Graceful Hands Home Care

Based on record review and interview, the manager failed to ensure there was a documented residency agreement with the assisted living facility and included the manager's signature and date signed, for two of two residents reviewed. The deficient practice posed a risk if the resident was not informed of the terms of residency. Findings include: 1. A review of R1's medical record revealed a residency agreement. However, this residency agreement did not include the signature of the manager and date signed. Based on R1's acceptance date, this documentation was required. 2. A review of R3's medical record revealed no residency agreement. Based on R3's acceptance date, this documentation was required. 3. In an interview, E1 acknowledged R1's residency agreement was not signed and dated by the manager and R3 did not have a residency agreement.

Based on record review and interview, the manager failed to ensure a caregiver's or assistant caregiver's skills and knowledge were verified and documented before providing physical health services for one of two caregivers reviewed. The deficient practice posed a risk if the employee was unable to meet a resident's needs. Findings include: 1. Review of E2’s personnel record revealed a hire date of January 3, 2023. E2’s record revealed no documentation indicating E2’s skills and knowledge were verified. 2. In an interview, E1 acknowledged E2’s personnel record did not contain documentation showing E2’s skills and knowledge were verified. 3. This is a repeat deficiency from the inspection conducted on October 15, 2024.

Based on record review and interview, the health care institution failed to develop and administer a training program for all staff regarding fall prevention and fall recovery that included initial training and continued competency training. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. Review of facility documentation revealed no documentation of a fall prevention and fall recovery training program. 2. Review of E1’s personnel record revealed documentation showing fall prevention and fall recovery training was completed on May 26, 2023. 3. Review E2’s personnel record revealed no documentation of completing fall prevention and fall recovery training. Based on E2's date of hire, this documentation was required. 4. In an interview, E1 acknowledged a fall prevention and fall recovery training program was not available, E1 did not complete continued training, and E2 did not complete initial training. 5. This is a repeat deficiency from the inspection conducted on October 15, 2024.

Based on documentation review, record review, and interview, the health care institution failed to implement tuberculosis (TB) infection control activities that included annual training and education related to recognizing the signs and symptoms of TB to individuals employed by the health care institution. The deficient practice posed a risk as the caregiver received no organized instruction or information related to TB surveillance. Findings include: 1. A review of the Centers for Disease Control and Prevention (CDC) website revealed a web page titled, "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005." The web page stated, "All health-care workers (HCWs) should receive training on the prevention, transmission, and symptoms of TB disease that is appropriate to their work responsibilities and setting. Initial training should be provided to all new employees, with annual refresher training thereafter." 2. Review of E1’s and E2’s personnel records revealed E1 and E2 did not include current documentation of training and education related to recognizing the signs and symptoms of TB. Based on E1’s and E2’s hire dates, this documentation was required. 3. In an interview, E1 acknowledged documentation was not available that showed E1 and E2 had completed training and education related to recognizing the signs and symptoms of TB annually.

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with A.R.S. § 36-411, for two of two employees reviewed. The deficient practice posed a risk if the employee was a danger to a vulnerable population. Findings include: 1. A.R.S. § 36-411(C)(4) states: "4. On or before March 31, 2025, verify that each employee is not on the adult protective services registry pursuant to section 46-459. If an employee is found to be on the adult protective services registry, the residential care institution, nursing care institution or home health agency shall take action to terminate the employment of that employee." 2. Review of E1’s personnel record did not reveal verification that E1 was not on the adult protective services registry. Based on E1’s hire date, this documentation was required. 3. Review of E2’s personnel record did not reveal verification that E2 was not on the adult protective services registry. Based on E2’s hire date, this documentation was required. 4. In an interview, E1 acknowledged E1 and E2 did not have adult protective services registry verification in their personnel records.

Based on observation, documentation review, record review, and interview, the manager failed to ensure a caregiver provided current documentation of first aid and cardiopulmonary resuscitation (CPR) training that included a demonstration of the individual's ability to perform CPR, before providing assisted living services, for one of two employees reviewed. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency. Findings include: 1. The Compliance Officers observed E1 working alone at the time of the inspection. 2. Review of the facility’s policy and procedure revealed a policy titled “First Aid and CPR Training” which stated, “8. The hiring person has to be current in the first aid and CPR certification and have the ability to evaluate new employee’s knowledge and performance in providing CPR and first aid.” 3. Review of E1’s personnel record revealed E1 had worked as a manager and had a hire date of January 28, 2016. The personnel record revealed an expired first aid and CPR card with a renewal date of March 2025. 4. In an interview, E1 acknowledged E1’s first aid and CPR card had expired and did not have current documentation of a valid first aid and CPR card.

Based on observation and interview, the manager failed to ensure that poisonous or toxic materials stored by the assisted living facility were maintained in labeled containers in a locked area separate from food preparation and storage, dining areas, and medications and were inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During the environmental inspection, the Compliance Officers observed the following chemicals unlocked and accessible to residents, on the premises: · Palmolive Liquid dish soap · Ajax liquid dish soap · CVS disinfectant spray · Multi-purpose disinfecting wipes · Glade air freshener spray · Weed killer 2. In an interview, E1 acknowledged that there were poisonous or toxic materials stored by the assisted living facility that were not in a locked or secure area and inaccessible to residents.

