GARDENS AT OCOTILLO SENIOR LIVING

Based on documentation review and interview, the manager failed to ensure that the health care institution did not have, establish or implement policies that prevent employees from providing appropriate first aid.

Findings include:

1. A.R.S. \'a7 36-420.B.2 states "Each health care institution: Shall provide appropriate first aid in accordance with its certification training for first aid before the arrival of emergency medical services...to a noninjured resident who has fallen, appears to be uninjured and is unable to reasonably recover independently..."

2. Review of the facility's policies and procedures revealed a policy titled "Fall-Lift Assist", revised August 1, 2023, which stated "i. Call for an additional team member or ensure at least two team members are present to assist the resident. 1. If only one team member is available call 911 for lift assist."

3. In an interview, E1 acknowledged that the policy prevented employees from providing appropriate first aid.

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

Findings include:

1. 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."

2. A review of E5's personnel record revealed no documentation showing that the owner had made a good faith effort to contact previous employers to obtain information or recommendations or verified the status of E5's fingerprint clearance card.

3. Review of the caregiver schedule for September 1-21 revealed that E5 worked 2:30pm-10:30pm on September 17-21.

4. In an interview, E1 acknowledged documentation of compliance with A.R.S. \'a7 36-411.C. for E5 was not available for review.

Based on documentation review, record review, and interview, the manager failed to immediately report suspected abuse according to A.R.S. \'a7 46-454. The deficient practice posed a risk of a potential resident rights violation if the resident was subjected to abuse.

Findings include:

1. A.R.S. \'a7 46-454(A) stated "...person who has responsibility for the care of a vulnerable adult and who has a reasonable basis to believe that abuse, neglect or exploitation of the adult has occurred shall immediately report or cause reports to be made of such reasonable basis to a peace officer or to the adult protective services central intake unit ... All of the above reports shall be made immediately by telephone or online."

2. R9-10-101.111 stated "Immediate" means without delay.

3. Review of facility incident reports revealed a document titled "State Reportable Form". This document reported an incident when a staff member observed bruises on R4 which looked like fingerprints. The document stated "Date reported to the ED:9/3/24" and "Have the following been notified? APS: 9/6/24". A print out of the "Adult Protective Services Online Submission Form" showed a reported date of September 6, 2024.

4. In an interview, E1 acknowledged the suspected abuse was not reported according to A.R.S. \'a7 46-454.

Based on record review and interview, the manager failed to ensure a written service plan was updated at least once every six months, for one of three residents reviewed receiving personal care services. The deficient practice posed a health and safety risk to the resident if the employees did not know what services the resident needed.

Findings include:

1. Review of R2's medical record revealed a current written service plan for personal care services dated December 20, 2023. However, a service plan after December 20, 2023 was not available for review.

2. In an interview, E1 acknowledged R2 received personal care services and the service plan was not updated at least once every six months.

This is a repeat deficiency from the on-site compliance inspection conducted on December 6, 2021.

Based on documentation review and interview, the manager failed to establish and document a policy and procedure to protect the health and safety of a resident that covered responding to and reporting an unexpected reaction to a medication.

Findings include:

1. Review of the facility's policies and procedures showed no policy and procedure that covered responding to and reporting an unexpected reaction to a medication.

2. In an interview, E1 acknowledged that a policy and procedure that covered responding to and reporting an unexpected reaction to a medication had not been established and documented.

Based on observation and interview, the manager failed to ensure that a current toxicology reference guide was available for use by personnel members.

Findings include:

1. The Compliance Officer observed the facility's toxicology guide available for use by personnel members was the "Elsevier Toxicology Handbook 3rd Edition".

2. A review of the publisher's website revealed the "Elsevier Toxicology Handbook 4th Edition" was the most recent edition.

3. In an interview, E1 acknowledged that a current toxicology reference guide was not available for use by personnel members.

Based on observation and interview, the manager failed to ensure that frozen foods were stored at a temperature of 0\'b0 F or below.

Findings include:

1. During a facility tour, the Compliance Officer observed the facility's freezer had a thermometer that registered 14\'b0 F. The freezer was tested with the Department issued thermometer and the temperature registered 17\'b0 F.

2. In an interview, E1 acknowledged that frozen foods were not stored at or below 0\'b0 F.

Based on observation 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. During an environmental inspection of the facility with E1, the Compliance Officer observed the following unlocked on a cart in the hallway:
-1 container of "Drano Max Gel" which stated "Danger: Keep out of Reach of Children and Pets. Harmful if swallowed. May burn eyes, skin, and muccous membranes on contact."

2. In an interview, E1 acknowledged poisonous or toxic material stored by the assisted living facility was not maintained in a locked area inaccessible to residents.

Based on documentation review, record review, and interview, the manager failed to implement policies and procedures to protect the health and safety of a resident covering cardiopulmonary resuscitation (CPR) training, including a demonstration of the employee's ability to perform CPR. The deficient practice posed a risk if E6 and E8 were unable to perform CPR.

Findings include:

1. A review of the facility's policies and procedures revealed a policy titled "Cardiopulmonary Resuscitation (CPR and First Aid Training - Arizona Specific" (dated December 2014). The policy stated "Upon hire and before providing any hands of care the team member will provide a copy of a current CPR card specific to adults that includes a demonstration of the caregiver's ability to perform CPR..."

2. A review of E6's (hired in 2022) personnel record revealed E6 was hired as a caregiver. The personnel record revealed documentation of CPR training from New Life CPR (issued January 29, 2022).

3. A review of the New Life CPR website revealed courses were conducted online.

4. A review of E8's (hired in 2021) personnel record revealed E8 was hired as a caregiver. The personnel record revealed documentation of CPR training from NationalCPRFoundation (issued August 17, 2022).

5. A review of the NationalCPRFoundation website revealed courses were conducted online. The NationalCPRFoundation website stated, "Help Save Lives Today with Your Online CPR Certification Training!"

6. In a joint interview, E1, E2, E3, and E4 acknowledged E6's and E8's online CPR training did not include a demonstration of E6's and E8's ability to perform CPR.

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 the caregiver or assistant caregiver provided physical health services, and according to policies and procedures, for one of five caregivers sampled. The deficient practice posed a risk if E11 was unable to meet a residents needs.

Findings include:

1. A review of the facility's policies and procedures revealed a policy titled "Team Member Training - Arizona Specific" (dated January 21, 2022). The policy stated "...All Resident Care team members knowledge and skills will be documented before they begin to provide direct care in the Community."

2. A review of E11's (hired in March 2023) personnel record revealed E11 was hired as a caregiver. A review of E11's personnel record revealed documentation of the verification of E11's skills and knowledge (dated in June 2023).

3. A review of facility documentation revealed a staffing schedule dated March 2023-June 2023. The staffing schedule revealed E11 was scheduled to work on the following dates:
-March 9-10, 2023;
-March 14, 2023;
-March 16-18, 2023;
-March 21-25, 2023;
-March 28-31, 2023;
-April 1, 2023;
-April 4-6, 2023;
-April 11-15, 2023;
-April 18-22, 2023;
-April 25-29, 2023;
-May 2-6, 2023;
-May 9-13, 2023;
-May 16-20, 2023;
-May 23-27, 2023;
-May 30-31, 2023;
-June 1-3, 2023;
-June 6-10, 2023;
-June 13-15, 2023;
-June 16-17, 2023; and
-June 20-24, 2023.

4. In a joint interview, E1, E2, E3, and E4 acknowledged E11's skills and knowledge were not verified and documented prior to E11 providing physical health services and according to the facility's policies and procedures.