Advance Healthcare of Scottsdale

Violation cited

Findings include: Resident #195 was admitted on December 02, 2023 with a diagnosis of Wedge compression fracture of T11-T12 vertebra, Chronic atrial fibrillation, Depression, Long term (current) use of anticoagulants, and Chest pain. A review of the current active physician orders revealed the following orders for: Oxycodone - Schedule II tablet, 5 mg; oral: Pain of 6-10 on a pain scale of 0-10, Every 6 Hours - PRN (order date of December 02, 2023) These orders were transcribed onto the MAR (Medication Administration Record) and the TAR (Treatment Administration Record) for December 2023. Review of the MAR and TAR for December 2023 revealed that Oxycodone - Schedule II tablet, 5 mg was given on December 3, 4 and 5, 2023 after monitoring the pain level. The Admission Minimum Data Set (MDS) assessment at the time of admission revealed a Brief Interview for Mental Status (BIMS) score of 15 which indicated the resident was alert and oriented. An interview with the Director of Nursing (DON/Staff #62) was conducted on December 14, 2023 at 10:25 AM who stated opioid consents are not present in the medical records and having consents for opioid medications was new to her. The policy and procedure document titled, "Resident Rights -version A0717" (updated 28 September 2022) was reviewed and revealed, that the resident has the right to be informed of, and participate in, his/her treatment, including: the right to be informed in advance, by the physician or other practitioner or professional, of the risks and benefits of proposed care, of treatment and treatment alternatives or treatment options and to choose the alternative or option he or she prefers.

Based on observations, review of records, maintenance log, policy review, as well as staff and resident interviews, the facility failed to provide a safe, clean, comfortable, home like environment for 3 out of 35 residents sampled and ensure that all areas in the facility are in good repair. The deficient practice could result in accidents and or impact resident health. Findings include: Resident #32 was admitted on October 30, 2023 with diagnosis including a closed fracture with routine healing, osteoarthritis of the hip, spinal stenosis, unspecified dementia, peripheral vascular disease, type 2 diabetes, age related osteoporosis, fall and hairy cell leukemia in remission. A review of the 5-day MDS (minimum data set) dated November 3, 2023 revealed a BIMS (brief interview of mental status) score of 12, suggesting moderate cognitive impairment. An observation was conducted on December 12, 2023 at 10:42 AM. The resident was observed to be walking to the bathroom and reminded by the caregiver to use his wheelchair and to be careful. The hot water temperature was measured in the bathroom and revealed no significant findings; however, the hot water temperature in the resident's kitchenette area revealed a temperature of 124.3 degrees Fahrenheit. The caregiver stated that the resident has dementia but that there is a private caregiver with the resident 24 hours a day, 7 days a week. _____________ Resident #25 was admitted on November 25, 2023 with diagnosis including joint replacement, generalized arthritis, acute kidney failure, protein-calorie malnutrition, atrial fibrillation, and long-term use of anticoagulants. A review of the 5-day MDS (minimum data set) dated November 30, 2023 revealed a BIMS (brief interview of mental status) score of 15, suggesting the resident is cognitively intact. An observation was conducted on December 12, 2023 at 10:50 AM. The hot water temperature in the resident's kitchenette area measured 125.2 degrees Fahrenheit. _____________ Resident #344 was admitted on December 4, 2023 with diagnosis including encephalopathy, urinary tract infection, sepsis, acute kidney failure, unspecified dementia, hypertensive heart disease, atherosclerotic heart disease and muscle weakness. A record review revealed no current completed MDS (minimum data set) was available. An observation was conducted on December 12, 2023 at 10:34 AM. The hot water temperature in the resident's kitchenette sink measured 122 degrees Fahrenheit. _____________ An observation was conducted on December 12, 2023 at 10:34 AM. This room (rm 202) was designated as a vacant room at the time and measured 121 degrees Fahrenheit for the in the kitchenette sink. ____________ An interview was conducted with the administrator, staff #115 and the DON (director of nursing) staff #62 on December 12, 2023 at 12:12 PM, informing them of the kitchenette hot water observations in the resident rooms. The administrator stated that she was surprised as they have a mixer and stated t

