Dikal 1031 LLC - Clinton Home

Based on documentation review, observation, and interview, for a facility that 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 risk if the facility was unaware of the general or specific whereabouts of a resident. Findings include: 1. A review of the license issued by the Department revealed the facility was licensed at the directed care level. 2. In observation, the facility had seven residents on site. 3. The Compliance Officer observed the front door had a non working alarm. The caregiver attempted to turn the alarm on, to no avail. A door exiting to the back patio had an alarm that was turned off. The alarm was turned on during the inspection. 4. In an interview, E1 acknowledged the front door alarm and the patio door alarm were both not working at the time of the inspection. The back door alarm was able to be turned on; however, the caregiver was unable to turn on the front door alarm and acknowledged the exits were required to control or alert the employees of the egress of a resident from the facility.

Based on record review and interview, for one of four employees reviewed, the governing authority failed to ensure an employee had a valid fingerprint clearance (FP) card, or submitted a completed application to the department of public safety, within twenty working days of employment. The deficient practice posed a risk to residents, if the facility did not ensure a caregiver had a valid fingerprint clearance card. 36-411. Residential care institutions; nursing care institutions; home health agencies; fingerprinting requirements; exemptions; definitions. A. Except as provided in subsections F, G, H and I of this section, as a condition of licensure or continued licensure of a residential care institution, a nursing care institution or a home health agency and as a condition of employment in a residential care institution, a nursing care institution or a home health agency, employees and owners of residential care institutions, nursing care institutions or home health agencies or contracted persons or volunteers who provide medical services, nursing services, behavioral health services, health-related services, home health services or supportive services and who have not been subject to the fingerprinting requirements of a health professional's regulatory board pursuant to title 32 shall have valid fingerprint clearance cards that are issued pursuant to title 41, chapter 12, article 3.1 or shall apply for a fingerprint clearance card within twenty working days of employment or beginning volunteer work. D. An employee, an owner, a contracted person or a volunteer or a facility on behalf of the employee, the owner, the contracted person or the volunteer shall submit a completed application that is provided by the department of public safety within twenty days after the date the person begins work or volunteer service. Findings include: 1. In record review, E4's personnel record included documentation of a FP clearance card which expired on March 13, 2024. The record included a receipt from the Arizona Department of Public Safety (DPS), dated June 13, 2024, for payment (from E4) for application fees for fingerprint clearance. 2. In documentation review, the DPS website indicated DPS received an application from E4, on June 13, 2024, with status documented as, "Waiting on Applicant Fingerprints." 3. During an interview, E1 reported E4 worked the night shift (alone) as a caregiver, from 7:00am - 7:00pm, since approximately July 6, 2024, while another caregiver was on vacation. 4. During a initial licensing inspection, conducted on July 2, 2024, E4's personnel record was reviewed, and included an expired FP card, which was reviewed with E5 and E6. E6 reported E4 was changed to an assistant caregiver, and did not provide direct care services, until E4 received a valid FP clearance card. 5. During an interview, E5 reported being unaware E4 continued to work at the facility, as a caregiver, and acknowledged E4's FP clearance application was incomplete, an

Based on observation, record review and interview, for one resident reviewed, the manager failed to ensure a resident had a written service plan that was reviewed and updated after a significant change in the resident's condition. The deficient practice posed a risk to a resident if the service plan did not include a description of the resident's condition, and services required. Findings include: "Service plan" means a written description of a resident's need for supervisory care services, personal care services, directed care services, ancillary services, or behavioral health services and the specific assisted living services to be provided to the resident. 1. In observation, R1 was observed sleeping in bed. R1 had several bruises on the face/head, and a bandage on the foot. R1's legs appeared swollen. 2. In record review, R1's medical record included a service plan, dated February 5, 2024, (received personal care and medication administration services). The service plan documented "thin frail skin... no open wounds..." 3. In record review, R1's medical record included a progress note, dated June 24, 2024, "[R1] has a blister that opened on ... left outer heel reported to manager and cleaned and bandaged it. A progress note dated June 25, 2024, "... [R1's] bottom sore looks the same I put cream... [R1] get up at 5am. 4. In record review, R1's medical record indicated R1 received Hospice services on approximately June 2, 2024. Hospice notes included the following documentation: "6/20... Pt comfortable... +3 edema to legs, denies pain... elevate legs fro edema... 2 m briefs, steri strips... wound cleanser, gauze, triple abx ointment left bedside..." "7-02-24... vitals, pain assessments, wound care... Instructions given to E4 regarding pain management and wound "7/8/24... assessment completed, wound care provided to coccyx and L heal. wound supplies left bedside... cut socks if cutting into skin... pain management. "7/12... pt hospitalized 48h ago... comfortable, Bruising generalized. Baseline orientation. Fatigued... "7-14-24... Wound care, wound now tunneled. Instructions to change soiled wound patch. Tramadol requested..." 5. During an interview, the findings were reviewed with E1 and E5, who acknowledged R1's service plan was not updated with R1's change of condition.

