Hartford Assisted Living

Based on record review and interview, the manager failed to ensure an employee provided documentation of freedom from infectious tuberculosis (TB) as specified in R9-10-113, for two of five caregivers. The deficient practice posed a potential 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. Review of the Centers for Disease Control and Prevention website revealed a web page titled "TB Screening and Testing of Health Care Personnel." The web page stated, "If the Mantoux tuberculin skin test (TST) is used to test health care personnel upon hire (preplacement), two-step testing should be used." 3. Review of E2's personnel record revealed a negative TB skin test that was less than 12 months old, however no additional documentation of freedom from infectious TB was available for review. Based on E2's hire date, this documentation was required. 4. Review of E3's personnel record revealed a negative TB skin test that was less than 12 months old, however no additional documentation of freedom from infectious TB was available for review. Based on E3's hire date, this documentation was required. 5. In an interview, E1 acknowledged E2 and E3 did not provide documentation of freedom from infectious TB as specified in R9-10-113. 6. Technical assistance was provided on this Rule during the compliance inspection conducted April 13, 2023.

Based on documentation review, record review, and interview, the manager failed to ensure a resident medical record contained documentation of notification of the resident of the availability of vaccination for pneumonia, according to A.R.S. \'a7 36-406(1)(d), to one of one resident reviewed. The deficient practice posed a potential illness risk to residents. Findings include: 1. A.R.S. \'a7 36-406(1)(d) states "The department shall: Require as a condition of licensure that nursing care institutions and assisted living facilities make vaccinations for influenza and pneumonia available to residents on site on a yearly basis. The department shall prescribe the manner by which the institutions and facilities shall document compliance with this subdivision, including documenting residents who refuse to be immunized. The department shall not impose a violation on a licensee for not making a vaccination available if there is a shortage of that vaccination in this state as determined by the director." 2. Review of R1's medical record revealed R1 refused the pneumonia vaccination November 10, 2021. However, current documentation was not available that showed the pneumonia vaccination was offered or received. Based on R1's acceptance date, this documentation was required. 3. In an interview, E1 acknowledged R1's medical record did not include current documentation that showed the pneumonia vaccination was offered or received.

Based on record review, observation, and interview, the manager failed to ensure a medication was administered in compliance with a medication order, for one of two residents reviewed. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. Review of R1's medical record revealed a current written service plan dated October 9, 2023. This service plan indicated R1 received medication administration. 2. Review of R1's medical record revealed signed medication orders dated January 11, 2024. These medication orders stated the following: "Ipratopium Bromide 0.02% solution for inhalation Take 2.5 milliliters inhalation three times a day as needed" "Albuterol Sulfate 2.5mg/3ml (0.083%) solution for nebulization take 3 milliliters inhalation every four hours" 3. Review of R1's medical record revealed a January 2024 medication administration record (MAR). This MAR stated the following: "Ipratropium Bromide 0.02% inhale Q6 HRS via NEB" and indicated one treatment was administered at 6am, 12pm, 6pm, and 12am February 1st - present. "Albuterol Sulfate 0.083% inhale Q4 HRS PRN via NEB" and did not include documentation the medication was administered February 1st - present. 4. During an observation of R1's medications, Ipratropium Bromide and Albuterol Sulfate were available. 5. In an interview, E2 reported the medications were administered per the MAR and E1 acknowledged R1's medications were not administered in compliance with the available medication orders.

Based on record review and interview, the manager failed to ensure when a resident had an incident that resulted in the resident needing medical services, a caregiver immediately notified the resident's emergency contact and primary care provider, for two of two residents reviewed who had an incident that resulted in the resident needing medical services. The deficient practice posed a health and safety risk. Findings include: 1. Review of R1's medical record revealed the following: -An incident report dated December 7, 2023 that indicated the time of incident was 5:31pm and stated "...(R1) did not feel well. Called 911 and (R1) was taken to ER..." This document did not include documentation R1's primary care provider was notified of this incident. -An incident report dated December 9, 2023 that indicated the time of the incident was 8:05am and stated "(R1) had elevated fever and did not feel well. Called 911 and sent (R1) to ER..." This document indicated R1's primary care provider was notified of this event on December 14, 2023 at 11:00am. -A document titled "After Visit Summary" from Honor Health indicating a hospital stay January 1, 2024 - January 6, 2024. Documentation was not available that showed R1's emergency contact and primary care provider were notified of this event. 2. