Chaparral Home Care

Based on record 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, for one of three caregivers sampled. The deficient practice posed a risk if the caregivers were unable to meet a resident's needs. Findings include: 1. Review of E5's personnel record revealed E5 worked as a caregiver and had a hire date of November 8, 2023. 2. Review of E5's personnel record revealed a document titled "Employment Orientation Checklist" showing that the following skills and knowledge had not been reviewed or verified: -"submit a complaint related to resident care"; -"Cardiopulmonary resuscitation (CPR) and first aid (FA) training [...]"; -"First Aid Training"; -"Staffing and recordkeeping"; -"the provision of ALH services [...]"; -"Cover health care directives"; -"Cover assistance in the self administration of medication, and medication administration". 3. In an interview, E2 reported that E5 had been hired as a cook while working on a caregiver certification, then promoted to caregiver when E5 was certified, and that E3 forgot to verify the skills and knowledge related to the caregiver position at the time of the promotion. E2 acknowledged that the manager failed to ensure that caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services.

Based on observation, record review, and interview, for one of three residents reviewed, the manager failed to ensure a resident's written service plan included the amount, type, and frequency of assisted living services being provided to the resident. The deficient practice posed a risk to the health and safety of a resident if a caregiver was unaware of the services to be provided to a resident. Findings include: 1. In observation, R2 was observed to have a foley catheter. 2. In record review, R2's medical record included documentation of a physician's order, dated November 25, 2023, for an "indwelling foley catheter..." R2's service plan did not include the amount, type, and frequency of foley catheter services provided for R2. 3. During an interview, E1 reported R2 had a foley catheter, and the caregivers provided services including cleaning, and changing the catheter bag, as needed. E1 acknowledged R2's service plan did not include the amount, type, and frequency of services provided for R2.

Based on record review and interview, for two of three residents reviewed, and receiving medication administration services, the manager failed to ensure a resident's medical record included the time of medication administration. The deficient practice posed a health and safety risk to a resident if the time of medication administration was not documented. Findings include: 1. In observation, R1 had Oxycodone medication (a schedule II controlled substance) and Lorazepam medication (a schedule IV controlled substance) stored by the facility. R2 had Tramadol medication (a schedule IV controlled substance) and Lorazepam medication stored by the facility. . 2. In record review, R1's medical record (received personal care and medication administration services) included a medication order for Oxycodone 10mg, po PRN every 4 hours, and a medication order for Lorazepam 1mg PO PRN. R1's medication administration record (MAR), dated January 2024, included documentation R1 was administered the Oxycodone medication once daily, and the Lorazepam medication on seventeen days in January 2024. The medication administration record did not include the times the medications were administered to R1. . 3. In record review, R2's medical record (received directed care and medication administration services) included a medication order for Lorazepam 0.5ml po PRN, and Tramadol 50mg PO PRN. R2's MAR, dated January 2024, included documentation R2 was administered the Tramadol medication January 11, through 30, 2024, and the Lorazepam medication eight days in January, 2024. The MAR did not include the times the medications were administered to R2. 4. In documentation review, a facility policy which covered medications, on page 21, documented, "... 25. Medication administration records will be filled by the authorized personnel that are doing medication administration... after observing the resident taking the medication. Time and date will be recorded ..." 5. During an interview, E1 acknowledged the residents' medication administration records did not include the time the PRN medications were administered to the residents.

Based on observation and interview, for the facility which provided directed care services, the manager failed to ensure there was a means of exiting the facility that provided access to an outside area which controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a health and safety risk to residents as an unlocked door provided access to the outside and street area, without alerting employees. Findings include: 1. In observation, the compliance officer observed nine residents resided at the facility. 2. Department documentation revealed the facility was licensed at the directed level of care. 3. During an environmental inspection, the compliance officer observed an unlocked door, in a hallway by resident bedrooms, which exited to the backyard. The door did not control or alert employees of the egress of a resident from the facility. A side yard gate was not locked, and allowed exit to the front of the house and the street. 4. During an interview, E1 acknowledged the door which allowed exit to the backyard did not have an alarm, and the side yard gate, which exited to the street, did not alert employees of the egress of a resident.

