Gracious Granny's

Based on documentation review, record review and interview, the manager failed to ensure that a caregiver’s or assistant caregiver’s skills and knowledge were verified and documented according to policies and procedures, for two of two sampled caregivers. The deficient practice posed a risk if the employees were unable to meet a resident's needs. Findings include: 1 . A review of facility documentation revealed a policy titled "Employee Orientation and In-Service Education." The policy stated, "Following the above orientations, new caregivers will have three days of orientation scheduled on the floor...They will work with the Lead Caregiver on the floor and complete the floor orientation..." 2 . A review of E1's and E2's personnel records revealed documentation of a completed floor orientation was not available for review at the time of inspection. 3 . In an interview, E4 reported E4 had verified E1's and E2's skills and knowledge, but had not documented the process of validation. 4 . In an exit interview, the findings were discussed with E4 and no additional information was provided.

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 an assisted living facility which included if the individual was expected to receive supervisory care services, personal care services, or directed care services, 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 two of two residents sampled. Findings include: 1 . A review of R1's and R2's medical records revealed documentation that was dated within 90 calendar days before the individual was accepted by an assisted living facility which included if the individual was expected to receive supervisory care services, personal care services, or directed care services, 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 was not available for review at the time of inspection. 2 . In an exit interview, the findings were discussed with E4 and no additional information was presented.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were inaccessible to residents. Findings include: 1 . During an environmental inspection of the facility, the Compliance Officers observed a cabinet under the kitchen sink. The cabinet was locked with a magnetic lock. However, when the Compliance Officers applied slight pressure when opening the cabinet, the latch disengaged and the Compliance Officers were able to access the following chemicals: -A bottle of "Cascade Complete" dishwasher detergent; -A bottle of "Fabuloso" multi-purpose cleaner; and -A bottle of "Finish" rinse aid. 2 . In an exit interview, the findings were discussed with E4 and no additional information was provided.

Based on documentation review and interview, the manager failed to ensure that two of two pets that were allowed in the facility, were licensed consistent with local ordinances. Findings include: 1. Documentation for O1, a dog allowed in the facility, failed to reflect that the dog was licensed. 2. Documentation for O2, a dog allowed in the facility, failed to reflect that the dog was licensed. 3. During a telephone interview with the local authority it was determined that the dogs required a license. 4. During an interview, E1 acknowledged that facility documentation failed to indicate the dogs had a current license.

Based on documentation review and interview, the manager failed to ensure that the health care institution established, documented, and implemented tuberculosis infection control activities that include the information found in subsections a. through f. of this rule. Findings include: 1. Review of facility documentation failed to reveal information indicating that the health care institution had established and documented tuberculosis infection control documentation and activities that include subsections a. through f. of this rule . 2. During an interview, E1 acknowledged that the required documentation was not available for review.

Based on record review, observation and interview, the manager failed to ensure that one of one sample service plan for a resident who was storing medication in their bedroom included how the medication would be stored and controlled. Findings include: 1. During an interview, E1 indicated that R1 self-administered their own medications and stored the medications in their room. 2. The record for R1 contained a current service plan that did not include how the resident's medication would be stored and controlled. 3. During an interview, E1, acknowledged the service plan did not indicate how the resident's medication would be stored and controlled in the room.

Based on documentation review and interview, the manager failed to ensure that medication administration policies and procedures were reviewed and approved by a medical practitioner, registered nurse, or pharmacist. Findings include: 1. The facility medication administration policies and procedures failed to reveal evidence that the policies had been reviewed and approved by a medical practitioner, registered nurse, or pharmacist. 2. During an interview, E1 acknowledged that facility residents receive medication administration services. 3. During an interview, E1 acknowledged the required documentation was not available for review.

