All Valley Home Care

Based on observation and interview, the manager failed to ensure a resident was treated with dignity, respect, and consideration. The deficient practice posed a risk to the health, safety, and well-being of the resident. Findings include: 1. During the environmental tour, the Compliance Officer observed R1’s closet full of items in bags, boxes, and on the shelves. The items included several pieces of women’s clothing. 2. In an interview, R1 reported the items in the closet did not belong to R1. 3. In an interview, E1 reported R1 arrived with no personal items, so the facility used the extra space in R1’s closet to store donations. 4. In the exit interview, the findings were reviewed with E1, and no additional information was provided. 5. Technical assistance was provided on this rule during complaint inspections on March 21, 2024 and May 21, 2024.

Based on documentation review and interview, the health care institution failed to develop and administer a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. A review of facility documentation revealed a Fall Prevention and Fall Recovery training program was not available for review. 2. In an interview, E1 acknowledged a Fall Prevention and Fall Recovery training program was not available for review.

Based on documentation review, record review, and interview, the manager failed to ensure a personnel record for each employee or volunteer included documentation of evidence of freedom from infectious tuberculosis (TB), if required for the individual according to subsection (A)(8), for two of two personnel sampled. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. Arizona Administrative Code (A.A.C.) R9-10-113(B)(1)(a)(i) states: "B. A health care institution's chief administrative officer shall: 1. For an individual for whom baseline screening and documentation of freedom from infectious tuberculosis is required by an Article in this Chapter...obtain one of the following as evidence of freedom from infectious tuberculosis: a. Documentation of a negative Mantoux skin test or other tuberculosis screening test that: i. Is recommended by the U.S. Centers for Disease Control and Prevention (CDC)." 2. A review of the CDC website revealed a page titled "Baseline Tuberculosis Screening and Testing for Health Care Personnel." The page stated, "If the Mantoux tuberculin skin test (TST) is used for baseline testing of health care personnel, use two-step testing." The page further stated, "Administer first TB skin test following proper protocol...If the result is negative, a second TB skin test is needed...Retest the health care personnel 1 to 3 weeks after the first TB skin test result is read." 3. A review of E1's personnel record revealed documentation of two negative TB skin tests. However, documentation of a TB screening questionnaire was not available for review at the time of inspection. 4. A review of E2's personnel record revealed documentation of two negative TB skin tests. However, documentation of a TB screening questionnaire was not available for review at the time of inspection. 5. In an interview, E1 acknowledged E1's and E2's personnel records did not contain documentation of a TB screening questionnaire at the time of the inspection.

Based on documentation review and interview, the manager failed to ensure that a pest control program that complies with A.A.C. R3-8-201(C)(4) was implemented and documented. The deficient practice posed a health and safety risk to the residents. Findings include: 1. Arizona Administrative Code (A.A.C.) R3-8-20l(C)(4) states: "An individual may not provide pest management services at a school, child care facility, health care institution, or food-handling establishment unless the individual is a certified applicator in the certification category for which services are being provided." 2. In an interview, E1 reported E1 provided E1's own pest management services at the assisted living home if necessary. E1 acknowledged E1 was not a certified applicator.

Based on observation, record review, and interview, the manager failed to ensure that a bell, intercom, or other mechanical means to alert employees to a resident's needs or emergencies was available in a bedroom being used by a resident receiving personal care services. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. The Compliance Officers observed R7's bedroom did not have a working bell, intercom or other mechanical means to alert employees to a resident's needs or emergencies. 2. A review of R7's medical record revealed a current written service plan for personal care services. 3. In an interview, E1 acknowledge R7's bedroom did not contain a bell, intercom, or other mechanical means available to alert employees to the resident's needs. This is a repeat deficiency from the complaint investigation conducted on March 21, 2024.

