Altercare Assisted Living Home

Based on record review and interview, the manager failed to ensure that a personnel record for each employee included initial training and continued competency training in fall prevention and fall recovery for one of two employees sampled. The deficient practice posed a risk as the caregiver received no organized instruction or information related to physical health services provided to residents. Findings Include: 1. A review of E2’s personnel record revealed a certificate for fall prevention training on December 6, 2025, however, documentation of fall recovery training was not available for review. A hire date was not available for E2. 2. During the inspection, the Compliance Officer observed E2 working and tending to residents. 3. In an exit interview, the findings were reviewed with E1, no additional information was provided. 4. This is a repeat deficiency from the inspection conducted on August 15, 2023.

Based on documentation review, record review, and interview, the health care institution failed to ensure that the health care institution implemented tuberculosis infection control activities that included providing training and education related to recognizing the signs and symptoms of tuberculosis to individuals employed by the health care institution for one of two employees sampled. 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. A review of E2's personnel record revealed no infectious tuberculosis training before providing services to the facility. 3. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on documentation review, record review, and interview, the manager failed to ensure compliance with A.R.S. § 36-411, for one of two employees sampled. The deficient practice posed a risk if the employee was a danger to a vulnerable population. Findings include: 1. A review of A.R.S. § 36-411 states "Each residential care institution, nursing care institution and home health agency shall make documented, good faith efforts to: 3. Beginning January 1, 2025, verify that a potential employee is not on the adult protective services registry pursuant to section 46-459. If a potential employee is found to be on the adult protective services registry, the residential care institution, nursing care institution or home health agency may not hire the potential employee. 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. 5. Beginning March 31, 2025, annually reverify that each employee is not on the adult protective services registry pursuant to section 46-459." 2. A review of E2's personnel record revealed no documentation that E2 was not on the adult protective services registry. 3. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on record review, documentation review, and interview, the manager failed to ensure that a caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services, and according to policies and procedures for one of the two employees sampled. The deficient practice posed a risk if the employees were unable to meet residents’ needs. Findings include: 1. A review of E2's personnel record revealed no documentation of skills and knowledge. 2. The Compliance Officer observed E2 was working at the facility, tending to residents. 3. A review of the facility's policies and procedures revealed the facility did not have a policy that specifically covered how they would verify the skills and knowledge of staff. 4. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on record review, observation, documentation review, and interview, the manager failed to ensure that before providing assisted living services to a resident, a caregiver received orientation that was specific to the duties to be performed by the caregiver for one of the two employees sampled. The deficient practice posed a risk if the employees were unable to meet residents’ needs. Findings include: 1. A review of E2's personnel record revealed no documentation of orientation. 2. The Compliance Officer observed E2 was working at the facility. 3. A review of the facility's policies and procedures revealed a section titled, "Orientation" with the following verbiage, "POLICY STATEMENT: Altercare LLC will establish an orientation process that will be completed before a caregiver, assistant caregiver or volunteer provides assisted living services to resident." 4. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on record review, documentation review, and interview, the manager failed to ensure that a personnel record included the individual’s education and experience applicable to the individual’s job duties, for one of the two employees sampled. The deficient practice posed a risk if the employee was unable to meet residents’ needs. Findings include: 1. A review of E2's personnel record revealed no documentation of education and experience applicable to E2's job duties. 2. The Compliance Officer observed E2 was working at the facility. 3. A review of the facility's policies and procedures revealed a section titled, "Staff Records" with the following verbiage, "POLICY STATEMENT: The Manager shall ensure that a personnel record for each staff member or volunteer is initiated upon hire and maintained throughout the staff member's or volunteer's period of providing services in or for Altercare Assisted Living and for at least two years after the last date the staff member or volunteer provided services in or for the Assisted Living Facility." 4. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on documentation review, record review, and interview, the manager failed to ensure that a resident provided evidence of freedom from infectious tuberculosis (TB) within seven calendar days after the resident's date of occupancy, as stated in R9-10-113 for one of two residents sampled. The deficient practice posed a TB exposure risk to residents. Findings include: 1. R9-10-113.A states "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...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)..." 2. A review of R2's medical record revealed no documentation of assessing risks of prior exposure to infectious TB and a determination of whether R2 had signs or symptoms of TB. Based on R2's date of occupancy, this documentation was required. 3. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on observation and interview, the manager failed to ensure that hot water temperatures were maintained between 95º F and 120º F in areas of an assisted living facility used by 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 hot water temperature at 133º F in the kitchen sink. 2. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

