Best Care Home of Moon Valley, LLC

Based on documentation review, observation, record review, and interview, for one of four caregivers and assistant caregivers reviewed, the manager failed to ensure an employee provided evidence of freedom from infectious tuberculosis (TB), as required by R9-10-113. The deficient practice posed a potential health and safety risk of TB exposure to residents and staff. 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. A review of the Centers for Disease Control and Prevention website revealed a web page titled, "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005." The web page stated, "If TST (Mantoux Skin Test) is used for baseline testing, two-step testing is recommended for HCWs (Health Care Workers) whose initial TST results are negative. If the first-step TST result is negative, the second-step TST should be administered 1-3 weeks after the first TST result was read." 3. In observation, E6 was observed working at the facility during the inspection. 4. In record review, E6's personnel record (hired as an assistant caregiver on March 25, 2024), included documentation of a negative TB skin test on hire; however, the record did not include documentation of a second negative TB test. 5. In documentation review, the staffing schedule for October 2024, included documentation E6 worked day shifts at the facility. 6. During an interview, E1 and E2 acknowledged E6's personnel record did not include documentation E6 provided evidence of freedom from TB, as required by R9-10-113.

Based on record review and interview, for one of two residents reviewed, the manager failed to ensure documentation of medication administration included the the name and signature of the individual administering medication. The deficient practice posed a health and safety risk to a resident if the facility did not properly document medication administration for a resident. Findings include: 1. In record review, R1's medication administration record (MAR), dated October 2024, included documentation R1 received Losartan Potassium, Nitrofurantoin, Senna, Aspirin, Acetaminophen, Divalproex, Sodium Chloride, Mirtazapine and Trazadone medications daily, as ordered. The medication administration record did not include the name of the individuals who administered the medications. 2. During an interview, E1 reported E1 and E4 administered the medications to R1. E1 and E2 acknowledged the documentation of medication administration did not include the names of the individuals administering medications.

Based on documentation review, record review, and interview, the administrator failed to ensure suspected abuse, neglect, or exploitation was reported according to A.R.S. \'a7 46-454. The deficient practice posed a risk as the facility did not immediately report suspected abuse of a resident, by an personnel member. Findings include: A.R.S. \'a7 46-454(A) states 46-454. Duty to report abuse, neglect and exploitation of vulnerable adults; duty to make medical records available; violation; classification A. A health professional, emergency medical technician, home health provider, hospital intern or resident, speech, physical or occupational therapist, long-term care provider, social worker, peace officer, medical examiner, guardian, conservator, fire protection personnel, developmental disabilities provider, employee of the department of economic security or other person who has responsibility for the care of a vulnerable adult and who has a reasonable basis to believe that abuse, neglect or exploitation of the adult has occurred shall immediately report or cause reports to be made of such reasonable basis to a peace officer or to the adult protective services central intake unit. The guardian or conservator of a vulnerable adult shall immediately report or cause reports to be made of such reasonable basis to the superior court and the adult protective services central intake unit. All of the above reports shall be made immediately by telephone or online.." D. Reports pursuant to subsections A and C of this section shall contain: 1. The names and addresses of the adult and any persons having control or custody of the adult, if known. 2. The adult's age and the nature and extent of the adult's vulnerability. 3. The nature and extent of the abuse, neglect or exploitation. 4. Any other information that the person reporting believes might be helpful in establishing the cause of the abuse, neglect or exploitation. E. Any person other than one required to report or cause reports to be made in subsection A or C of this section who has a reasonable basis to believe that abuse, neglect or exploitation of a vulnerable adult has occurred may report the information to a peace officer or to the adult protective services central intake unit. R9-10-101.110 states "Immediate" means without delay. 1. In record review, a facility "Incident/Accident Report," documented on April 11, 2023, R1 was sitting in a recliner, screamed and stated being hit, while a male resident was observed standing next to R1. R1 was observed to have a bruise and a swelling size of a quarter on the left forehead. The report did not include documentation of notification to a peace officer or to adult protective services. The report did not include documentation of the person present during the incident who observed R1 and R2 immediately following the incident. The report did not include the nature and extent of the adult's vulnerability. 2. In documentation review, the facility provided docu