resident's written service plan included the amount, type, and frequency of assisted living services being provided to the resident, for three of eight residents sampled.

Findings include:

1. A review of R4's medical record revealed a service plan for personal care services dated September 26, 2023. The service plan stated, "ADL Needs: Bathing...I need physical assist with bathing for my back, buttocks and feet but I can participate in part of the bathing activity for the rest; I am dependent on staff for my entire bathing activity; I require 1 staff to assist with my bathing; My caregivers will observe for any changes in my ability to participate in my care and report any changes in ADL function/need to nurse and coordinator; ADL: Bathing/Showering." However, R4's service plan did not include the amount and frequency provided for this service. R4's service plan also stated, "ADL Needs: Grooming...I need physical assistance for grooming. I will be able to participate in part of the grooming activity. ADL: Grooming." However, R4's service plan did not specify the amount, type, and frequency provided for this service.

2. A review of R5's medical record revealed a service plan for personal care services dated September 26, 2023. R5's service plan stated, "ADL Needs: Bathing...I require staff standby supervision, set up, verbal cues and/or reminders to complete tasks; My caregivers will observe for any changes in my ability to participate in my care and report any changes in ADL function/need to nurse and coordinator; ADL: Bathing/Showering." However, R5's service plan did not include the amount and frequency provided for this service.

3. A review of R6's medical record revealed a service plan for directed care services dated June 24, 2023. R6's service plan stated, "ADL Needs: Bathing...I require staff standby supervision, set up, verbal cues and/or reminders to complete tasks; My caregivers will observe for any changes in my ability to participate in my care and report any changes in ADL function/need to nurse and coordinator; ADL: Bathing/Showering." However, R6's service plan did not include the amount and frequency provided for this service.R6's service plan also stated, "ADL Needs: Grooming...I need stand-by supervision; setup, verbal cues and/or reminders to complete tasks." However, R4's service plan did not specify the type and frequency provided for this service.

4. In an interview, E2 acknowledged the aforementioned services in R4's, R5's, and R6's service plans did not include the amount, type, and frequency of the assisted living services being provided to the resident.

Based on record review and interview, the manager failed to ensure a medication administered to a resident was administered in compliance with a medication order, for one of eight residents sampled; and failed to ensure a medication administered to a resident was documented in the resident's medical record, for two of eight residents sampled.

Findings include:

1. A review of R5's medical record revealed a medication order, dated January 23, 2023, for "Lantus SoloStar Solution Pen-Injector 100 UNIT/ML (Insulin Glargine) Inject 30 unit subcutaneously in the morning..."

2. Further review of R5's medical record revealed a medication administration record (MAR) dated September 2023. R5's September 2023 MAR indicated R5 was administered "Lantus" injections as ordered on September 1-16, 18, 20-22, and 25, 2023. An "O" was documented in the boxes on the MAR for September 17, 19, and 23-25, 2023. At the bottom of the MAR was a section titled "Chart Codes" which stated, "O=Other/See Progress Notes." R5's medical record contained a section titled "Prog Notes" which contained notes for R5 dated September 23, 24, and 25, 2023. The notes stated, ""Lantus SoloStar Solution Pen-Injector...No Battery." However, no further information was provided in these notes, and no progress notes were available for September 17 and 19, 2023.

3. In an interview, E11 reported E11 was not sure why R5 did not receive administration of medication on September 17, 19, 23-25, and reported med techs were supposed to document the reasons why medication was not administered. E11 acknowledged the "O"s documented on R5's MAR indicated R5 did not receive the aforementioned medication as ordered on those days.

4. A review of R2's medical record revealed a medication order for "Levothyroxine 100 mcg (micrograms) tablet by mouth daily."

5. Further review of R2's medical record revealed a MAR dated September 2023 which indicated R2 received administration of "Levothyroxine" on September 1-11 and 13-26, 2023. However, "Levothyroxine" was not documented as administered on September 12, 2023.

6. A review of R4's medical record revealed medication orders for the following medications:
-"Lisinopril Oral Tablet 10 MG (milligrams), Give 1 tablet by mouth one time a day...";
-"Magnesium Oxide Oral Tablet 400 MG. Give 1 tablet by mouth one time a day for Supplement"; and
-"metFormin HCl Oral Tablet 500 MG, Give 1 tablet by mouth two times a day..."

7. Further review of R4's medical record revealed a MAR dated September 2023 which indicated R4 received the above medications as ordered on September 1-11 and 13-26, 2023. However, R4's MAR was blank and did not document the aforementioned medications were administered as ordered on September 12, 2023.

8. In an interview, E2 reported since the boxes on the MAR for the aforementioned dates were blank, facility staff likely forgot to document the administration of the aforementioned medications on those dates. E2 acknowledged facility staff failed to ensure a medication administered to R2 and R4 was documented in R2's and R4's medical records.