Based on closed clinical record review, staff interviews, and facility policy review, the facility failed to ensure medications were administer as ordered by the physician for one resident (#195). The deficient practice could result in adverse effects to the residents. Findings include: Resident #195 was admitted on December 02, 2023 with a diagnosis of Wedge compression fracture of T11-T12 vertebra, Chronic atrial fibrillation, Depression, Long term (current) use of anticoagulants, and Chest pain. A review of the current active physician orders revealed the following orders for: Duloxetine capsule, 20mg; oral for Depression (order date of December 02, 2023 Twice A Day 07:00 -09:00, 19:00 -21:00); Eliquis (apixaban) tablet, 5mg; oral for Anticoagulant (order date of December 02, 2023 Twice A Day 07:00 - 09:00, 19:00 -21:00); Escitalopram oxalate tablet, 10mg; oral for Depression (order date of December 02, 2023 Once A Day 07:00 - 09:00); Pantoprazole tablet, 40mg; oral for GERD (order date of December 02, 2023 At Bedtime, 19:00 -21:00). These orders were transcribed onto the MAR (Medication Administration Record) and the TAR (Treatment Administration Record) for December 2023. Review of the MAR and TAR for December 2023 revealed that Duloxetine capsule, Eliquis (apixaban) tablet, Escitalopram oxalate tablet, and Pantoprazole tablet were administered late from half an hour to an hour on December 2, 9 and 10 ,2023. Further review of the clinical record revealed no documentation of reason why these medications were not administered as ordered. An interview was conducted with resident (#195) on December 12, 2023 at 9:49 AM. The resident stated that her medications were delayed by an hour to two hours at night and when she notified to Licensed Practical Nurse (LPN, staff #75), staff #75 stated that she got lots of patient and it takes her longer. An interview was conducted with resident (#195) again on December 14, 2023 at 9:25 AM. The resident stated that LPN (staff #75), missed pills of Eliquis (apixaban) tablet and when she notified staff #75 then it was remedied. A phone interview was conducted with LPN (staff #75) on December 14, 2023 at 9:46 AM. The staff (#75) stated about late medication administration that she is new to facility and tries to do things quickly but wants to be safe and sometime resident has emergency. She further stated about risk associated with late medication administration that it is unavoidable and she is not aware of whether any medications are of high risk. An interview was conducted with Director of Nursing (DON, staff #62) on December 14, 2023 at 10:19 AM. The staff (#62) stated about late medication administration that it is appropriate to give medication late, depend on situation. She further stated about risk associated with late medication that you need to be specific and not general. When pulled the resident (#195) clinical record of MAR and TAR and asked DON about whether it is acceptable to administer medication

Based on closed clinical record review, staff interviews, and facility policy review, the facility failed to ensure medications were administer as ordered by the physician for one resident (#195). Findings include: Resident #195 was admitted on December 02, 2023 with a diagnosis of Wedge compression fracture of T11-T12 vertebra, Chronic atrial fibrillation, Depression, Long term (current) use of anticoagulants, and Chest pain. A review of the current active physician orders revealed the following orders for: Duloxetine capsule, 20mg; oral for Depression (order date of December 02, 2023 Twice A Day 07:00 -09:00, 19:00 -21:00); Eliquis (apixaban) tablet, 5mg; oral for Anticoagulant (order date of December 02, 2023 Twice A Day 07:00 - 09:00, 19:00 -21:00); Escitalopram oxalate tablet, 10mg; oral for Depression (order date of December 02, 2023 Once A Day 07:00 - 09:00); Pantoprazole tablet, 40mg; oral for GERD (order date of December 02, 2023 At Bedtime, 19:00 -21:00). These orders were transcribed onto the MAR (Medication Administration Record) and the TAR (Treatment Administration Record) for December 2023. Review of the MAR and TAR for December 2023 revealed that Duloxetine capsule, Eliquis (apixaban) tablet, Escitalopram oxalate tablet, and Pantoprazole tablet were administered late from half an hour to an hour on December 2, 9 and 10 ,2023. Further review of the clinical record revealed no documentation of reason why these medications were not administered as ordered. An interview was conducted with resident (#195) on December 12, 2023 at 9:49 AM. The resident stated that her medications were delayed by an hour to two hours at night and when she notified to Licensed Practical Nurse (LPN, staff #75), staff #75 stated that she got lots of patient and it takes her longer. An interview was conducted with resident (#195) again on December 14, 2023 at 9:25 AM. The resident stated that LPN (staff #75), missed pills of Eliquis (apixaban) tablet and when she notified staff #75 then it was remedied. A phone interview was conducted with LPN (staff #75) on December 14, 2023 at 9:46 AM. The staff (#75) stated about late medication administration that she is new to facility and tries to do things quickly but wants to be safe and sometime resident has emergency. She further stated about risk associated with late medication administration that it is unavoidable and she is not aware of whether any medications are of high risk. An interview was conducted with Director of Nursing (DON, staff #62) on December 14, 2023 at 10:19 AM. The staff (#62) stated about late medication administration that it is appropriate to give medication late, depend on situation. She further stated about risk associated with late medication that you need to be specific and not general. When pulled the resident (#195) clinical record of MAR and TAR and asked DON about whether it is acceptable to administer medication late and risks associated with it then DON stated that nurse prioritize

