GRACEFUL HANDS HOME CARE

INSP-0131116

Complete

Date: 5/9/2025

Type: Complaint;Compliance (Annual)

Worksheet: Assisted Living Home

SOD Sent: 2025-05-21

Summary:

The following deficiencies were found during the on-site compliance inspection and investigation of complaint 00129939 conducted on March 9, 2025:

Deficiencies Found: 7

Deficiency #1

Rule/Regulation Violated:

A.R.S. § 36-420.01.A. Health care institutions; fall prevention and fall recovery; training programs; definition A. Each health care institution shall develop and administer a training program for all staff regarding fall prevention and fall recovery. The training program shall include initial training and continued competency training in fall prevention and fall recovery. A health care institution may use information and training materials from the department's Arizona falls prevention coalition in developing the training program.

Evidence/Findings:

Based on record review and interview, the health care institution failed to develop and administer a training program for all staff regarding fall prevention and fall recovery that included initial training and continued competency training. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. Review of facility documentation revealed no documentation of a fall prevention and fall recovery training program. 2. Review of E1’s personnel record revealed documentation showing fall prevention and fall recovery training was completed on May 26, 2023. 3. Review E2’s personnel record revealed no documentation of completing fall prevention and fall recovery training. Based on E2's date of hire, this documentation was required. 4. In an interview, E1 acknowledged a fall prevention and fall recovery training program was not available, E1 did not complete continued training, and E2 did not complete initial training. 5. This is a repeat deficiency from the inspection conducted on October 15, 2024.

Temporary Solution:

All employees have completed Fall prevention and fall recovery training.

Permanent Solution:

Annually the manager will conduct a fall prevention and fall recovery training course.

Person Responsible:

Nuraine A Hagos

Deficiency #2

Rule/Regulation Violated:

R9-10-113.A.1-2. Tuberculosis Screening A. 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: 1. Are consistent with recommendations in Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019, published by the U.S. Department of Health and Human Services, Atlanta, GA 30333, available at https://www.cdc.gov/mmwr/volumes/68/wr/mm6819a3.htm, incorporated by reference, on file with the Department, and including no future editions or amendments; and 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); b. If an individual may have a latent tuberculosis infection, as defined in A.A.C. R9-6-1201: i. Referring the individual for assessment or treatment; and ii. Annually obtaining documentation of the individual's freedom from symptoms of infectious tuberculosis, signed by a medical practitioner, occupation health provider, as defined in A.A.C. R9-6-801, or local health agency, as defined in A.A.C. R9-6-101; c. Annually providing training and education related to recognizing the signs and symptoms of tuberculosis to individuals employed by or providing volunteer services for the health care institution; d. Annually assessing the health care institution's risk of exposure to infectious tuberculosis; e. Reporting, as specified in A.A.C. R9-6-202, an individual who is suspected of exposure to infectious tuberculosis; and f. If an exposure to infectious tuberculosis occurs in the health care institution, coordinating and sharing information with the local health agency, as defined in A.A.C. R9-6-101, for identifying, locating, and investigating contacts, as defined in A.A.C. R9-6-101.

Evidence/Findings:

Based on documentation review, record review, and interview, the health care institution failed to implement tuberculosis (TB) infection control activities that included annual training and education related to recognizing the signs and symptoms of TB to individuals employed by the health care institution. The deficient practice posed a risk as the caregiver received no organized instruction or information related to TB surveillance. Findings include: 1. A review of the Centers for Disease Control and Prevention (CDC) website revealed a web page titled, "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005." The web page stated, "All health-care workers (HCWs) should receive training on the prevention, transmission, and symptoms of TB disease that is appropriate to their work responsibilities and setting. Initial training should be provided to all new employees, with annual refresher training thereafter." 2. Review of E1’s and E2’s personnel records revealed E1 and E2 did not include current documentation of training and education related to recognizing the signs and symptoms of TB. Based on E1’s and E2’s hire dates, this documentation was required. 3. In an interview, E1 acknowledged documentation was not available that showed E1 and E2 had completed training and education related to recognizing the signs and symptoms of TB annually.

Temporary Solution:

Caregivers shall receive initial orientation on TB protocols and screening.