Based on observation, record review, and interview, the manager failed to ensure that a bell, intercom, or other mechanical means to alert employees to a resident's needs or emergencies was available in a bedroom being used by a resident receiving directed care services. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. The Compliance Officers observed R5's bedroom did not contain a working bell, intercom or other mechanical means to alert employees to a resident's needs or emergencies. 2. A review of R5's medical record revealed a current written service plan for directed care services. 3. In an interview, E1 acknowledge R5's bedroom did not contain a bell, intercom, or other mechanical means available to alert employees to the residents' needs. This is a repeat deficiency from the complaint investigation conducted on March 21, 2024.

Based on observation and interview, the manager failed to ensure that medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed a risk to residents who were unable to self-administer medications. Findings include: 1. The Compliance Officers observed a drawer in the kitchen, which was unlocked. Inside the drawer, the Compliance Officers observed a box of "Trelegy Ellipta 100-62.5-25". Also inside the drawer, the Compliance Officers observed an inhaler "Albuterol" that was opened. 2. The Compliance Officers observed in an empty resident room, a refrigerator with a small black box equipped with a locking mechanism. However, the box was able to be opened with little effort. Inside the box, the Compliance Officers observed "Bisacodyl Suppository 10 MG", "Insulin Glargine 100 units/mL (U-100)" and "Glucagon Emergency Kit for Blood Sugars." 3. In an interview, E1 acknowledged medications were stored unlocked. This is a repeat deficiency from the complaint investigation conducted on March 21, 2024.

Based on observation, documentation review and interview, the manager failed to ensure garbage and refuse were stored in covered containers. The deficient practice posed a risk to the health and safety of the residents as an uncovered garbage container can lead to the possibility of infection. Findings include: 1. The Compliance Officers observed a garbage container in R5's and R8's shared bedroom. The garbage container contained a liner, however, did not contain a cover. 2. The Compliance Officers observed a garbage container in an unoccupied resident bedroom. The garbage container contained a liner, however, did not contain a cover. 3. The Compliance Officers observed a garbage container in a caregiver's bedroom. The garbage container contained a liner, however, did not contain a cover. 4. A review of facility documentation revealed a policy titled "Environmental and Physical Plant Safety". The policy stated "10. All garbage and refuse will be stored in covered containers ..." 5. In an interview, E1 acknowledged there were garbage containers throughout the facility that were not covered. This is a repeat deficiency from the complaint investigation conducted on March 21, 2024.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials were maintained in a locked area and were inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. The Compliance Officers observed the following poisonous or toxic materials sitting on the kitchen counter: -Two bottles of Palmolive dish detergent The bottles contained toxic warning labels. 2. The Compliance Officers observed the following poisonous or toxic material in the kitchen sink: -Palmolive dish detergent The bottle contained a toxic warning label. 3. The Compliance Officers observed, in the hallway bathroom, an unlocked cabinet beneath the sink. The cabinet contained the following toxic material: -Palmolive dish detergent The bottle contained a toxic warning label. 4. The Compliance Officers observed, in the hallway bathroom, sitting on a portable toilet stand, the following toxic material: -LA's Totally Awesome Bleach The bottle contained a toxic warning label. 5. In an interview, E1 acknowledged the unlocked materials throughout the facility were unlocked and accessible to residents. E1 reported the bleach container had been emptied and now contained water but acknowledged the bleach container still smelled of bleach. This is a repeat deficiency from the complaint investigation conducted on March 21, 2024.

