Grandma's Angel #2

Based on documentation 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 sampled. The deficient practice posed a risk if employees were unable to meet the needs of residents. Findings include: 1. A review of E2's personnel record revealed E2 was hired as a caregiver on November 20/ 2023. Evidence indicating E2's skills and knowledge were verified and documented before providing physical health services was unavailable for review. 2. A review of the facility's policies and procedures, updated December 28, 2022, revealed a policy titled, "Caregiver Job Descriptions, Duties and Qualifications." The policy read as follows: "1. Before providing direct care to the residents at this facility, the Manager will ensure that each caregiver will meet the following... d. Demonstrates the qualifications, skills and knowledge required to provide assisted living services...(Please see Skill Verification Checklist completed by caregiver, manager and or trainer)" 3. In an interview, E1 agreed evidence of documentation of verification of E2's skills and knowledge was unavailable for review.

Based on record review, documentation review, and interview, the manager failed to ensure a manager, a caregiver, and an assistant caregiver provided evidence of freedom from infectious tuberculosis (TB) as specified in R9-10-113, for one of two caregivers sampled. Findings include: 1. A review of E2's personnel record revealed evidence of a signs, symptoms and risk assessment signed by a registered nurse, however evidence of documentation of freedom from infectious TB was available for review. 2. In an interview, E1 affirmed E2 had conducted two skin tests at least one week apart, which were both negative for TB. However, E1 agreed E2's personnel record did not contain current documentation of evidence of freedom from infectious TB.

Based on record review and interview, the manager failed to ensure a resident had a written service plan to include the amount, type, and frequency of assisted living services being provided to the resident for two of two residents sampled. Findings include: 1. A review of R1's medical record revealed a service plan dated February 2, 2024 for personal care services. The service plan included incontinence care and assistance with brief changes. However, the service plan did not include the frequency of brief changes or the amount of assistance R1 required with brief changes. 2. A review of R2's medical record revealed a service plan dated February 20, 2024 for personal care services. The service plan included incontinence care and assistance with brief changes. However, the service plan did not include the frequency of brief changes or the amount of assistance R2 required with brief changes. Further, R2's service plan included a section titled, "Grooming," and indicated R2 required "Complete Assist." However, the service plan did not include the amount and frequency of the service. 3. In an interview, E1 acknowledged R1's and R2's service plans did not include the amount and frequency of all assisted living services being provided to each resident.

Based on record review and interview, the manager failed to ensure a caregiver documented the services provided in the resident's medical record, for two of four 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 R2's medical record revealed an admission date in June 2023 and a service plan dated in June 2023, for personal care services. However, evidence of documentation of services provided were unavailable for review. 2. A review of R3's medical record revealed an admission date in April 2023 and a service plan dated in April 2023, for personal care services. Further review revealed evidence of documentation of services provided on May 1 and May 2, 2023, however additional evidence of documentation of services provided during the month of April or the remainder of May 2023 was not available for review. 3. In an interview, E2 reported they were unable to locate documentation of services provided for R2, or remaining documentation of services provided for R3. E2 advised R2 had passed away in late June 2023, approximately one week after they were admitted, and R3 had passed away in early May, approximately three weeks after admission.

Based on documentation review, record review, and interview, the manager failed to ensure policies and procedures for medication administration included a process for documenting an individual, authorized, according to the definition of "administer" in A.R.S. \'a7 32-1901, by a medical practitioner to administer medication under the direction of the medical practitioner, for three of four residents sampled. Findings include: 1. A review of the facility's policies and procedures manual (reviewed December 28, 2022) revealed a policy titled, "Medication Policy," which stated " ...M. The Manager will identify caregivers...who may provide medication administration...A medical practioner will sign and date the Caregiver Authorization to Administer Medications (Please see Form Caregiver Authorization to Administer Meds) for those caregivers who are authorized to administer medications and treatments at the facility. 2. A review of R3's medical record revealed a service plan which indicated R3 received medication administration. Further review revealed evidence of documentation of an individual authorized by a medical practitioner to administer medication under the direction of the medical practitioner was unavailable for review. R3's medical record contained a medication administration record (MAR) which indicated R3 was administered medication exclusively by E3. 4. A review of E3's personnel record revealed evidence E3 had received training in administration of mediation, however evidence of documentation R3 was authorized by a medical practitioner to administer medication under the direction of the medical practitioner was unavailable for review. 5. In an interview, E2 acknowledged R3's medical record did not contain and E3's personnel record did not include evidence of documentation of an individual authorized by a medical practitioner to administer medication under the direction of the medical practitioner.