Assisted Living Amber Hills, LLC

Based on record review and interview, the manager failed to ensure a personnel record included documentation of evidence of freedom from infectious tuberculosis (TB), for one of three personnel members sampled. The deficient practice posed a risk as the Department was provided false or misleading information. Findings include: 1. A review of E2's personnel record revealed E2 was hired as a caregiver. The personnel record revealed documentation of evidence of freedom from infectious TB (dated in April 2022) dated and signed by a registered nurse and E1. 2. A review of E2's personnel record revealed documentation of evidence of freedom from infectious TB (dated in April 2023) dated and signed by a registered nurse and E1. The documentation appeared to be a photocopy of the April 2022 TB documentation. The documentation appeared to have a mark at the end of "2022" to appear as "2023." 3. In an interview, E1 reported E1 did not sign E2's documentation of evidence of freedom from infectious TB (dated in April 2023). E1 reported the documentation appeared to be a photocopy of the documentation from April 2022. E1 reported the documentation appeared to have a mark at the end of "2022" to appear as "2023." 4. In an interview, E1 reported E1 had an employee who reviewed and maintained records for the facility. E1 reported this employee may have been the individual who created the aformentioned TB documentation for E2 dated in April 2023. 5. In an interview, the findings were reviewed with E1 and no additional comments or statements were provided regarding the findings.

Based on documentation review, record review, and interview, the manager failed to ensure there was a documented residency agreement with the assisted living facility, for six of six current residents sampled. Findings include: 1. A review of Department documentation revealed a change of ownership from AL11002 to AL12041 on November 4, 2021. 2. A review of Department documentation revealed a letter sent to the licensee on November 4, 2021. The letter stated "due to the change in ownership, Residency Agreements for any current resident(s) must be updated to reflect the agreement between the new licensee and the resident(s)." 3. A review of R1's medical record revealed a residency agreement (dated in 2019) between R1 and AL11002. However, an updated residency agreement between R1 and AL12041 was not available for review. 4. A review of R2's medical record revealed a residency agreement (dated in 2021) between R2 and AL11002. However, an updated residency agreement between R2 and AL12041 was not available for review. 5. A review of R2's medical record revealed a document titled "Residency Agreement Addendum" (dated August 18, 2023) to R2's residency agreement between R2 and AL11002, dated in 2021. The document stated "[R2] will remain in the Assisted Living home, ... as a resident of Amber Hills Assisted Living. It agreed and understood the increased service fee is ... The fee includes the following services ... Any cost incurred out side of these services will be invoiced to ... Manager will notify ... prior to paying for any supplies requested or deemed necessary." However, an updated residency agreement between R2 and AL12041 to include the requirements in R9-10-807(D)(2)(a)(4)(5)(6)(7)(8)(9) was not available for review. 6. A review of R3's medical record revealed a residency agreement (dated in 2020) between R3 and AL11002. However, an updated residency agreement between R3 and AL12041 was not available for review. 7. A review of R4's medical record revealed a residency agreement (dated in 2020) between R4 and AL11002. However, an updated residency agreement between R4 and AL12041 was not available for review. 8. A review of R5's medical record revealed a residency agreement (dated in 2020) between R5 and AL11002. However, an updated residency agreement between R5 and AL12041 was not available for review. 9. A review of R6's medical record revealed a residency agreement (dated in 2021) between R6 and AL11002. However, an updated residency agreement between R6 and AL12041 was not available for review. 10. In an interview, E1 reported to be unaware residency agreements were to be updated. E1 reported E1 would honor the previous residency agreements between residents and AL11002. 11. In an interview, E1 acknowledged R1's, R2's, R3's, R4's, R5's, and R6's residency agreements were not between R1 and AL12041, between R2 and AL12041, between R3 and AL12041, between R4 and AL12041, between R5 and AL12041, and between R6 and AL12041 .