Based on observation, record review, documentation review, and interview, for two of three residents reviewed, who received a controlled substance, the manager failed to ensure policies and procedures were implemented for inventorying controlled substances. The deficient practice posed a risk if controlled substances were not inventoried and accounted for by the facility. Findings include: 1. In observation, R1 had Oxycodone medication (a schedule II controlled substance) and Lorazepam medication (a schedule IV controlled substance) stored by the facility. R2 had Tramadol medication (a schedule IV controlled substance) and Lorazepam medication stored by the facility. 2. In record review, R1's medical record (received personal care and medication administration services) included a medication order for Oxycodone 10mg, po PRN every 4 hours, and a medication order for Lorazepam 1mg PO PRN. R1's medication administration record (MAR), dated January 2024, included documentation R1 received the Oxycodone medication once daily, and the Lorazepam medication on seventeen days in January 2024. R1's record did not include documentation of an inventory of the controlled substances. 3. In record review, R2's medical record (received directed care and medication administration services) included a medication order for Lorazepam 0.5ml po PRN, and Tramadol 50mg PO PRN. R2's MAR, dated January 2024, included documentation R2 was administered the Tramadol medication January 11 through 30, 2024, and the Lorazepam medication eight days in January, 2024. R2's record did not include documentation of an inventory of the controlled substances. 4. In documentation review, a facility policy which covered medications, on page 21, documented, "... Controlled Substances: ... b. The manager will check weekly the inventory of the controlled substance medications..." 5. During an interview, E1 acknowledged the residents were administered controlled substances, and the facility did not maintain an inventory of the controlled substances.

Based on documentation review and interview, the manager failed to ensure an employee disaster drill was conducted on each shift at least once every three months and documented. The deficient practice posed a health and safety risk to residents if the employees were not trained to implement the disaster plan. Findings include: 1. In documentation review, the facility had documentation a disaster drill was last conducted on September 1, 2023, and no further documentation to indicate a disaster drill was conducted on each shift since September 1, 2023. 2. During an interview, E1 reported the facility had two shifts, and acknowledged a disaster drill was not conducted on each shift at least once every three months, as required.

Based on observation, record review, and interview, for two of three residents reviewed, and receiving opioid medication, without an active malignancy or an end of life condition, the manager failed to ensure an individual, authorized to administer opioids, documented in the resident's medical record an identification of the resident's need for the opioid before the opioid was administered, and the monitoring of the effect of the opioid administered. The deficient practice posed a risk to a resident if a resident's pain was not identified, monitored and documented, as required. Findings include: 1. In observation, R1 had Oxycodone medication (a schedule II controlled substance and opioid) stored by the facility. R2 had Tramadol medication (a schedule IV controlled substance and opioid) stored by the facility. . 2. In record review, R1's medical record (received personal care and medication administration services) included a medication order for Oxycodone 10mg, po PRN every 4 hours. R1's medication administration record (MAR), dated January 2024, included documentation R1 was administered the Oxycodone medication once daily. R1's record did not include documentation of an identification of the resident's need for the opioid before the opioid was administered, and monitoring of the effect of the opioid administered. 3. In record review, R2's medical record included a medication order for Tramadol 50mg PO PRN. R2's MAR, dated January 2024, included documentation R2 was administered the Tramadol medication January 11 through 30, 2024. R2's record did not include documentation of an identification of the resident's need for the opioid before the opioid was administered, and monitoring of the effect of the opioid administered. 4. During an interview, E1 reported the residents received opioid medication, and acknowledged the residents' records did not include documentation of an identification of the residents' need for the opioid before the opioid was administered, and monitoring of the effect of the opioid administered.