Permanent Solution:

Caregivers shall receive annual training and education on recognizing the signs and symptoms of TB. Documentation of training completion shall be maintained in each caregiver personnel files.

Person Responsible:

Nuraine A Hagos

Deficiency #3

Rule/Regulation Violated:

R9-10-803.A.9. Administration A. A governing authority shall: 9. Ensure compliance with A.R.S. § 36-411.

Evidence/Findings:

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with A.R.S. § 36-411, for two of two employees reviewed. The deficient practice posed a risk if the employee was a danger to a vulnerable population. Findings include: 1. A.R.S. § 36-411(C)(4) states: "4. On or before March 31, 2025, verify that each employee is not on the adult protective services registry pursuant to section 46-459. If an employee is found to be on the adult protective services registry, the residential care institution, nursing care institution or home health agency shall take action to terminate the employment of that employee." 2. Review of E1’s personnel record did not reveal verification that E1 was not on the adult protective services registry. Based on E1’s hire date, this documentation was required. 3. Review of E2’s personnel record did not reveal verification that E2 was not on the adult protective services registry. Based on E2’s hire date, this documentation was required. 4. In an interview, E1 acknowledged E1 and E2 did not have adult protective services registry verification in their personnel records.

Temporary Solution:

Manager has verified and completed an APS Registry search on all current employees. All employees have passed the verification process twice. This verification process was also completed during the last inspection on October 15, 2024, by DHS inspection surveyor. it unclear way I received a deficiency for this.

Permanent Solution:

Manger will ensure an APS registry is complete during new hire orientation process.

Person Responsible:

Nuraine A Hagos

Deficiency #4

Rule/Regulation Violated:

R9-10-806.A.10. Personnel A. A manager shall ensure that: 10. Before providing assisted living services to a resident, a manager or caregiver provides current documentation of first aid training and cardiopulmonary resuscitation training certification specific to adults.

Evidence/Findings:

Based on observation, documentation review, record review, and interview, the manager failed to ensure a caregiver provided current documentation of first aid and cardiopulmonary resuscitation (CPR) training that included a demonstration of the individual's ability to perform CPR, before providing assisted living services, for one of two employees reviewed. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency. Findings include: 1. The Compliance Officers observed E1 working alone at the time of the inspection. 2. Review of the facility’s policy and procedure revealed a policy titled “First Aid and CPR Training” which stated, “8. The hiring person has to be current in the first aid and CPR certification and have the ability to evaluate new employee’s knowledge and performance in providing CPR and first aid.” 3. Review of E1’s personnel record revealed E1 had worked as a manager and had a hire date of January 28, 2016. The personnel record revealed an expired first aid and CPR card with a renewal date of March 2025. 4. In an interview, E1 acknowledged E1’s first aid and CPR card had expired and did not have current documentation of a valid first aid and CPR card.

Temporary Solution:

Manager has completed and received a new CPR certification.

Permanent Solution:

Manager will send out an email and a 30-day notice before expiration date to remind all employees to renew their CPR certification.

Person Responsible:

Nuraine A Hagos

Deficiency #5

Rule/Regulation Violated:

R9-10-806.A.4.a-b. Personnel A. A manager shall ensure that: 4. A caregiver's or assistant caregiver's skills and knowledge are verified and documented: a. Before the caregiver or assistant caregiver provides physical health services or behavioral health services, and b. According to policies and procedures;

Evidence/Findings:

Based on 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 for one of two caregivers reviewed. The deficient practice posed a risk if the employee was unable to meet a resident's needs. Findings include: 1. Review of E2’s personnel record revealed a hire date of January 3, 2023. E2’s record revealed no documentation indicating E2’s skills and knowledge were verified. 2. In an interview, E1 acknowledged E2’s personnel record did not contain documentation showing E2’s skills and knowledge were verified. 3. This is a repeat deficiency from the inspection conducted on October 15, 2024.

Temporary Solution:

Manager has completed a skill and knowledge form on all previous employees

Permanent Solution:

Manager will ensure all new hire will complete the skill and knowledge form. Manager will ensure this form is completed and filed in all new employee folder.

