Angel's Touch Care Home

Based on record review and interview, the manager failed to ensure that for two of two sample resident records, a standardized emergency responder patient information form was completed and maintained for each resident. Findings include: 1. The record for R2 failed to contain the completed emergency responder patient information documentation. 2. The record for R3 failed to contain the completed emergency responder patient information documentation. 3. During an interview, E2 acknowledged that the required documentation was not available for review.

Based on record review and interview the health care institution failed to develop and administer a training program for all staff regarding fall prevention and fall recovery as required in A.R.S. \'a7 36-420.01. Findings include: 1. Review of facility documentation failed to reveal that the health care institution had developed a training program for all staff regarding fall prevention and fall recovery as required in A.R.S. \'a7 36-420.01. 2. During an interview, E2 acknowledged the required documentation was not available for review. This is a repeat deficiency from the compliance inspection conducted on November 2, 2022.

Based on documentation review and interview, the manager failed to designate, in writing, a caregiver who was present on the assisted living facility's premises and accountable for the assisted living facility when the manager was not present. Findings include: 1. Upon entry into the facility E3 and E4 were observed to be the only staff in the facility with six residents. 2. During an interview, E3 indicated that E3 was the facility housekeeper and that E3 and E4 were the only employees present at the facility. 3. During an interview, E4 indicated E4 was a "caregiver" and that E4 and E3 were the only employees present at the facility. 4. Review of the record for E4 revealed that E4 was not a certified caregiver. 5. During an interview E3 indicated that E2 was a caregiver and E2 had left the facility earlier to run errands. 6. E2 returned to the facility approximately 30 minutes after the survey had begun. 7. Review of the record for E2 revealed that E2 was a certified caregiver. 8. Review of the delegation of authority statement revealed that E2 had been designated to act as the manager designee in the manager's absence. 9. During an interview, E2 acknowledged that when the Surveyor entered the facility, no manager designee had been present on the assisted living facilities premises and accountable for the assisted living facility.

Based on documentation review and interview, the manager had reasonable basis to believe abuse had occurred on the premises and failed to implement subsections 1. through 6. of this rule. Findings include: 1. During an interview, E2 stated "We got a letter from Adult Protective Services (APS), it said the complaint was closed." 2. Review of the documentation from APS revealed the following: "Adult Protective Services has completed its investigation. We are writing to notify you that based on the information discovered through the investigation of this report allegations were substantiated against (E2). This case is now closed. Description of Disposition: On or about September 15, 2023, (E2) abused a vulnerable adult through the intentional infliction of physical harm." 3. No facility documentation was available for review reflecting that once the manager had reasonable basis to believe that abuse had occurred, the manager documented and implemented subsections 1. through 6. of this rule. 4. During an interview, E2 acknowledged the required documentation was not available for review.

Based on documentation review and interview, the manager failed to ensure that documentation is maintained for the caregivers and assistant caregivers working each day, including the hours worked by each. Findings Include: 1. Twelve months of employee work schedules were reviewed. The schedule for the day of the survey failed to correctly reflect the names and hours worked for the caregivers and assistant caregivers observed in the facility. 2. Upon entry into the facility, E3 and E4 were observed to be the only employees present. 3. During and interview, E3 and E4 indicated they were the only employees present and that E2 had left to run errands. 4. E2 arrived at the facility approximately 30 minutes after the Surveyor arrived. 5. Review of the facility staffing schedule for day of the survey indicated that E1, E2 and E3 were scheduled to provide caregiving services to residents from 7a.-7p. 6. During and interview, E2 stated, "(E1) is on vacation." 7. During an interview, E2 acknowledged the required documentation was not available for review.

Based on observation, record review and interview the manager failed to ensure that at least the manager or a caregiver is present at an assisted living home when a resident is present in the assisted living home and except for nighttime hours, the manager or caregiver is awake. Findings include: 1. Upon entry into the facility E3 and E4 were observed to be the only staff in the facility with six residents. 2. During an interview, E3 indicated that E3 was the facility housekeeper and that E3 and E4 were the only employees present at the facility. 3. During an interview, E4 indicated E4 was a "caregiver" and that E4 and E3 were the only employees present at the facility. 4. Review of the record for E4 revealed that E4 was not a certified caregiver. 5. During an interview E3 indicated that E2 was a caregiver and E2 had left the facility earlier to run errands. 6. Approximately 30 minutes after the survey had begun E2 arrived at the facility. 7. Review of the record for E2 revealed that E2 was a certified caregiver. 8. Review of the employee schedule for the day of the survey indicated that E2, E4 and E5 were scheduled to work from 7a. to 7p. 9. During an interview, E2 acknowledged that when the Surveyor entered the facility, there was no manager or caregiver present on the assisted living facilities premises when residents are present.