Based on documentation review, record review, and interview, the manager failed to ensure a personnel record for each employee included documentation of the individual's completed orientation required by policies and procedures, for four of four sampled personnel members. The deficient practice posed a risk if the employee was unable to meet a resident's needs. Findings include: 1. A review of facility documentation revealed a policy titled "Orientation and in-Service Training" The policy stated "1. It is required that each employee and employee and volunteer receive orientation before providing assisted living services to a resident. ." 2. A review of four of four personnel record sampled revealed E1, E2, E3, and E4 personnel record did not contain documentation of orientation 3. In an interview, E1 acknowledged E1, E2, E3, and E4 personnel record did not contain documentation of orientation.

Based on documentation, record review, and interview, the governing authority failed to administer a training program for four of four staff members regarding fall prevention and fall recovery. The deficient practice posed a risk if a staff member was not properly trained to assist a resident who had fallen and was unable to recover independently. Findings include: 1. A review of facility documentation revealed no documentation was available for review for a training program for fall prevention and fall recovery. 2. A review of E1's, E2's, E3's, and E4's personnel records revealed no documentation of training in fall prevention and fall recovery was unavailable for review at the time of inspection. 3. In an interview, E1 acknowledged documentation of training in fall prevention and fall recovery was unavailable for review. E1 acknowledged no documentation for E1's, E2's, E3's, and E4's regarding fall prevention and fall recovery training was available for review at the time of inspection. E1 also report that facility does not have a fall prevent fall recovery program or training in place. E1 reported the facility calls the fire department anytime residents fall.

Based on documentation review, and interview, a manager failed to implement policies and procedures to protect the health and safety of a resident that covered methods by which an assisted living center was aware of the general or specific whereabouts of a resident, based on the level of assisted living services provided to the resident and the assisted living services the assisted living center is authorized to provide. Findings include: 1. A review of facility documentation revealed a policy titled "Safety of Wandering Residents". The policy statement stated, " To ensure residents have the freedom and opportunity to wander within the facility, while ensuring that the facility egress control is operable in compliance with state rule. The personnel of the facility will make every attempt to keep residents from wandering away from the facility by following the steps outlined in the procedures below. " The policy procedure stated, " ...4. Caregivers will maintain security of the locks on the front door, yards and hazardous areas at all times. ...5. If alarms are being used on doors and/or windows, the caregiver will check them daily for operation and security." 2. In an interview, E1 acknowledged the policy was not implemented.

Based on record review and interview, the manager failed to ensure an assistant caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services on behalf of the facility, for three of three sampled caregiver and assistant caregivers. The deficient practice posed a risk if employees did not have the skills and knowledge necessary to ensure the health and safety of residents. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer arrived at 9:00 am and observed E3 working at the facility as an assistant caregiver and providing care to residents at the time of the inspection. At about 9:45 E2 arrivied at the facility and E3 left the facility for the day. Around 10:30 AM E1 arrivied at the facility. 2. In an interview, E1 acknowledged E4 had worked on October 16, 2024 afternoon shift at the facility. 3. A review of E2's, E3's and E4's personnel record revealed no documented verification of E2's, E3's and E4's skills and knowledge. 4. In an interview, E1 acknowledged E2's, E3's and E4's personnel record did not contain documentation of verification of skills and knowledge.

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 or intermittent nursing services, or restraints, for two of two residents sampled. The deficient practice posed a risk if staff were unable to meet the needs of residents. Findings include: 1. A review of R1's and R2's medical records revealed no documentation dated within 90 calendar days before R1's and R2's were accepted by the assisted living facility to include whether R1's and R2's required continuous medical services, continuous or intermittent nursing services, or restraints. 2. In an interview, E1 acknowledged R1's and R2's medical records did not contain the required documentation.

Based on an observation and interview, the manager failed to ensure a means of exiting the facility 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. During the environmental inspection of the facility, the Compliance Officer observed the front door leading to the front yard had a mechanism to alert employees of the egress of a resident, However, the front door was unlocked and the mechanism on the front door was not working at the time of the inspection. The Compliance Officer also observed a door leading from the common living room area to the back yard and a door leading from the common office area to the back yard which were unlocked and did not have a mechanism to alert employees of the egress of a resident. 2. In an interview, E1 acknowledged the front door was unlocked and the mechanism was not working at the time of the inspection. E1 also acknowledged the doors in the common living room area and common office area of the facility were unlocked and did not have mechanism to alert the staff of a resident leaving the facility.

Based on observation and interview, the manager failed to ensure medications stored by the facility were stored in a locked area. The deficient practice posed a health and safety risk to residents with access to the medications. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed an unlocked medication cabinet in the common office area. The medication cabinet contained medication for eight residents. 2. In an interview, E1 acknowledged the medications were not stored in a locked area and were accessible to residents.

Based on observation, documentation review, and interview, the manager failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed a risk to residents who were unable to self-administer medications. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed an unlocked medication box inside the kitchen refrigerator. Inside the box, the Compliance Officer observed a medication bottle with "Morphine Sulfate Oral Solution 100 mg (milligrams) per 5 mL (milliliters)." The Compliance Officer also observed ambulatory residents in the facility. 2. A review of facility policies and procedures revealed a policy titled "Medications Including Opioids and Narcotics." The policy stated, "Medication stored by the facility will be locked in the medication storage area." 3. In an interview, E1 acknowledged the aforementioned medication was not stored in a locked area at the time of the inspection.