Based on record review and interview, the manager failed to ensure that two of two sample personnel records contained evidence of freedom from infectious tuberculosis (TB), as specified in R9-10-113. Findings include: 1. The record for E3 (Manager Designee, hired June 16, 2023) contained documentation indicating that one TB test was administered within the 12 months prior to the date of hire. No other TB test documentation conducted within the past 12 months was found in the record. 2. The record for E4 (Manager Designee, hired May 16, 2022) contained documentation indicating that one TB test was administered within the 12 months prior to the date of hire. No other TB test documentation conducted within the past 12 months was found in the record. 3. During an interview, E1 acknowledged that the employees worked more than eight hours per week and the documentation did not reflect that the employee records contained evidence of freedom from TB as specified in R9-10-113, prior to providing services to residents.

Based on record review and interview, the manager failed to ensure that the health care institution established, documented, and implemented tuberculosis infection control activities that included annually providing training and education related to recognizing the signs and symptoms of tuberculosis (TB) to individuals employed by the health care institution. Findings include: 1. Review of the record for E1 failed to reveal documentation indicating that annual training related to recognizing the signs and symptoms of TB had been completed. No TB training documentation was available for review. 2. Review of the record for E2 failed to reveal documentation indicating that annual training related to recognizing the signs and symptoms of TB had been completed. No TB training documentation was available for review. 3. Review of the record for E3 failed to reveal documentation indicating that annual training related to recognizing the signs and symptoms of TB had been completed. No TB training documentation was available for review. 4. Review of the record for E4 failed to reveal documentation indicating that annual training related to recognizing the signs and symptoms of TB had been completed. No TB training documentation was available for review. 5. During an interview, E1 acknowledge that the required documentation was not available.

Based on documentation review and interview, the manager failed to ensure that the health care institution established, documented, and implemented tuberculosis infection control activities that included annually assessing the health care institution's risk of exposure to infectious tuberculosis. Findings include: 1. Review of facility documentation failed to reveal an annual assessment of the health care institution's risk of exposure to infectious tuberculosis. 2. During an interview, E1 acknowledged that the required documentation was not available for review.

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 as required in A.R.S.36-420.01. Findings include: 1. Review of the record for E1 (hired August 1, 2018), failed to reveal documentation of fall prevention and fall recovery training. 2. Review of the record for E2 (hired November 5, 2020), failed to reveal documentation of fall prevention and fall recovery training. 3. Review of the record for E3 (hired May 16, 2022), failed to reveal documentation of fall prevention and fall recovery training. 4. During an interview, E1 indicated that training for fall prevention and fall recovery had not been developed and administered to staff.

Based on record review and interview, the manager failed to ensure that two of two sample resident records contained documentation of notification to the resident of the availability of vaccinations for influenza and pneumonia. Findings include: 1. The record belonging to R2 contained no documentation indicating that the resident had been notified of the availability of either the influenza or pneumonia vaccination on a yearly basis. No additional documentation indicating when the resident had been offered, refused or received either vaccination, was available for review. Based on the resident's date of acceptance, this documentation was required. 2. The record belonging to R3 contained documentation indicating that the resident was last notified of the availability of the pneumonia vaccination on October 25, 2021. No additional documentation indicating when the resident had been offered, refused or received either vaccination, was available for review. Based on the resident's date of acceptance, this documentation was required. 3. During an interview, E1 acknowledged that the vaccination had been made available to the resident on a yearly basis however, the record did not contain the required documentation.

Based on observation and interview, the manager failed to ensure that the swimming pool had a self-closing, self-latching gate, that opened away from the swimming pool. Findings include: 1. Observation of the facility swimming pool revealed that the gate opened inward toward the pool. 2. During an interview, E1 acknowledged that the pool gate did not open away from the swimming pool.

Based on observation and interview, the manager failed to ensure that pool safety requirements are conspicuously posted in the swimming pool area. Findings include: 1. Observation of the swimming pool area failed to reveal that pool safety requirements were conspicuously posted in the swimming pool area. 2. During an interview, E1 stated "We had them posted but they must have blown away."