Based on observations, review of records, maintenance log, policy review, as well as staff and resident interviews, the facility failed to provide a safe, clean, comfortable, home like environment for 3 out of 35 residents sampled and ensure that all areas in the facility are in good repair. The deficient practice could result in accidents and or impact resident health. Findings include: Resident #32 was admitted on October 30, 2023 with diagnosis including a closed fracture with routine healing, osteoarthritis of the hip, spinal stenosis, unspecified dementia, peripheral vascular disease, type 2 diabetes, age related osteoporosis, fall and hairy cell leukemia in remission. A review of the 5-day MDS (minimum data set) dated November 3, 2023 revealed a BIMS (brief interview of mental status) score of 12, suggesting moderate cognitive impairment. An observation was conducted on December 12, 2023 at 10:42 AM. The resident was observed to be walking to the bathroom and reminded by the caregiver to use his wheelchair and to be careful. The hot water temperature was measured in the bathroom and revealed no significant findings; however, the hot water temperature in the resident's kitchenette area revealed a temperature of 124.3 degrees Fahrenheit. The caregiver stated that the resident has dementia but that there is a private caregiver with the resident 24 hours a day, 7 days a week. _____________ Resident #25 was admitted on November 25, 2023 with diagnosis including joint replacement, generalized arthritis, acute kidney failure, protein-calorie malnutrition, atrial fibrillation, and long-term use of anticoagulants. A review of the 5-day MDS (minimum data set) dated November 30, 2023 revealed a BIMS (brief interview of mental status) score of 15, suggesting the resident is cognitively intact. An observation was conducted on December 12, 2023 at 10:50 AM. The hot water temperature in the resident's kitchenette area measured 125.2 degrees Fahrenheit. _____________ Resident #344 was admitted on December 4, 2023 with diagnosis including encephalopathy, urinary tract infection, sepsis, acute kidney failure, unspecified dementia, hypertensive heart disease, atherosclerotic heart disease and muscle weakness. A record review revealed no current completed MDS (minimum data set) was available. An observation was conducted on December 12, 2023 at 10:34 AM. The hot water temperature in the resident's kitchenette sink measured 122 degrees Fahrenheit. _____________ An observation was conducted on December 12, 2023 at 10:34 AM. This room (rm 202) was designated as a vacant room at the time and measured 121 degrees Fahrenheit for the in the kitchenette sink. ____________ An interview was conducted with the administrator, staff #115 and the DON (director of nursing) staff #62 on December 12, 2023 at 12:12 PM, informing them of the kitchenette hot water observations in the resident rooms. The administrator stated that she was surprised as they have a mixer and stated t

