Amazing Care Assisted Living

Based on documentation review, record review, and interview, the manager failed to establish, document, and implement policies and procedures to protect the health and safety of a resident to cover qualifications, including required skills and knowledge, education, and experience for employees and volunteers. The deficient practice posed a risk if the employees were unable to meet a resident's needs. Findings include: 1. A review of the facility's policies and procedures revealed no documentation of a policy covering how a caregiver's or assistant caregiver's skills and knowledge are verified and documented. 2. In an interview, E1 acknowledged a policy and procedure covering how a caregiver's or assistant caregiver's skills and knowledge are verified and documented was not available for review at the time of the inspection.

Based on documentation review and interview, the manager failed to ensure policies and procedures were established and documented to protect the health and safety of a resident covering how a caregiver would respond to a resident's sudden, intense, or out of control behavior to prevent harm to the resident or another individual. Findings include: 1. A review of the facility's policies and procedures revealed no policy and procedure covering how a caregiver would respond to a resident's sudden, intense, or out of control behavior to prevent harm to the resident or another individual. 2. In an interview, E2 acknowledged a policy and procedure was not available covering how a caregiver would respond to a resident's sudden, intense, or out of control behavior to prevent harm to the resident or another individual.

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 three 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(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 E2's and E3'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. 3. In an interview, E1 acknowledged E2's and E3's personnel records did not contain documentation of a TB screening questionnaire at the time of the inspection.

Based on record review and interview, the manager failed to ensure a personnel record for each employee included documentation of the individual's skills and knowledge applicable to the individual's job duties, for one of three sampled personnel members. The deficient practice posed a risk if an employee did not possess the skills and knowledge to meet the needs of residents. Findings include: 1. A review of E2's personnel record revealed documentation of verification of skills and knowledge was not available for review at the time of inspection. 2. In an interview, E2 acknowledged E2's personnel record did not include documented verification of E2's skills and knowledge at the time of the inspection.

Based on documentation review, record review, and interview, the manager failed to ensure a personnel record for each employee included documentation of compliance with the requirements in Arizona Revised Statutes (A.R.S.) \'a7 36-411(A), for one of three employees sampled. The deficient practice posed a risk if E2 was a danger to a vulnerable population. Findings include: 1. A.R.S. \'a7 36-411(A) states: "A. Except as provided in subsection F of this section, as a condition of licensure or continued licensure of a residential care institution, a nursing care institution or a home health agency and as a condition of employment in a residential care institution, a nursing care institution or a home health agency, employees and owners of residential care institutions, nursing care institutions or home health agencies, contracted persons of residential care institutions, nursing care institutions or home health agencies or volunteers of residential care institutions, nursing care institutions or home health agencies who provide medical services, nursing services, behavioral health services, health-related services, home health services or direct supportive services and who have not been subject to the fingerprinting requirements of a health professional's regulatory board pursuant to title 32 shall have valid fingerprint clearance cards that are issued pursuant to title 41, chapter 12, article 3.1 or shall apply for a fingerprint clearance card within twenty working days of employment or beginning volunteer work or contracted work." 2. A review of E2's personnel record revealed a fingerprint card which expired on November 11, 2024. 3. In an interview, E2 acknowledged E2's personnel record did not include documentation of compliance with the requirements in A.R.S. \'a7 36-411(A).

Based on record review and interview, the manager failed to ensure a resident's medical record contained documentation of freedom from infectious tuberculosis (TB), for two of two sampled residents. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. A review of R1's and R2's medical records revealed documentation of freedom from TB. However, documentation of TB screening was not available for review at the time of inspection. 2. In an interview, E2 acknowledged failure to ensure a resident's medical record contained documentation of TB screening.

Based on observation and interview, the manager failed to ensure the 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, controlled or alerted employees of the egress of a resident from the facility to the outside area allowing the resident to be at least 30 feet away 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. The Compliance Officers observed a door in the living room leading to the back yard which allowed a resident to be at least 30 ft away from the facility. However, the door did not control or alert employees of the egress of a resident from the facility. 2. In an interview, E2 acknowledged the back door alert was not functional.

Based on observation and interview, the manager failed to ensure a food menu was conspicuously posted at least one calendar day before the first meal on the food menu was served. Findings include: 1. During an environmental inspection of the facility, the Compliance Officers observed a posted food menu for the week of December 1 - 7, 2024. 2. In an interview, E2 acknowledged the current food menu was not conspicuously posted.

Based on observation and interview, the manager failed to ensure a refrigerator used by an assisted living facility to store food or medication contained a thermometer, accurate to plus or minus 3 \'b0F, placed at the warmest part of the refrigerator. Findings include: 1. During the environmental inspection of the facility, the Compliance Officers observed no thermometer placed at the warmest part of the refrigerator. 2. In an interview, E1 acknowledged the kitchen refrigerator did not contain a thermometer accurate to plus or minus 3 \'b0F, placed at the warmest part of the refrigerator.