Based on record review and interview, the manager failed to ensure that two of two sample resident records contained documentation of notification to the resident of the availability of vaccination for pneumonia. Findings include: 1. The record belonging to R2 contained documentation indicating that the resident was last notified of the availability of the pneumonia vaccination on May 18, 2022. No additional documentation indicating when the resident had been offered, refused or received the vaccination, was available for review. Based on the resident's date of acceptance, this documentation was required. 2. The record belonging to R3 contained documentation indicating that the resident was last notified of the availability of the pneumonia vaccination on August 5, 2022. No additional documentation indicating when the resident had been offered, refused or received the vaccination, was available for review. Based on the resident's date of acceptance, this documentation was required. 3. During an interview, E2 acknowledged that the records did not contain the required documentation.

Based on a review of facility records and interview, the manager failed to ensure that a medical record was established and maintained for each resident. Findings include: 1. No record for R1 was available for review. Based on the resident's date of acceptance, this was required. 2. During an interview, E2 stated, "That person doesn't have a file. They...will stay off and on a couple of times a month. They stay for two to five days at a time. They are a cousin of (E1). They need help with lots of things, medication, toilet, walking." 3. During an interview, E2 acknowledged the required documentation was not available for review.

Based on record review and interview for two of two sample directed care resident records, the manager failed to obtain the following documentation: documentation reflecting that the resident or resident's representative requested that the resident reside in the facility and a signed and dated statement from a medical practitioner indicating that the resident's needs can be met by the facility as per their scope of services. Findings include: 1. During an interview, E2 indicated that R2 was non-ambulatory, has not walked since their date of acceptance and cannot walk even when assisted. 2. The resident's record did not contain a request from the resident or their representative to remain in the facility or a statement from the medical practitioner that the resident's needs can be met as per the facility's scope of services. Based on the resident's date of acceptance this documentation was required. 3. During an interview, E2 acknowledged that the required documentation was not in the resident's record. This is a repeat deficiency from the compliance inspection conducted on November 2, 2022.

Based on observation and interview, the manager failed to ensure that a current drug reference guide was available for use by personnel members. Findings include: 1. The drug reference guide available for review was the Nursing Drug Handbook, copyright date 2022. 2. The Internet web site for the drug reference guide revealed that a more current edition was available for distribution. 3. During an interview, E2 stated, "That's the most current one I can find."

Based on observation and interview, the manager failed to ensure that a current toxicology reference guide was available for use by personnel members. Findings include: 1. The toxicology guide available for use by personnel members was the Toxicology Handbook, 3rd. edition. 2. The Internet web site for the toxicology guide revealed that a more current edition was available for distribution. 3. During an interview, E2 acknowledged that a current toxicology reference guide was not available for use by personnel members.

Based on documentation review and interview, the chief administrative officer failed to ensure that the health care institution establishes, documents, and implements tuberculosis infection control activities that are consistent with recommendations in Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019, published by the U.S. Department of Health and Human Services, Atlanta, GA 30333, available at https://www.cdc.gov/mmwr/volumes/68/wr/mm6819a3.htm, incorporated by reference, on file with the Department, and including no future editions or amendments and include the information required in subsections 2. a. - f. of this rule. Findings include: 1. Review of facility policies and procedures failed to reveal documentation indicating that the health care institution had established and documented tuberculosis infection control activities. 2. During an interview, E2 acknowledged that the required documentation was not available for review.

Based on record review and interview, the chief administrative officer failed to ensure that the health care institution established, documented, and implemented tuberculosis infection control activities that included annually providing training and education related to recognizing the signs and symptoms of tuberculosis (TB) to individuals employed by the health care institution. Findings include: 1. Review of the record for E1 failed to reveal documentation indicating that annual training related to recognizing the signs and symptoms of TB had been completed. No TB training documentation was available for review. 2. Review of the record for E2 failed to reveal documentation indicating that annual training related to recognizing the signs and symptoms of TB had been completed. No TB training documentation was available for review. 3. Review of the record for E4 failed to reveal documentation indicating that annual training related to recognizing the signs and symptoms of TB had been completed. No TB training documentation was available for review. 4. During an interview, E2 acknowledge that the required documentation was not available.

Based on documentation review and interview, the chief administrative officer failed to ensure that the health care institution establishes, documents, and implements tuberculosis infection control activities that included annually assessing the health care institution's risk of exposure to infectious tuberculosis. Findings include: 1. Review of facility documentation failed to reveal an annual assessment of the health care institution's risk of exposure to infectious tuberculosis. 2. During an interview, E2 acknowledged that the required documentation was not available for review.