Daisy Miller Adult Foster Care Home

Based on record review and interview, the manager failed to ensure that a caregiver provided evidence of freedom from infectious tuberculosis on or before the date the individual began providing services at or on behalf of the assisted living facility and as specified in R9-10-113. Findings include: 1. R9-10-113- "A health care institution’s chief administrative officer shall: 1. For an individual for whom baseline screening and documentation of freedom from infectious tuberculosis is required by an Article in this Chapter, as specified in subsection (A)(2)(a), obtain one of the following as evidence of freedom from infectious tuberculosis: a. b. c. 2. Documentation of a negative Mantoux skin test or other tuberculosis screening test that: i. Is recommended by the U.S. Centers for Disease Control and Prevention (CDC), ii. iii. Was administered within 12 months before the date the individual begins providing services at or on behalf of the health care institution or is admitted to the health care institution, and.." 2. The Centers for Disease Control website states, "If the Mantoux tuberculin skin test (TST) is used for baseline testing of health care personnel, use two-step testing." 3. A record review of E2's personnel record revealed a document titled "PERMISSION TO ADMINISTER PPD SKIN TEST TUBERCULOSIS SKIN TEST (PPD-MANTOUX METHOD)". The document showed that a skin test was completed, but no second test was done. 4. In an interview, E1 acknowledged that E2 did not have the second skin test and was not aware of that rule.

Based on record review and interview, the manager failed to ensure that a resident provided evidence of freedom from infectious tuberculosis before or within seven calendar days after the resident’s date of occupancy, with a screening and risk assessment. Findings Include: 1. R9-10-113: "A health care institution’s chief administrative officer shall: 1. For an individual for whom baseline screening and documentation of freedom from infectious tuberculosis is required by an Article in this Chapter, as specified in subsection (A)(2)(a), obtain one of the following as evidence of freedom from infectious tuberculosis: a. b. c. 2. Documentation of a negative Mantoux skin test or other tuberculosis screening test that: i. Is recommended by the U.S. Centers for Disease Control and Prevention (CDC), ii. iii. Was administered within 12 months before the date the individual begins providing services at or on behalf of the health care institution or is admitted to the health care institution, and Includes the date and the type of tuberculosis screening test;" 2. A record review of R1 and R2 revealed no sign/symptom screening and risk assessment. Based on the residents' dates of acceptance, this documentation was required. 3. In an interview, E1 acknowledged R1 and R2 did not have evidence of freedom from infectious tuberculosis before or within seven calendar days after the resident’s date of occupancy, and as specified in R9-10-113. This is a repeat deficiency from the compliance inspection conducted on September 20, 2023.

Based on 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 two of two residents sampled. The deficient practice posed a TB exposure risk to residents. Findings include: 1. A review of R1's (admitted in June 2022) medical record revealed a chest x-ray dated in June 2022. The chest x-ray stated "negative for TB." However, there was no evidence R1 had a history of a positive skin test or other TB screening test recommended by the Centers for Disease Control and Prevention (CDC). 2. A review of R2's (admitted in September 2023) medical record revealed a chest x-ray dated in January 2023. The chest x-ray stated "negative for TB." However, there was no evidence R2 had a history of a positive skin test or other TB screening test recommended by the Centers for Disease Control and Prevention (CDC). 3. In an interview, E1 acknowledged R1 and R2 did not provide current documentation of freedom from infectious TB in compliance with R9-10-113.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance of an individual, the individual submitted documentation dated within 90 calendar days before the individual was accepted by the assisted living facility to include whether the individual required continuous medical services, continuous nursing services, intermittent nursing services or restraints; signed and dated by a physician, registered nurse practitioner, registered nurse or physician assistant, for one of two residents sampled. Findings include: 1. A review of R1's (admitted in 2022) medical record revealed a document titled "Determination form". However, the document was dated nine calendar days after R1's admission. 2. In an interview, E1 acknowledged the above mentioned document was not completed within 90 calendar days before R1 was accepted.