Person Responsible:

Nuraine A Hagos

Deficiency #6

Rule/Regulation Violated:

R9-10-807.D.1-10. Residency and Residency Agreements D. Before or at the time of an individual's acceptance by an assisted living facility, a manager shall ensure that there is a documented residency agreement with the assisted living facility that includes: 1. The individual's name; 2. Terms of occupancy, including: a. Date of occupancy or expected date of occupancy, b. Resident responsibilities, and c. Responsibilities of the assisted living facility; 3. A list of the services to be provided by the assisted living facility to the resident; 4. A list of the services available from the assisted living facility at an additional fee or charge; 5. For an assisted living home, whether the manager or a caregiver is awake during nighttime hours; 6. The policy for refunding fees, charges, or deposits; 7. The policy and procedure for a resident to terminate residency, including terminating residency because services were not provided to the resident according to the resident's service plan; 8. The policy and procedure for an assisted living facility to terminate residency; 9. The complaint process; and 10. The manager's signature and date signed.

Evidence/Findings:

Based on record review and interview, the manager failed to ensure there was a documented residency agreement with the assisted living facility and included the manager's signature and date signed, for two of two residents reviewed. The deficient practice posed a risk if the resident was not informed of the terms of residency. Findings include: 1. A review of R1's medical record revealed a residency agreement. However, this residency agreement did not include the signature of the manager and date signed. Based on R1's acceptance date, this documentation was required. 2. A review of R3's medical record revealed no residency agreement. Based on R3's acceptance date, this documentation was required. 3. In an interview, E1 acknowledged R1's residency agreement was not signed and dated by the manager and R3 did not have a residency agreement.

Temporary Solution:

This was a usual situation, however, moving forward manager has been educated on the importance of this matter and will handle this matter the same way as all residency agreement.

Permanent Solution:

Manager will ensure that all residency agreement is signed at time of move in. If a usual situation like this occurs again, manager will contact DHS for assistance.

Person Responsible:

Nuraine A Hagos

Deficiency #7

Rule/Regulation Violated:

R9-10-819.A.11. Environmental Standards A. A manager shall ensure that: 11. Poisonous or toxic materials stored by the assisted living facility are maintained in labeled containers in a locked area separate from food preparation and storage, dining areas, and medications and are inaccessible to residents;

Evidence/Findings:

Based on observation and interview, the manager failed to ensure that poisonous or toxic materials stored by the assisted living facility were maintained in labeled containers in a locked area separate from food preparation and storage, dining areas, and medications and were inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During the environmental inspection, the Compliance Officers observed the following chemicals unlocked and accessible to residents, on the premises:· Palmolive Liquid dish soap· Ajax liquid dish soap· CVS disinfectant spray· Multi-purpose disinfecting wipes· Glade air freshener spray· Weed killer 2. In an interview, E1 acknowledged that there were poisonous or toxic materials stored by the assisted living facility that were not in a locked or secure area and inaccessible to residents.

Temporary Solution:

Manager has placed a lock on the shed door.

Permanent Solution:

All hazardous materials have been locked away and all employees have been trained on storing and locking up hazardous materials.

Person Responsible:

Nuraine A Hagos

INSP-0069741

Complete

Date: 10/15/2024

Type: Complaint

Worksheet: Assisted Living Home

SOD Sent: 2024-11-25

Summary:

An on-site investigation of complaint AZ00217273 was conducted on October 15, 2024, and the following deficiencies were cited :

Deficiencies Found: 7

Deficiency #1

Rule/Regulation Violated:

36-420.01. Health care institutions; fall prevention and fall recovery; training programs; definition
A. Each health care institution shall develop and administer a training program for all staff regarding fall prevention and fall recovery. The training program shall include initial training and continued competency training in fall prevention and fall recovery. A health care institution may use information and training materials from the department's Arizona falls prevention coalition in developing the training program.

Evidence/Findings:

Based on documentation, record review, and interview, the governing authority failed to administer a training program for four of four staff members regarding fall prevention and fall recovery. The deficient practice posed a risk if a staff member was not properly trained to assist a resident who had fallen and was unable to recover independently.

Findings include:

1. A review of facility documentation revealed no documentation was available for review for a training program for fall prevention and fall recovery.