Based on observation, record review, documentation review and interview, the manager failed to ensure a caregiver or an assistant caregiver provided a resident with the assisted living services in the resident's service plan, for two of four residents sampled. The deficient practice posed a risk as the service plan to direct services was not followed, and the Department was provided false or misleading information. Findings include: 1. During the environmental tour, the Compliance Officers observed R1, R2, R3 and R4 were undressed and covered by blankets. 2. A review of R1's medical record revealed a service plan for personal care services. The service plan stated the following services were provided to R1: "Bathing - Bed Bath - Frequency: Daily," and "Dressing - Assistance needed in putting or removing cloths - Specify: Total Assist." 3. A documentation review of facility documents revealed a printed electronic copy of an Activities of Daily Living (ADL) sheet for R1. The ADL sheet revealed R1 received a partial bath and assistance with dressing on March 21, 2024. 4. In an interview, R1 reported not having a partial bath or a shower on March 21, 2024. 5. A review of R2's medical record revealed a service plan personal care services. The service plan stated the following services were provided to R2: "Bathing - Shower - Frequency: twice weekly," and "Dressing - Assistance needed in putting or removing cloths - Specify: Total Assist." 6. A documentation review of facility documents revealed a printed electronic copy of an ADL sheet for R2. The ADL sheet revealed R2 received a partial bath and assistance with dressing on March 21, 2024. 7. In an interview, R2 reported not having a partial bath or a shower on March 21, 2024. 8. In an interview, E1 reported that R1 and R2 were given a wipe down in the morning. E1 acknowledged R1 and R2 were not provided with the services as stated in the service plans.

Based on observation, record review, and interview, the manager failed to ensure that a bell, intercom, or other mechanical means to alert employees to a resident's needs or emergencies was available in a bedroom being used by a resident receiving personal care services. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During the environmental tour, the Compliance Officers observed R2's bedroom did not have a working bell, intercom or other mechanical means to alert employees to a resident's needs or emergencies. 2. A review of R2's medical record revealed a current written service plan for personal care services. 3. In an interview, E1 acknowledge R2's bedroom did not contain a bell, intercom, or other mechanical means available to alert employees to the resident's needs.

Based on observation, record review, and interview, the manager failed to ensure that a bell, intercom, or other mechanical means to alert employees to a resident's needs or emergencies was available in a bedroom being used by a resident receiving directed care services. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During the environmental tour, the Compliance Officers observed R3's and R4's bedrooms did not contain a working bell, intercom or other mechanical means to alert employees to a resident's needs or emergencies. 2. A review of R3's and R4's medical records revealed a current written service plan for directed care services. 3. In an interview, E1 acknowledge R3's and R4's bedrooms did not contain a bell, intercom, or other mechanical means available to alert employees to the residents' needs.

Based on documentation review, observation, and interview, the manager failed to ensure there was a means of exiting the facility to an outside area which did not control or alert 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. A documentation review of the license issued by the Department revealed the facility was authorized to provide directed care services. 2. During the environmental tour, the Compliance Officers observed the door exiting to the backyard was open. In addition, the facility did not have a device that was intended to alert employees to the egress of a resident to the outside area. 3. In an interview, E1 report the device intended to alert employees was not available. E1 acknowledged there was a means of exiting the facility to an outside area which did not control or alert employees of the egress of a resident from the facility.

Based on observation, documentation review, and interview, the manager failed to ensure medications stored by the facility were stored in a locked area. The deficient practice posed a risk to residents who were not prescribed the accessible medication. Findings include: 1. During the environmental tour, the Compliance Officers observed the following unlocked medications: - Two medication storage boxes of resident medication were found on the kitchen counter, with multiple medications inside. - Two packages of "Stiolto Respimat 2.5 mcg" and "Nicotine Transdermal system 14 patches step 2 - 14 mg" were found in the kitchen counter belonging to E1. - Three blister packs of "Loperamide Hydrochloride Tablet, 2 mg," one pill bottle of "DIPEN/ATROP TAB 2.5 MG " and "MECLIZINE 25 MG TAB" was found in a kitchen drawer. - A pill bottle of "METOPROLOL TAR TAB 25 MG" was found in a common bathroom closet. 2. In an interview, the Compliance Officers questioned E1 about the unlocked medication. E1 stated they were a mix of resident and personnel medications. 3. A review of facility documentation revealed a policy titled "Part II - Receiving, Storing, Inventorying, Tracking, Dispensing Medication Including Opioids and Narcotics." The policy stated "2. Medication will be locked in the medication storage area." 4. In an interview, E1 and E2 acknowledged that medications were unlocked and accessible to residents.

