Brookdale Chandler Ray Road

Based on record review, documentation review, and interview, the manager failed to ensure a caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services, and according to policies and procedures, for one caregiver reviewed. The deficient practice posed a health and safety risk to residents if a caregiver did not have the documented skills and knowledge to provide care and services for a resident. Findings include: 1) A review of the facility's policies and procedures revealed a policy titled "Caregivers Job Descriptions, Duties and Qualifications." This policy stated, "A caregiver's or assistant caregiver's skills and knowledge are verified and documented." 2) A review of E3's personnel record revealed a hire date of October 30, 2020. E3's record revealed no documentation verifying E3's skills and knowledge. 3) In an interview, E1 acknowledged verification of E3's skills and knowledge was not documented before services were provided.

Based on record review and interview, the manager failed to ensure a resident's medical record contained documentation of the resident's orientation to exits from the assisted living facility, for four of five sampled residents. The deficient practice posed a risk if a resident was unaware of the evacuation path to be used in an emergency. Findings include: 1. A review of R1, R2, R3, and R5's medical records revealed documentation of the resident's orientation to exits from the assisted living facility was not available for review at the time of inspection. 2. In an interview, E1 acknowledged R1, R2, R3, and R5's medical records did not contain documentation of the resident's orientation to exits from the assisted living facility at the time of the inspection.

Based on documentation review, record review, and interview, the governing authority failed to make a documented good faith effort to contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in the facility, for three out of five employees reviewed. The deficient practice posed a safety risk to residents. Findings include: 1) A.R.S. § 36-411(C) states: "C. Owners shall make documented, good faith efforts to: 1. Contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in a residential care institution, nursing care institution or home health agency. 2) A review of the personnel records for E2 (hired September 2024), E3 (hired October 2020), and E4 (hired December 2024) did not include documentation a good faith effort was made to contact previous employers. 3) In an interview, E1 acknowledged the facility did not have documentation that a good faith effort was made to contact previous employers, as required.

Based on documentation review, record review, and interview, the manager failed to ensure a resident provided evidence of freedom from infectious tuberculosis (TB) as specified in R9-10-113, for one of five residents sampled. The deficient practice posed a 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. A review of R1's medical record revealed no documentation of a risk assessment of prior exposure to infectious TB or a determination if R1 had signs or symptoms of TB. Based on R2's date of acceptance, this documentation was required. 3. In an interview, E1 acknowledged R1's medical record did not include documentation of a risk assessment of prior exposure to infectious TB or a determination if they had signs of symptoms of TB.