Based on clinical record review and staff interviews, the facility failed to ensure resident #4 and/or their representative was informed of the risk and benefits of opioid medications prior to administration. The deficient practice can result in the resident and/or the resident representative not being aware of the benefits and the potential adverse side effects of taking opioid medications. Findings include: Resident #4 was admitted on November 29, 2023 with diagnoses of acute respiratory failure with hypoxia, rheumatoid arthritis, and polyneuropathy. The admission Minimum Data Set (MDS) dated December 4, 2023 revealed a Brief Interview for Mental Status (BIMS) score of 11, which indicated the resident has moderate cognitive impairment. The assessment also included the resident is taking opioid medication. Review of the clinical records for the month of November and December 2023 revealed the following physician's orders:Review of the clinical records for the month of November and December 2023 revealed the following physician's orders: OPIOID medication use-Observe patient closely for: Tolerance (meaning more medication may be needed to achieve the same level of pain relief). Physical dependence which causes symptoms of withdrawal when opioid medication is stopped, or a dose is held or missed. Increased sensitivity to pain. Constipation, Nausea, Vomiting, Dry mouth, Sleepiness, Dizziness, Confusion, Depression, Itching, Sweating. Special instructions: Document +/- results. Explain + results in NN every shift, date of order November 29, 2023; Tramadol- Schedule IV tablet 50 mg orally every 12 hours as needed for diagnosis of Pain 4-6/10 * Pain Scale 0-10/10. This medication had a start date of November 29, 2023 and discontinued date of December 9, 2023; Gabapentin capsule; 300mg; oral Special Instructions: DX. Neuropathy every 8 hours. Start date November 29, 2023 and discontinued date of December 13, 2023; Cyclobenzaprine tablet; 5mg; amount to administer: 5 mg; oral three times a day - PRN for muscle spasms as needed. Start date December 3, 2023 and discontinued date December 4, 2023; Cyclobenzaprine tablet; 5mg; amount to administer: 5 mg; oral three times a day for muscle spasms. Start date December 3, 2023 and discontinued date December 3, 2023; Cyclobenzaprine tablet; 5mg; amount to administer: 5 mg; oral every 8 hours - PRN diagnosis. Muscle spasms. Start date December 4, 2023 and discontinued date December 10, 2023; Trazadone tablet; 50 mg; amount: 50 mg; oral Special Instructions: DX: Insomnia as evidenced by inability to fall/stay asleep at bedtime; oxycodone - Schedule II tablet; 5mg; amount: 5mg; oral Special Instructions: Diagnosis- Pain 4-10/10 * Pain Scale 0-10/10 every 6 hours -PRN ordered on December 9, 2023; Tramadol- Schedule IV tablet 50 mg orally once a day for diagnosis of chronic pain on December 9, 2023; Tramadol- Schedule IV tablet 50 mg orally every 12 hours as needed for diagnosis of Pain 4-6/10 * Pain Scale 0-10/10. T

Based on closed clinical record review, staff interviews, and facility policy review, the facility failed to inform residents #32, #195, #4, and #146, in advance, of the risks and benefits of proposed care for opioid medications via informed consent. The deficient practice could result in treatment decisions not being identified and granted to residents. Findings include: Resident #195 was admitted on December 02, 2023 with a diagnosis of Wedge compression fracture of T11-T12 vertebra, Chronic atrial fibrillation, Depression, Long term (current) use of anticoagulants, and Chest pain. A review of the current active physician orders revealed the following orders for: Oxycodone - Schedule II tablet, 5 mg; oral: Pain of 6-10 on a pain scale of 0-10, Every 6 Hours - PRN (order date of December 02, 2023) These orders were transcribed onto the MAR (Medication Administration Record) and the TAR (Treatment Administration Record) for December 2023. Review of the MAR and TAR for December 2023 revealed that Oxycodone - Schedule II tablet, 5 mg was given on December 3, 4 and 5, 2023 after monitoring the pain level. The Admission Minimum Data Set (MDS) assessment at the time of admission revealed a Brief Interview for Mental Status (BIMS) score of 15 which indicated the resident was alert and oriented. An interview with the Director of Nursing (DON/Staff #62) was conducted on December 14, 2023 at 10:25 AM who stated opioid consents are not present in the medical records and having consents for opioid medications was new to her. The policy and procedure document titled, "Resident Rights -version A0717" (updated 28 September 2022) was reviewed and revealed, that the resident has the right to be informed of, and participate in, his/her treatment, including: the right to be informed in advance, by the physician or other practitioner or professional, of the risks and benefits of proposed care, of treatment and treatment alternatives or treatment options and to choose the alternative or option he or she prefers.