2. A review of E1's, E2's, E3's, and E4's personnel records revealed no documentation of training in fall prevention and fall recovery was unavailable for review at the time of inspection.

3. In an interview, E1 acknowledged documentation of training in fall prevention and fall recovery was unavailable for review. E1 acknowledged no documentation for E1's, E2's, E3's, and E4's regarding fall prevention and fall recovery training was available for review at the time of inspection. E1 also report that facility does not have a fall prevent fall recovery program or training in place. E1 reported the facility calls the fire department anytime residents fall.

Deficiency #2

Rule/Regulation Violated:

C. A manager shall ensure that policies and procedures are:
1. Established, documented, and implemented to protect the health and safety of a resident that:
m. Cover methods by which the assisted living facility is aware of the general or specific whereabouts of a resident, based on the level of assisted living services provided to the resident and the assisted living services the assisted living facility is authorized to provide;

Evidence/Findings:

Based on documentation review, and interview, a manager failed to implement policies and procedures to protect the health and safety of a resident that covered methods by which an assisted living center was aware of the general or specific whereabouts of a resident, based on the level of assisted living services provided to the resident and the assisted living services the assisted living center is authorized to provide.

Findings include:

1. A review of facility documentation revealed a policy titled "Safety of Wandering Residents". The policy statement stated, " To ensure residents have the freedom and opportunity to wander within the facility, while ensuring that the facility egress control is operable in compliance with state rule. The personnel of the facility will make every attempt to keep residents from wandering away from the facility by following the steps outlined in the procedures below. " The policy procedure stated, " ...4. Caregivers will maintain security of the locks on the front door, yards and hazardous areas at all times. ...5. If alarms are being used on doors and/or windows, the caregiver will check them daily for operation and security."

2. In an interview, E1 acknowledged the policy was not implemented.

Deficiency #3

Rule/Regulation Violated:

A. A manager shall ensure that:
4. A caregiver's or assistant caregiver's skills and knowledge are verified and documented:
a. Before the caregiver or assistant caregiver provides physical health services or behavioral health services, and

Evidence/Findings:

Based on record review and interview, the manager failed to ensure an assistant caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services on behalf of the facility, for three of three sampled caregiver and assistant caregivers. The deficient practice posed a risk if employees did not have the skills and knowledge necessary to ensure the health and safety of residents.

Findings include:

1. During the environmental inspection of the facility, the Compliance Officer arrived at 9:00 am and observed E3 working at the facility as an assistant caregiver and providing care to residents at the time of the inspection. At about 9:45 E2 arrivied at the facility and E3 left the facility for the day. Around 10:30 AM E1 arrivied at the facility.

2. In an interview, E1 acknowledged E4 had worked on October 16, 2024 afternoon shift at the facility.

3. A review of E2's, E3's and E4's personnel record revealed no documented verification of E2's, E3's and E4's skills and knowledge.

4. In an interview, E1 acknowledged E2's, E3's and E4's personnel record did not contain documentation of verification of skills and knowledge.

Deficiency #4

Rule/Regulation Violated:

C. A manager shall ensure that a personnel record for each employee or volunteer:
1. Includes:
c. Documentation of:
iii. The individual's completed orientation and in-service education required by policies and procedures;

Evidence/Findings:

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 completed orientation required by policies and procedures, for four of four sampled personnel members. The deficient practice posed a risk if the employee was unable to meet a resident's needs.

Findings include:

1. A review of facility documentation revealed a policy titled "Orientation and in-Service Training" The policy stated "1. It is required that each employee and employee and volunteer receive orientation before providing assisted living services to a resident. ."

2. A review of four of four personnel record sampled revealed E1, E2, E3, and E4 personnel record did not contain documentation of orientation

3. In an interview, E1 acknowledged E1, E2, E3, and E4 personnel record did not contain documentation of orientation.

Deficiency #5

Rule/Regulation Violated:

B. A manager shall ensure that before or at the time of acceptance of an individual, the individual submits documentation that is dated within 90 calendar days before the individual is accepted by an assisted living facility and:
1. If an individual is requesting or is expected to receive supervisory care services, personal care services, or directed care services:
a. Includes whether the individual requires:
i. Continuous medical services,
ii. Continuous or intermittent nursing services, or
iii. Restraints; and

Evidence/Findings:

Based on record 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 the individual was accepted by the assisted living facility to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, for two of two residents sampled. The deficient practice posed a risk if staff were unable to meet the needs of residents.