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 to include initial training and continued competency training in fall prevention and fall recovery. The deficient practice posed a risk as organized instruction and information related to resident care and safety was not implemented. Findings include: 1. A review of facility documentation revealed a policy and procedure titled "Environmental Hazards, Fall Prevention & Safety" (dated April 2023). The policy and procedure stated " ...STAT 36-420.01 HCI Shall have an initial Training Program and a Continued Competency for fall prevention/recovery for all staff. The training program shall include initial training and continued competence training in fall prevention/recovery." 2. A review of facility documentation revealed a training program for fall prevention. However, the training program did not include fall recovery. 3. In an interview, E1 acknowledged the health care institution failed to develop and administer a training program for all staff regarding fall prevention and fall recovery. 4. A review of Department documentation revealed A.R.S. \'a7 36-420.01. went into effect on October 1, 2021.

Based on record review and interview, the manager failed to ensure a residency agreement contained provisions allowing a manager to terminate residency of a resident in compliance with A.A.C. R9-10-807(G), for one of two residents sampled. Findings include: 1. A review of R1's medical record revealed a residency agreement dated in December 2021. The residency agreement stated "...1. The management will terminate the residency agreement without notice if: -The resident exhibits behavior that is an immediate threat to the health and safety of the resident or other individuals in the assisted living facility. -The resident's medical or health needs require immediate transfer to another healthcare institution. -The resident's care and service needs exceed the services the facility is licensed to provide. 2. The management will terminate the residency agreement after providing fourteen (14) days written notice to a resident or the representative for any of the following reasons: -Documented failure to pay fees or charges. -Documented non-compliance with the residency agreement or internal facility requirements." However, documentation to indicate the policy and procedure for an assisted living facility to terminate residency, in compliance with A.A.C. R9-10-807(G) was not available for review. 2. In an interview, E1 acknowledged R1's residency agreement did not include the correct provisions for an assisted living facility to terminate residency.

Based on record review and interview, the manager failed to ensure a caregiver provided a resident with the assisted living services in the resident's service plan, for two of two residents sampled. The deficient practice posed a risk as residents did not receive the expected services. Findings include: 1. A review of R1's medical record revealed a service plan dated in June 2023 for personal care services. The service plan stated R1 was to receive assistance in activities of daily living for the following services: -Nail care: Check fingernails to clean, Trim fingernails PRN, Check toenails after each complete bath & clean; and -Incontinent Checks: Check garment & peri-care if soiled. 2. A review of R1's activities of daily living (ADL) sheet dated in August 2023 revealed documentation to indicate R1 received assistance with the above mentioned services according to R1's service plan was not available for review. 3. A review of R2's medical record revealed a service plan dated in August 2023 for directed care services. The service plan stated R2 was to receive assistance in activities of daily living for the following services: -Nail care: Check fingernails to clean, Trim fingernails PRN, Check toenails after each complete bath & clean; and -Incontinent Checks: Every 2 hours, Check garment & peri-care if soiled, Apply skin barrier. 4. A review of R2's ADL sheet dated in August 2023 revealed documentation to indicate R2 received assistance with the above mentioned services according to R2's service plan was not available for review. 5. In an interview, E1 acknowledged a caregiver had not provided R1 and R2 with the assisted living services according to the resident's service plans.