Based on observation, documentation review and interview, the manager failed to ensure policies and procedures were implemented for discarding medication. The deficient practice posed a risk as the standards expected of employees were not followed. Findings include: 1. During the environment tour, the Compliance Officers observed the following medication belonged to residents that no longer resided in the facility: - "DIPEN/ATROP TAB 2.5 MG." - "MECLIZINE 25 MG TAB." 2. During the environmental tour, the Compliance Officers observed the following expired medication for R1 in an unlocked kitchen drawer: - "METOPROLOL TAR TAB 25 MG. Expires: 01/03/2024" 3. A review of facility documentation revealed a policy titled "Part IV - Disposal (discarding) of Medication including Opioids and Narcotics, medication recall." The policy stated "1. On a monthly basis the facility manager or manager designee will check all medication in the facility to identify and locate any discontinued medication, expired medication, including medication of deceased residents. 2. Such medication will be disposed of by facility manager ... c. Disposed of by mixing the pills with hot water and cooking flour, closing the container's lid on securely, and shaking. Then scrape the label off of the container and toss in trash." 4. In an interview, E1 acknowledged the medications were not discarded per the policies and procedures.

Based on observation, documentation review and interview, the manager failed to ensure garbage and refuse were stored in covered containers. The deficient practice posed a risk to the health and safety of the residents as an uncovered garbage container can lead to the possibility of infection. Findings include: 1. During the environmental tour, the Compliance Officers observed multiple uncovered containers storing garbage and refuse in the bathrooms and resident bedrooms. 2. During the environmental tour, the Compliance Officers observed multiple soiled disposable bed underpad's all over R2's bed and the floor. 3. A review of facility documentation revealed a policy titled "Environmental and Physical Plant Safety". The policy stated "10. All garbage and refuse will be stored in covered containers ..." 4. In an interview, R2 reported that the disposable bed underpad's were left out all night. 5. In an interview, E1 reported the soiled disposable bed underpad's were removed at the end of the day. E1 acknowledged the garbage and refuse were not stored in covered containers.

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, labeled and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During the environmental tour, the Compliance Officers observed the following poisonous and toxic materials in an unlocked cabinet under the kitchen sink: - one spray canister of "WD-40" - one canister of "Ajax with Bleach" - one spray bottle of "Oven Grill Cleaner" - one bottle "Clorox Concentrated Liquid Bleach" - and several unlabeled chemical containers. 2. During the environmental tour, the Compliance Officers observed poisonous and toxic materials unlocked in resident rooms, and bathrooms. The Compliance Officers observed Febreze Air Freshener, Lysol Disinfectant Spray, unlabeled Peri Care spray bottles and unlabeled chemical bottles. 3. In an interview, E1 acknowledged poisonous and toxic materials stored by the assisted living facility were not maintained in a locked area, labeled and inaccessible to residents.

Based on observation, documentation review and interview, the manager failed to ensure a resident bathroom contained a slip-resistant surface in the shower. The deficient practice posed a fall risk for residents. Findings include: 1. During the environmental tour, the Compliance Officers observed E2 assisting a resident to one of the shared bathrooms in the facility. However, the shower did not contain a slip-resistant surface. 2. A review of facility documentation revealed a policy titled "Environmental and Physical Plant Safety". The policy stated "33. Showers and tubs will have slip proof devices on their floors before any resident may use them..." 3. In an interview, E1 acknowledged the shower in the shared resident bathroom did not contain a slip-resistant surface.

Based on observation and interview, the manager failed to ensure each sleeping area included sheets and mattress pads, for four of four residents sampled. Findings include: 1. During the environmental tour, the Compliance Officers observed R1's, R2's, R3's, and R4's beds did not have sheets or mattress pads. In addition, the Compliance Officers observed multiple disposable bed underpads used as linens. 2. In an interview, R2 reported that disposable bed underpads were left all night. 3. In an interview, E1 acknowledged R1's, R2's, R3's and R4's beds did not have sheets or mattress pads.