Findings include:

1. A review of R1's and R2's medical records revealed no documentation dated within 90 calendar days before R1's and R2's were accepted by the assisted living facility to include whether R1's and R2's required continuous medical services, continuous or intermittent nursing services, or restraints.

2. In an interview, E1 acknowledged R1's and R2's medical records did not contain the required documentation.

Deficiency #6

Rule/Regulation Violated:

F. A manager of an assisted living facility authorized to provide directed care services shall ensure that:
2. There is 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 that meets one of the following:
a. Provides access to an outside area that:
i. Allows the resident to be at least 30 feet away from the facility, and
ii. Controls or alerts employees of the egress of a resident from the facility;

Evidence/Findings:

Based on an observation and interview, the manager failed to ensure a means of exiting the facility 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. During the environmental inspection of the facility, the Compliance Officer observed the front door leading to the front yard had a mechanism to alert employees of the egress of a resident, However, the front door was unlocked and the mechanism on the front door was not working at the time of the inspection. The Compliance Officer also observed a door leading from the common living room area to the back yard and a door leading from the common office area to the back yard which were unlocked and did not have a mechanism to alert employees of the egress of a resident.

2. In an interview, E1 acknowledged the front door was unlocked and the mechanism was not working at the time of the inspection. E1 also acknowledged the doors in the common living room area and common office area of the facility were unlocked and did not have mechanism to alert the staff of a resident leaving the facility.

Deficiency #7

Rule/Regulation Violated:

F. When medication is stored by an assisted living facility, a manager shall ensure that:
1. Medication is stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage;

Evidence/Findings:

Based on observation and interview, the manager failed to ensure medications stored by the facility were stored in a locked area. The deficient practice posed a health and safety risk to residents with access to the medications.

Findings include:

1. During the environmental inspection of the facility, the Compliance Officer observed an unlocked medication cabinet in the common office area. The medication cabinet contained medication for eight residents.

2. In an interview, E1 acknowledged the medications were not stored in a locked area and were accessible to residents.

Facility Information

Inspection History

INSP-0131116

Summary:

Deficiencies Found: 7

Deficiency #1

Rule/Regulation Violated:

Evidence/Findings:

Temporary Solution:

Permanent Solution:

Person Responsible:

Deficiency #2

Rule/Regulation Violated:

Evidence/Findings:

Temporary Solution:

Permanent Solution:

Person Responsible:

Deficiency #3

Rule/Regulation Violated:

Evidence/Findings:

Temporary Solution:

Permanent Solution:

Person Responsible:

Deficiency #4

Rule/Regulation Violated:

Evidence/Findings:

Temporary Solution:

Permanent Solution:

Person Responsible:

Deficiency #5

Rule/Regulation Violated:

Evidence/Findings:

Temporary Solution:

Permanent Solution:

Person Responsible:

Deficiency #6

Rule/Regulation Violated:

Evidence/Findings:

Temporary Solution:

Permanent Solution:

Person Responsible:

Deficiency #7

Rule/Regulation Violated:

Evidence/Findings:

Temporary Solution:

Permanent Solution:

Person Responsible:

INSP-0069741

Summary:

Deficiencies Found: 7

Deficiency #1

Rule/Regulation Violated:

Evidence/Findings:

Deficiency #2

Rule/Regulation Violated:

Evidence/Findings:

Deficiency #3

Rule/Regulation Violated:

Evidence/Findings:

Deficiency #4

Rule/Regulation Violated:

Evidence/Findings:

Deficiency #5

Rule/Regulation Violated:

Evidence/Findings:

Deficiency #6

Rule/Regulation Violated:

Evidence/Findings:

Deficiency #7

Rule/Regulation Violated:

Evidence/Findings:

INSP-0069739

Summary:

Deficiencies Found: 1

Deficiency #1

Rule/Regulation Violated:

Evidence/Findings: