Diamond Quality Assisted Living Care Home

Based on documentation review, record review, and interview, for one resident reviewed, the manager failed to implement the facility's incident reporting policy. The deficient practice posed a risk to the health and safety of residents if incident reporting policies and procedures were not implemented, and documentation of incident reports did not include all relevant information, notifications, and actions implemented to prevent recurrence. Findings include: 1. In documentation review, a facility policy titled, "Quality Management Program, including incident reports," documented, "... In order to provide quality and safe services to the ... residents, the manager shall ensure ... Facility personnel will document and evaluate incidents at the facility to ensure adequate quality of services provided... Caregivers... will report to the Manager any incidents may occur while assisting residents with their ADLs or providing residents with activities... The manager will notify resident representative, primary care provider, case manager, if applicable, and document and proceed to updating resident's service plan, if needed... The individual reporting the incident ... will cause a "Report of Unusual Occurrence" and follow all instructions and corrective actions specified in the report... The reports of unusual occurrence will be reviewed and signed by the manager, further instructions and corrective criticism will be give to the employee handling the incident, if needed..." 2. In documentation review, the Department received a report related to R1's falls and bruising, which documented, "sustained bruising to ... face due to ... "walking into a wall." 3. In record review for R1, a Hospice visit note dated December 1, 2023 (Thursday) , documented, "... cg reports new bruise above to left eyebrow since Monday morning (November 29, 2023). They noticed when pt woke up, ... must have hit ... face on the bed..." A Hospice note dated December 13, 2023, documented, "... E1 advised R1 is exhibiting signs of UTI with foul smelling urine that is cloudy..." A Hospice note dated January 17, 2024, documented, "... Biopsy taken came back as basal carcinoma and treatment had been started..." 4. In record review, the facility did not have any incident reports for R1. 5. During an interview, O1 reported [O1], during a visit to the facility, found R1 with a "big bruise" on the forehead, and asked the caregiver (name unknown) who did not respond. O1 reported [O1] is R1's POA and was not contacted about the bruise. A few weeks later, O1 observed R1 had a scrape on head and was told R1 "fell out of bed or ran into a wall." O1 reported [O1] had requested to be notified of incidents involving R1; however, was not notified of either incident. 6. During an interview, O2 reported [O2] was not notified of R1's incidents. 7. During an interview, the findings were reviewed with E1, who acknowledged the facility did not have incident reports for R1. E1 and E2 reported being unaware R

Based on documentation review, record review, and interview, for one resident reviewed, the administrator failed to report and document an allegation of exploitation, according to Arizona Revised Statutes (A.R.S.) \'a7 46-454. The deficient practice posed a risk as the Department was unable to assess if there was an immediate health and safety concern for residents who resided in the assisted living facility. Findings include: 1. A.R.S. \'a7 46-454(A) states: " 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.." 2. Arizona Administrative Code (A.A.C.) R9-10-101(110) states "Immediate" means "without delay." 3. In documentation review, the Department received a report, which documented, "...there have been charges to the patients credit card that were not approved and have been traced back to the Fry's Grocery store. ... able to confirm that a second patient's name had been added to the account that is attached to R1's Fry card and charges have been made..." 3. In record review, R1's medical record (received directed care services) did not include documentation of the reported allegation, the facility's investigation, and the required reporting per A.R.S. \'a7 46-454. 4. During an interview, E1 reported O1 informed [E1] of the allegation related to R1's credit card on file at Fry's. E1 reported the facility refilled R1's medications at Fry's pharmacy, using R1's credit card on file. E1 reported being unaware of another resident being added to the credit card account. E1 reported the allegation, made by O1, was investigated; however, the facility did not have documentation of the suspected exploitation; any action taken according to subsection (J)(1); the report required, in subsection (J)(2); documentation of an investigation, the dates, times, and description of the alleged exploitation, etc.

Based on record review, and interview, for one assistant caregiver reviewed, the manager failed to ensure an assistant caregiver's skills and knowledge were verified and documented before the assistant caregiver provided physical health services or behavioral health services, and according to policies and procedures. The deficient practice posed a health and safety risk to residents, if an assistant caregiver did not have the documented skills and knowledge to provide care and services for a resident. Findings include: 1. In observation, E3 was observed at the facility during the inspection. E3 was observed preparing the lunch meal, going in and out of resident rooms, and applying lotion to a resident's ankle and legs. 2. During an interview, E1, E2, and E3 reported E3 was a cook. 3. In documentation review, the facility's staffing schedules for December, 2023, and January, and February 2024, documented E3 worked five days a week as a cook, on the day shift. 4. In record review, E3's personnel record included a job description titled, "Environmental Services personnel qualifications," and documented, "...The housekeeper... has qualifications, skills, and knowledge required to provide this service.. does not provide any type of assistance to the residents...." 5. In record review, E3's personnel record did not include documentation of the verification of E3's skills and knowledge. 6. During an interview, E1 acknowledged E3 was observed providing direct care services to a resident, and E3's personnel record did not include documentation E3 had the skills and knowledge required, to provide health services to a resident. 7. This is a repeat deficiency from the Complaint Investigation conducted on December 19, 2022.

Based on observation, record review, documentation review, and interview, for one assistant caregiver reviewed, the manager failed to ensure that before providing assisted living services, a caregiver or assistant caregiver received orientation specific to the duties to be performed by the caregiver. The deficient practice posed a health and safety risk to residents if a caregiver did not receive the required orientation. Findings include: 1. In observation, E3 was observed working at the facility, during the inspection. E3 was observed preparing the lunch meal, going in and out of resident rooms, and applying lotion to a residents ankle and legs. 2. During an interview, E1, E2, and E3 reported E3 was a cook. 3. In documentation review, the facility's staffing schedules for December, 2023, January, and February 2024, documented E3 worked five days a week as a cook, on the day shift. 4. In record review, E3's personnel record included a job description titled, "Environmental Services personnel qualifications," and documented, "...The housekeeper... has qualifications, skills, and knowledge required to provide this service.. does not provide any type of assistance to the residents...." 5. In record review, E3's personnel record did not include documentation of orientation. 6. During an interview, E1 acknowledged E3 was observed providing services to a resident, and E3's personnel record did not include orientation specific to the duties to be performed.

Based on observation, record review, and interview, for one of three caregivers reviewed, the manager failed to ensure a caregiver provided documentation of cardiopulmonary resuscitation training (CPR) certification specific to adults which included a demonstration. The deficient practice posed a health and safety risk to residents if caregivers did not have CPR training which included a demonstration of the employee's ability to perform CPR. Findings include: 1. In observation, E2 was the only caregiver working on site, with 10 residents. 2. In record review, E2's personnel record included documentation of CPR certification, dated December 26, 2022, from NationalCPRFoundation, which was an online-only training program, and did not include a demonstration. 3. During an interview, E2 reported the CPR training was obtained online. E1 acknowledged E2's CPR training was online, and did not include a demonstration of the employee's ability to perform CPR.

Based on observation, record review, and interview, for one resident reviewed, who was unable to walk, even with assistance, the manager failed to ensure the resident's primary care provider (PCP) or other medical practitioner (MP) examined the resident every six months, reviewed the facility's scope of services, and signed and dated a determination stating the resident's needs were being met by the facility. The deficient practice posed a health risk to a resident if a resident's condition was not reviewed by a PCP or MP, to approve a resident's stay at the facility. Findings include: 1. In observation, R1 was observed sitting on the sofa in the common area, with eyes closed. 2. In record review, R1's medical record included documentation R1 received directed care services, and was unable to walk. R1's medical record included a signed and dated determination, dated June 20, 2023; which documented R1 "is confined to wheelchair/bed..." however, the record did not include a signed and dated determination by the MP, since June 20, 2023, and every six months. 3. During an interview, E1 and E2 reported R1 was still unable to walk, even with assistance. E1 reported R1's medical record did not include documentation of a signed and dated determination by the MP, since June 20, 2023, and every six months, as required.

Based on record review and interview, for one resident reviewed, the manager failed to ensure the service plan, for a resident receiving directed care services. included skin maintenance to prevent and treat bruises, injuries, pressure sores, and infections. Findings include: 1. In observation, R1 was observed sitting on the sofa in the common area, with eyes closed. R1 was observed to have small open areas on forehead and on the side of face. 2. During an interview, E1 reported R1 picked and scratched [R1's] skin, and had a skin cancer on the left side of the face near the ear. R1 reported socks were put on R1's hands to prevent scratching of face. 3. In record review, R1's service plan dated November 12, 2023, included documentation R2's skin was "WARM/DRY/INTACT", and did not include documentation of the scratching behavior, skin cancer, and skin maintenance to address these issues. 4. In record review, a Hospice visit note, dated December 1, 2023, documented, "... cg reports new bruise above to left eyebrow since Monday morning. They noticed when pt woke up, ... must have hit ... face on the bed..." Hospice note dated December 13, 2023, documented, "... E1 advised R1 is exhibiting signs of UTI with foul smelling urine that is cloudy..." Hospice note dated January 17, 2024, documented, "... Biopsy taken came back as basal carcinoma and treatment had been started..." 5. During an interview, E1 acknowledged R1's service plan did not include skin maintenance to prevent and treat bruises, injuries, pressure sores and infections.