Ambience Care Home

Based on observation, documentation review, record review, and interview, the manager failed to ensure an assistant caregiver who had or was expected to have more than eight hours per week of direct interaction with residents, provided evidence of freedom from infectious tuberculosis (TB) on or before the date the individual began providing services at or on behalf of the assisted living facility, for one of three personnel sampled. Findings include: 1 . During an environmental inspection of the facility, the Compliance Officers observed E3 providing services at the facility. 2 . A review of facility documentation revealed an employee schedule for August 2025. The schedule included E3 working Monday through Friday all month except weekends. 3 . A review of E3's personnel record revealed documentation of two negative TB skin tests. However, documentation of a completed TB risk assessment and TB symptom screening was not available for review at the time of inspection. 4 . In an exit interview, the findings were presented to E2, and no additional information was added.

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 . During an environmental inspection of the facility, the Compliance Officers observed a cabinet located in the kitchen. The cabinet had a magnetic lock on the right cabinet door, and the left cabinet door was supposed to be held in place by the right cabinet door. However, the left cabinet door was sitting on top of the right cabinet door, and the Compliance Officers were able to access the cabinet. The cabinet contained the residents' medication. 2 . In an exit interview, the findings were discussed with E2 and no additional information was provided.

Based on documentation review, record review and interview, the manage failed to ensure that a caregiver's or assistant a caregiver's skills and knowledge were verified and documented, according to policies and procedures for two of two caregivers sampled. Findings include: 1. A review of facility documentation revealed a policy titled "Employees and Volunteers Qualifications." The policy stated "The hiring individual will check and document qualifications, skills and knowledge for each employee and volunteer to ensure they meet criteria and are able to perform the job duties before starting to provide assisted living services to the residents. Documentation of such check is going to be kept in the employees' records upon hiring ("Employee Orientation") and Employee Training, Qualifications and Skills." 2. A review of E2's and E3's personnel record revealed documentation of "Employee Training, Qualifications and Skills" was not available for review at the time of inspection. 3. In an interview, E2 acknowledged E2 and E3 were missing skills and knowledge documentation according to policies and procedures.

Based on record review, documentation review and interview, the manager failed to ensure a caregiver provided a resident with the assisted living services in the resident's service plan, was only assigned to provide the assisted living services the caregiver or assistant caregiver had the documented skills and knowledge to perform, and documented the services provided in the resident's medical record, for one of three residents sampled. The deficient practice posed a risk if a resident did not receive required services from a qualified employee to meet their needs, and services could not be verified as provided against a service plan. Findings include: 1. A review of R3's medical record revealed a service plan. The service plan stated "Nail care 1x a week." However, a review of R3's Activities of Daily Living (ADL) sheet revealed nail care was not documented as provided from September 1, 2024 to September 13, 2024. 2. A review of facility documentation revealed a policy titled "Employees and Volunteers Qualifications." The policy stated "The hiring individual will check and document qualifications, skills and knowledge for each employee and volunteer to ensure they meet criteria and are able to perform the job duties before starting to provide assisted living services to the residents. Documentation of such check is going to be kept in the employees' records upon hiring ("Employee Orientation") and Employee Training, Qualifications and Skills." 3. A review of E2's and E3's personnel record revealed documentation of "Employee Training, Qualifications and Skills" was not available for review at the time of inspection. 4. In an interview, E2 acknowledged nail care was not documented as provided and E2 and E3 were missing skills and knowledge documentation appropriate to provide services.