Based on documentation review, record review, and interview, for one resident reviewed, the manager failed to ensure when a resident had an accident, emergency, or injury resulting in the resident needing medical services, a caregiver documented the date and time of the incident, a description of the accident, emergency or injury, the names of individuals who observed the incident, the actions taken by the caregiver, the individuals notified by the caregiver, and any action taken to prevent the incident from occurring in the future. The deficient practice posed a risk if the facility did not document an accident, emergency, or injury, as required, to ensure the health and safety of residents. Findings include: 1. In documentation review, a facility policy titled, "Resident Care Events/Incident Reporting & Investigation," documented, "... Spectrum Retirement Communities, LLC... recognizes the importance of reporting accidents and incidents as an integral part of its risk identification and risk management strategy's as well as quality assurance and process improvement.... is committed to improving the quality of care and safety of residents... through the consistent monitoring and review of incidents that result, or had the potential to result in injury, damage or other loss. The community will investigate any incidents involving residents or visitors to determine the cause of the incident. The Incident Report must be filled out with accurate information after an incident has happened and immediately after the person involved in the incident is safe. The investigation and conclusions shall be completed within 3 days.... The DON or ED must document what was observed and report on the INCIDENT REPORT FORM. a. Complete the INCIDENT REPORT in the Electronic Health Record (HER). The DON or Wellness Nurse will evaluate the resident after the incident has occurred... All incidents involving Residents require an evaluation within 3 business days of the incident... Document any communication with the Resident or resident representative in the EHR." 2. In documentation review, the Department received a report, which documented, "... R1 was seen by ... mobile doctor ... saw that ... right ear was severely bruised, swollen, cut and infected. Prescribed drops for infection... nobody on staff notified , ... medical (POA)... visit in the afternoon, ... discovered... injury... was concerned about the swelling in the inner area near the ear opening. The bruising went down... neck a few inches too. ... (POA) took ... to urgent care..." 3. During an interview, O2 reported O1 visited the facility on May 31, 2024, and observed R1 had bruising of the head and neck area, and requested O2 come to the facility to see R1. O2 went to the facility and saw R1 had a bruise on ear, that was swollen and cut, and the bruise was down through R1's neck. O2 reported it looked like a trauma injury; however, didn't know what happened. O2 took R1 to urgent care for treatment. O2 spoke

Based on observation, record review, interview, and documentation review, a person established, conducted, and maintained a health care institution without a current and valid license issued by the Department. The deficient practice posed a risk as the unlicensed operation or maintenance of a health care institution is prohibited and is declared a nuisance inimical to the public health and safety, per A.R.S. \'a7 36-430. Findings include: 1. Based on observation, during an initial licensure inspection, the Compliance Officer observed nine residents, one caregiver, and one assistant caregiver, were present at the facility. The residents were observed receiving assisted living services, provided by the caregivers. 2. In record review, the facility had medical records for R1 (received Personal care services), R2 (received Directed care services), R3 (received Personal care services), R4 (received Personal care services), R5 (received Directed care services), R6 (received Directed care services), R7 (received Personal care services), R8 (received Personal care services), and R9 (received Directed care services). 3. In documentation review, the Department received an application for licensure, from the facility, on December 26, 2023; however, the application was withdrawn due to unmet time frames. The Department received another application for licensure from the from the facility on April 25, 2024, for which an administrative complete letter was sent to the facility on May 3, 2024. 4. During an interview, E1 and E2 acknowledged nine residents were present on site at the facility, and received assisted living services. O1 reported the facility ownership changed approximately one year ago, and the new owners continued to provide services for the residents at the facility, and accepted new residents. E1 and E2 acknowledged the facility was operating a HCI without a current and valid license issued by the Department.