Based on record review and interview, the manager failed to ensure a resident had a written service plan completed no later than 14 calendar days after the resident's date of acceptance, for one of two residents sampled. The deficient practice posed a risk as there was no service plan to direct services to be provided to a resident. Findings include: 1. A review of R2's medical record revealed a service plan dated February 1, 2024. No other documentation of a service plan for R2 was provided for review. Based on R2's admission date, the service plan was completed more than 14 calendar days after R2's admission to the facility. 2. In an interview, E1 acknowledged R2's service was not completed no more than 14 days after R2's admission to the facility.

Based on record review and interview, the manager failed to ensure when a resident had an incident resulting in the resident needing medical services, a caregiver immediately notified the resident's primary care provider and emergency contact. The deficient practice posed a risk of potential re-injury if the resident did not receive adequate follow-up care. Findings include: 1. In an interview, E1 reported R1 went to the hospital on January 26, 2024. 2. A review of R1's medical record revealed a document titled "Report of Unusual Occurrence" dated January 26, 2024, which reflected "Resident was complaining of right hand/arm pain at time of shower when [R1] was undressed, immediately caregiver noticed bruising on upper right shoulder. 911/manager was contacted immediately and patient was transferred to hospital for evaluation." The form did not indicate R1's primary care provider or emergency contact were notified. 3. In an interview, E1 acknowledged the "Report of Unusual Occurrence" documentation did not reflect R1's primary care provider or emergency contact were notified of the incident.

Based on observation, documentation review, and interview, the manager failed to ensure documentation was maintained of the caregivers and assistant caregivers working each day, including the hours worked. Findings include: 1. The compliance officer observed E2 and E3 as the only caregivers working at the time of the inspection. 2. The compliance officer requested the October 2023, personnel schedule, however, the schedule was not yet created at the time of the inspection. 3. During an interview, E2 reported E2 has not yet created the October personnel schedule. E2 reported when the schedule is created it would reflect E1, E2, and E3, worked October 1, 2023, to the present. 4. During an interview, E1 acknowledged the manager failed to ensure at the time of the inspection documentation was maintained of the caregivers working each day, including the hours worked.

Based on record review and interview, the manager failed to ensure a resident provided documentation of freedom from infectious tuberculosis (TB) as specified in R9-10-113. Findings include: 1. Review of R1's medical record revealed a chest x-ray identifying R1 was free from infectious TB. R1's medical record did not include documentation R1 has a documented history of testing positive for TB requiring a chest x-ray. R1's medical record revealed no additional documentation of freedom from infectious TB. Based on R1's acceptance date, this documentation was required. 2. In an interview, E1 acknowledged R1's medical record only included a chest x-ray with no documented history as identified. E1 acknowledged the manager failed to ensure R1's medical record included documentation showing freedom from infectious TB as specified in R9-10-113.

Based on record review and interview, the manager failed to ensure a caregiver documented the services provided in the resident's medical record, for two of two residents reviewed. Findings: 1. Review of R1's personal care service plan dated September 2, 2023, identified the following services to be provided to R1; "Dressing, requires assistance twice daily and as needed, bathing requires assistance twice weekly and as needed." A review of R1's record revealed no documentation to demonstrate R1 received the identified services since admission to the facility. 2. Review of R2's personal care service plan dated September 13, 2023, identified the following services to be provided to R2; " Oral care requires supervision twice daily, hair care requires assistance daily and as needed, bathing requires assistance twice weekly and as needed." A review of R2's record revealed no documentation to demonstrate R2 received the identified services since September 27, 2023. 3. In an interview, E2 reported E2 and E3 provided the identified services to R1 and R2 on the identified dates. E2 acknowledged E2 and E3 did not document the services in the medical records. 4. In an interview, E1 acknowledged E1, E2, and E3 did not document the services in the medical records. E1 acknowledged the manager failed to ensure a caregiver documented the services provided in the resident's medical record.

Based on record review, observation, and interview, the manager failed to ensure medication administered to a resident was documented in the resident's medical record. Findings include: 1. A review of R2's medical record revealed R2 receives medication administration. 2. A review of R2's medical record revealed signed medication orders for the following medications; Buspirone HCL 7.5 mg take 1 tablet daily, Depakote 125 mg take one tablet three times daily, Donepezil HCL 10 mg take one tab QD, Lisinopril 20 mg take one tab QD, and Zyprexa 2.5 mg take one tablet BID. A review of R2's medical record revealed the identified medications were not documented as administered to R2 since the morning of September 27, 2023, through the present. 3. The compliance officer observed R2's medications were available at the facility. 4. In an interview, E2 reported E2 provided R2 with the identified medications on some of the dates identified. E2 reported E2 did not document the administration of the medication for the time identified. 5. In an interview. E1 acknowledged the manager failed to ensure medication administered to a resident was documented in the resident's medical record.