Golden Care for Elderly, LLC

Based on documentation review, record review, and interview, the manager failed to ensure a caregiver's skills and knowledge were verified and documented according to policies and procedures for two of the two caregivers sampled. Findings include: 1 . A review of facility documentation revealed a policy titled "Employees and Volunteers Qualifications." The policy stated, "The hiring individual will check and document qualification, skills and knowledge for each employee and volunteer to ensure they meet criteria and are able to perform the job duties before starting to provide assisted living services to the residents. Documentation of such check is going to be kept in the employees' records upon hiring ("Employee Orientation" and "Employee Qualifications and Skills")." 2 . A review of E2's and E3's personnel records revealed documentation of "Employee Qualifications and Skills" was not available for review at the time of inspection. 3 . In an interview, E4 acknowledged skills and knowledge documentation was not available for review for E2 and E3.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were maintained in a locked area and were inaccessible to residents. Findings include: 1 . During an environmental inspection of the facility, the Compliance Officer observed a cabinet under the kitchen sink. Both doors were equipped with magnetic locks. However, the magnetic lock on the right cabinet door was disengaged, and the Compliance Officer was able to access the cabinet. Inside the cabinet were two bottles of bleach. 2 . In an interview, E4 acknowledged the cabinet under the sink contained bleach which was accessible to residents at the time of inspection.

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 three current residents sampled. The deficient practice posed a TB exposure risk to residents. Findings include: 1. A review of R1's (admitted in 2023) medical record revealed a chest x-ray dated in May 2023. The chest x-ray stated "No acute cardiopulmonary abnormality." However, 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) was not available for review; and the chest x-ray was not an infectious TB screening test. 2. A review of R3's (admitted in 2023) medical record revealed a chest x-ray dated in June 2023. The chest x-ray stated "Free from s/sx TB." However, evidence R3 had a history of a positive skin test or other TB screening test recommended by the Centers for Disease Control and Prevention (CDC) was not available for review; and the chest x-ray was not an infectious TB screening test. 3. In an interview, E1 acknowledged R1 and R3 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 an individual's acceptance by the assisted living facility, there was a documented residency agreement with the assisted living facility to include the manager's signature and date signed, for two of three current residents sampled. Findings include: 1. A review of R1's (admitted in 2023) medical record revealed a documented residency agreement. However, the residency agreement did not include the manager's signature and date signed. 2. A review of R3's (admitted in 2023) medical record revealed a documented residency agreement. However, the residency agreement did not include the date signed. 3. In an interview, E1 acknowledged R1's and R3's residency agreements did not include the manager's signature and date signed.

Based on record review and interview, the manager failed to ensure a caregiver or assistant caregiver documented the services provided in the resident's medical record, for three of five residents sampled. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. A review of R1's medical record revealed a service plan for directed care services dated in August 2023. The service plan stated R1 was to receive "reposition every 2 - 3 hours... complete bath... 2 x week/PRN... dressing... daily... comb hair... daily..." 2. A review of R1's medical record revealed activities of daily living (ADL) document dated August 2023. The ADL document revealed the following: -A full bath was given on August 7, 2023. However, bed/sponge baths were given August 1 - present; and -Repositioning, dressing, and combing hair were not documented on the ADL document. 3. A review of R3's medical record revealed a service plan for directed care services dated in July 2023. The service plan stated R3 was to receive "reposition every 2 - 3 hours... complete bath... 2 x week/PRN... dressing daily... comb hair... daily..." 4. A review of R3's medical record revealed an ADL document dated August 2023. The ADL document revealed the following: -A full bath was not given from August 1, 2023 - present. However, bed/sponge baths were given August 1, 2023 - present; and -Repositioning, dressing, and combing hair were not documented on the ADL document. 5. A review of R5's (admitted 2023) medical record revealed an order from Coronado Care Center dated March 28, 2023. The order stated "Please provide skilled nursing services for home safety eval, med management, wound care and PT/OT evaluation/treatment: Cleanse right 2nd toe with wound cleanser, apply Xeroform, cover with dry dressing 3x/week. TX: Cleanse right great toe with wound cleanser, pat dry, cover with dry dressing 3/ week." 6. A review of R5's medical record revealed a document from the house doctor dated April 10, 2023. The document stated "[R5] had foot surgery about 6 weeks ago to remove right great toe and 2nd toe due to infected ulceration/gangrene. [R5] never followed up with surgeon, states daughter messed it up. Has not had any post-op care, dressing changes, or suture removal..." 7. A review of R5's medical record revealed an ADL document dated April 2023. The ADL document revealed no documentation of wound care. 8. In an interview, E1 reported R5 arrived to the facility after R5 was in rehab due to toe surgery. E1 reported cleaning R5's wound, however, reported not documenting the services provided. E1 reported R5 did not have a contract with a home health provider to clean the wound. 9. In an interview, E1 reported R1 and R3 frequently refused complete baths. However, E1 reported all services in R1's and R3's service plans were completed but acknowledged they were not documented.

Based on record review and interview, the manager accepted a resident who was confined to a bed or chair because of an inability to ambulate even with assistance without meeting the requirements in R9-814(B)(2)(b)(i)(ii), two of three residents sampled who received directed care services. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: R9-10-814(B)(2) A manager of an assisted living facility authorized to provide personal care services may accept or retain a resident who is confined to a bed or chair because of an inability to ambulate even with assistance if: b. The resident's primary care provider or other medical practitioner: i. Examines the resident at the onset of the condition, or within 30 calendar days before acceptance, and at least once every six months throughout the duration of the resident's condition; ii. Reviews the assisted living facility's scope of services; 1. A review of R1's (admitted 2023) medical record revealed a service plan (dated in August 2023) for directed care services. The service plan stated "Mobility...Non-Ambulatory..." 2. A review of R1's medical record revealed a document titled "Authorization for Continued Residency" dated in July 2023. The document stated "I authorize [R1] to continue in the care home... The resident appears above shall be well, have a good care, and all needs [sic]. If the resident's condition shall be change [sic], and another setting more appropriate for the resident shall be good [sic], this authorization shall be revoked." The document was signed by a medical practitioner. However, the document did not include an examination by R1's primary care doctor or other medical practitioner within 30 calendar days before acceptance and reviewed the assisted living facility's scope of services. 3. A review of R3's medical record revealed a service plan (dated in July 2023) for directed care services. The service plan stated "Mobility...Wheelchair... non ambulatory..." 4. A review of R3's medical record revealed a document titled "Authorization for Continued Residency" dated in June 2023. The document stated "I authorize [R3] to continue in the care home... The resident appears above shall be well, have a good care, and all needs [sic]. If the resident's condition shall be change [sic], and another setting more appropriate for the resident shall be good [sic], this authorization shall be revoked." The document was signed by a medical practitioner. However, the document did not include an examination by R3's primary care doctor or other medical practitioner within 30 calendar days before acceptance and reviewed the assisted living facility's scope of services. 5. In an interview, E1 reported R1 and R3 were unable to ambulate. E1 acknowledged R1's and R3's documentation did not include the requirements in R9-814(B)(2)(b)(i)(ii).