Ambiance AL

Based on documentation review, record review, and interview, the manager failed to ensure that emergency responders were provided a written document that included: reason for request on behalf of the resident, a list of medications, current pharmacy, medical history, advanced directives, HIPAA release, primary care physician, patient representative, and facility contact. The deficient practice posed a risk if safety measures were not in place to meet a resident's needs. Findings include: 1. A review of Department documentation revealed a report which included sworn testimony which stated, “On Scene Narrative (Author): E35 on scene of lift assist for pt that lives at Ambiance Assisted Living Home. Pt fell on the bathroom floor, only requiring lift assist. Staff was unable to assist pt, called 911 for E35 to perform lift assist. Staff on scene were not able to tell E35 basic info on pt including the patient's name. Pt then provided information, signs refusal document." 2. A review of R1's "Progress Notes" dated November 30, 2024, revealed that the resident slipped getting out of the shower while trying to reach for the resident's wheelchair. The resident asked the facility staff to call 911. The resident was helped into the wheelchair and not transported by Emergency Medical Services (EMS). 3. A review of R2 and R3's medical records, revealed that a completed EMS sheet was not available for review. E1 completed the documents during the inspection. 3. In an interview, E1 acknowledged that the manager failed to ensure that emergency responders were provided a written document that included: reason for request on behalf of the resident, a list of medications, current pharmacy, medical history, advanced directives, HIPAA release, primary care physician, patient representative, and facility contact.

Based on documentation review and interviews, the manager failed to ensure that personnel provided appropriate first aid in accordance with its certification training for first aid before the arrival of emergency medical services to a non-injured resident who had fallen, appeared to be uninjured and was unable to reasonably recover independently. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency. Findings include: 1. A review of Department documentation revealed a report which included sworn testimony which stated, “On Scene Narrative (Author): E35 on scene of lift assist for pt that lives at Ambiance Assisted Living Home. Pt fell on the bathroom floor, only requiring lift assist. Staff was unable to assist pt, called 911 for E35 to perform lift assist. Staff on scene were not able to tell E35 basic info on pt including the patient's name. Pt then provided information, signs refusal document." 2. A review of the facility's Policies and Procedures revealed a policy titled, "Fall Prevention and Recovery" which stated, "The facility personnel who renders CPR or First Aid in good faith to a person who has fallen, is free of civil damages as a result of an act or omission by the person rendering such care if the person rendering aid acted under any of the following circumstances: CPR or First Aid is rendered in good faith and is consistent with certification standards; At the direction of the emergency dispatch operator; To prevent further and imminent and serious injury to the fallen person, pr the fallen person appeared to be uninjured and is unable to reasonably recover independently, or stated that the person was not injured and requested assistance." 3. In an interview, E1 revealed that personnel were told not to hurt themselves by trying to pick up R1 and to call 911 for assistance. 4. In an interview, E1 acknowledged that first aid was not administered before the arrival of emergency medical services to a non-injured resident who had fallen, appeared to be uninjured and was unable to reasonably recover independently.

Based on record review, documentation review, and interview, the manager failed to ensure that an employee provided documentation of freedom from infectious Tuberculosis (TB) as specified in R9-10-113. The deficient practice posed a potential 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. Review of the Centers for Disease Control and Prevention website revealed a web page titled "TB Screening and Testing of Health Care Personnel." The web page stated, "If the Mantoux tuberculin skin test (TST) is used to test health care personnel upon hire (preplacement), two-step testing should be used." 3. A review of E2's personnel record revealed a negative TB skin test dated August 20, 2024. However, no documentation indicating that the employee completed the two-step TB process was provided. 4. A review of E3's personnel record revealed a negative TB skin test dated January 30, 2024. However, no documentation indicating that the employee completed the two-step TB process was provided. 5. In an interview, E1 acknowledged that the manager failed to provide documentation of freedom from infectious Tuberculosis (TB) tests for E2 and E3.