Greenfield Amazing Home LLC

Based on record review and interview, the manager of an assisted living home failed to maintain a standardized form for each resident that included the information prescribed in Arizona Revised Statute (A.R.S.) § 36-420.04(A)(1) through (9), for two out of two sampled residents. Findings include: 1. A.R.S. 36-420.04.A states, "A. An assisted living center or assisted living home that contacts an emergency responder on behalf of a resident shall provide to the emergency responder a written document that includes all of the following: 1. The reason or reasons the emergency responder was requested on behalf of the resident. 2. Whether the resident receives medication services and, if the resident has provided this information to the assisted living center or assisted living home, a list of all the resident's prescription and over-the-counter medications, their dosages and how frequently they are administered. 3. The name, address and telephone number of the resident's current pharmacy. 4. A list of any known allergies to any medications, additives, preservatives or materials like latex or adhesive. 5. The name and contact information for the resident's primary care physician and power of attorney or authorized representative. 6. Basic information about the resident's physical and mental conditions and basic medical history, such as having diabetes or a pacemaker or experiencing frequent falls or cardiovascular and cerebrovascular events, as well as dates of recent episodes, if known. 7. The point-of-contact information for the assisted living center or assisted living home, including the telephone number, if available, cell phone number and email address. A point of contact must be available to respond to questions regarding the information provided twenty-four hours a day, seven days a week. 8. A copy of the resident's health insurance portability and accountability act release authorizing a receiving hospital to communicate with the assisted living center or assisted living home to plan for the resident's discharge. This paragraph does not preclude a resident from revoking the resident's health insurance portability and accountability act release authorization. 9. A copy of the resident's advance directives, if any, on file at the assisted living center or assisted living home. This paragraph does not preclude a resident from revoking or modifying the resident's advance directives." 2. A review of R1's and R2's medical records revealed standardized emergency responder forms were not available for review. 3. In an interview, E2 acknowledged medical records for R1 and R2 did not contain standardized emergency responder forms as required by this statute.

Based on documentation review, record review, and interview, for one of five employees reviewed, the health care institution failed to implement tuberculosis (TB) infection control activities, including annually providing 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 potential illness risk to residents. Findings include: 1 . A review of the facility's policies and procedures revealed a policy titled "Facility's Tuberculosis (TB) Control- Tuberculosis Screening policies and procedures" that stated "...1. All individual employed by the facility...will be required to complete Tuberculosis (TB) training and Education upon hire and annually thereafter...the annual training and education related training to recognizing the signs and symptoms of TB...." 2. A review of E2's personnel record revealed E2 worked as a caregiver (hired on March 20, 2024) and did not include documentation of training and education related to recognizing the signs and symptoms of TB. 3. In an interview, E2 acknowledged documentation was not available that showed E2 had completed training and education related to recognizing the signs and symptoms of TB.

Based on observation, record review, and interview, the manager failed to ensure that an assistant caregiver interacted with residents under the supervision of a manager or caregiver. The deficient practice posed a risk if the individuals were not trained to provide the required services. Findings include: 1. Upon arrival, the Compliance Officer observed E4 providing services to a resident in the resident's bedroom alone. 2. A review of E4's personnel record revealed a job titled of "Assistant Caregiver". E4's personnel record did not contain documentation of a completed caregiver training program. 3. In an interview, E2 reported E4 was an assistant caregiver and acknowledged E4 interacted with residents not under the supervision of a manager or caregiver.

Based on observation, documentation review, record review, and interview, the manager failed to ensure a caregiver's skills and knowledge were verified and documented before the caregiver provided services, for one of five caregivers reviewed. The deficient practice posed a health and safety risk to residents if a caregiver did not have the documented skills and knowledge to provide services for residents. Findings include: 1. Upon arrival, the Compliance Officer observed E4 providing services to residents. 2. A review of the facility's policies and procedures revealed a policy titled "Verifying Caregivers Skills and Knowledge". This policy stated, "Before the caregiver provides physical health services or behavioral health services, his or her skills and knowledge are verified and documented". 3. A review of E4's record did not include documentation verifying E4's skills and knowledge. 4. In an interview, E2 reported E4 was hired as an assistant caregiver the day of the inspection and acknowledged documentation was not available showing E4's skills and knowledge were verified and documented before E4 provided services to a resident.

Based on documentation review, 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 one of two residents sampled. The deficient practice posed a TB exposure risk to residents. Findings include: 1. R9-10-113.A states, "If a health care institution is subject to the requirements of this Section, as specified in an Article in this Chapter, the health care institution's chief administrative officer shall ensure that the health care institution establishes, documents, and implements tuberculosis infection control activities that...2. Include: a. For each individual who is employed by the health care institution, provides volunteer services for the health care institution, or is admitted to the health care institution and who is subject to the requirements of this Section, screening, on or before the date specified in the applicable Article of this Chapter, that consists of: i. Assessing risks of prior exposure to infectious tuberculosis, ii. Determining if the individual has signs or symptoms of tuberculosis, and iii. Obtaining documentation of the individual's freedom from infectious tuberculosis according to subsection (B)(1)..." 2. A review of R1's medical record revealed no documentation of a risk assessment of prior exposure to infectious TB or a determination if R1 had signs or symptoms of TB. Based on R1's date of acceptance, this documentation was required. 3 . In an interview, E2 acknowledged R1's medical record did not include documentation of a risk assessment of prior exposure to infections TB or a determination if they had signs or symptoms of TB.

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 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 medical practitioner or registered nurse, for two of two residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R1's medical record revealed no documentation that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints. Based on R1’s acceptance date, this documentation was required. 2. A review of R2's medical record revealed no documentation that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints. Based on R2’s acceptance date, this documentation was required. 3. In an interview, E2 acknowledged R1 and R2 did not provide documentation signed by a medical practitioner or a registered nurse that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints.

Based on record review and interview, the manager failed to ensure a written service plan was completed no later than 14 calendar days after the resident's date of acceptance, for one of two residents sampled. The deficient practice posed a risk as there was no service plan to direct the services to be provided to a resident. Findings include: 1. A review of R1's medical record revealed an initial service plan was not available for review at the time of inspection. Based on R1's date of acceptance, this documentation was required. 2. In an interview, E2 acknowledged R1 had no service plan documented at the time of inspection.

Based on record review and interview, the manager failed to ensure that a resident had a written service plan that was reviewed and updated at least once every six months for a resident receiving personal care services, for one of two residents sampled. The deficient practice posed a risk if a resident's service plan was not updated as required to reinforce and clarify services, and a caregiver was not aware of the services to be provided for a resident. Findings include: 1. A review of R2's medical record revealed a service plan for personal care services dated September 1, 2024. However, documentation of a service plan after September 1, 2024 was not available for review. 2. In an interview, E2 acknowledged R2's medical record did not include a service plan updated at least once every six months.

Based on documentation review, observation, and interview, the manager failed to ensure there was a means of exiting the facility for a resident who did not have a key, special knowledge for egress, or the ability to expend increased physical effort, that provided access to an outside area, and 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. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. During a facility tour, the Compliance Officer observed an uncontrolled door leading out to the backyard. The door had part of a device that was intended to alert employees to the egress of a resident to the outside area. However, the device did not alert employees of egress from the facility. 3. In an interview, E2 acknowledged there was no control or alert on the door leading to the back yard.