Family Matters II

Based on record review and interview, the manager failed to ensure that before or at the time of acceptance of an individual, the individual submitted documentation that was dated within 90 calendar days before the individual was accepted by the assisted living facility and included whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, and was dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant for one of two residents sampled. Findings include: 1. A review of R2's medical records revealed no documentation to indicate whether R2 required continuous medical services, continuous or intermittent nursing services, or restraints, dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant. Based on the resident's date of acceptance, this documentation was required. 2. In an interview, E1 acknowledged that the medical record for R2 did not include the required documentation dated within 90 calendar days before R2 was accepted by the assisted living facility.

Based record review, and interview, the manager failed to ensure that within five working days after a resident's acceptance by the assisted living facility, the documented agreement required in subsection (D), was signed by the resident's representative, the resident's legal guardian, or another individual who has been designated by the individual under A.R.S. § 36-3221 to make health care decisions on the individual's behalf, for one of two residents sampled. Findings include: 1. A review of R2's medical record revealed R2 received directed care services. Further review revealed a residency agreement with all required elements. However, the resident agreement was not signed by the resident's representative, the resident's legal guardian, or another individual designated by the resident. 2. In an interview, E1 acknowledged R2's medical records did not include a residency agreement signed by the resident's representative, the resident's legal guardian, or another individual who has been designated by the resident, within five days of R2's acceptance into the facility.

Based on record review, observation, and interview, the manager failed to ensure that there was a means of exiting the facility that controlled or alerted employees of the egress of a resident from the facility. Findings include: 1. During an environmental tour of the facility, the Compliance Officers observed three sliding back doors leading to the back yard. However, none of the doors had a control or alerted employees of the egress of residents from the facility. The facility is licensed for directed care services. 2. In an interview, E1 acknowledged there was no means of exiting the facility that controlled or alerted employees of the egress of a resident from the facility.

Based on documentation review, observation, and interview, the manager failed to ensure a pest control program that complied with A.A.C. R3-8-201(C)(4) was implemented and effective. The deficient practice posed a potential risk to residents. Findings include: 1. R3-8-201.C.4. stated "C. Applicator licensure. 4. An individual may not provide pest management services at a school, child care facility, health care institution, or food-handling establishment unless the individual is a certified applicator in the certification category for which services are being provided." 2. Review of the facility Maintenance log revealed pest control was not documented in the years of 2024 to current day. 3. The Compliance Officers observed a spray bottle of Hot Shot Bed Bug Killer that E1 brought to them. 4. In an interview, E1 acknowledged E1 does the facility’s pest control and E1 reported that he uses the spray bottle mentioned above along the baseboards. E1 reported E1 was not a licensed applicator 5. In an interview, E1 acknowledged the facility did not utilize a pest control program compliant with A.A.C. R3-8-201(C)(4).

Based on record review and interview, the manager failed to ensure a resident provided evidence of freedom from infectious tuberculosis (TB) before or within seven calendar days after the resident's date of occupancy, for one of two residents sampled. The deficient practice posed a TB exposure risk to residents. Findings include: R9-10-113(B) 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. 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. 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 iii. Includes the date and the type of tuberculosis screening test; b. If the individual had a history of tuberculosis or documentation of latent tuberculosis infection, as defined in A.A.C. R9-6-1201, compliance with subsection (A)(2)(b); or c. If the individual had a positive Mantoux skin test or other tuberculosis screening test according to subsection (B)(1)(a) and does not have history of tuberculosis or documentation of latent tuberculosis infection, as defined in A.A.C. R9-6-1201, a written statement: i. That the individual is free from infectious tuberculosis, signed by a medical practitioner or local health agency, as defined in A.A.C. R9-6-101; and ii. Dated 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. As part of the annual assessment of the health care institution's risk of exposure to infectious tuberculosis according to subsection (A)(2)(d), ensure that documentation is obtained for each individual required to be screened for infectious tuberculosis that: a. Indicates the individual's freedom from symptoms of infectious tuberculosis; and b. Is signed by a medical practitioner, occupation health provider, as defined in A.A.C. R9-6-801, or local health agency, as defined in A.A.C. R9-6-101. 1. A review of R1's (admitted in 2023) medical record revealed a document titled "T.B Test.." signed and dated by a physician. The document stated, "...x-ray results - normal..." However, the medical record revealed 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); and the chest x-ray was not an infectious TB screening test. 2. In an interview, E1 acknowledged R1 did not provide documentation of freedom from infectious TB.

Based on record review and interview, the manager failed to ensure a caregiver provided a resident with the assisted living services in the resident's service plan, for one of two residents sampled. The deficient practice posed a risk as the residents did not receive the expected service. Findings include: 1. A review of R1's medical record revealed a current service plan for personal care services dated in April 2023. The service plan revealed R1 was to receive the following service: -"Bathing... Complete bath 2 X Week/PRN..." 2. A review of R1's medical record revealed an activities of daily living (ADL) log for June 2023 and July 2023. The ADL revealed R1 received the following services on the following dates: - Full Bath on June 5, 12, 19, 25, and 30, 2023; - Full Bath on July 1, 5, 10, 15, 22, 26, and 30, 2023. However, documentation to indicate R1 received a complete bath two times weekly in June 2023 and July 2023 was not available for review. 3. In an interview, E1 reported R1 refused bathing. 4. In an interview, E1 acknowledged R1 had not received showering or bathing services per R1's service plan.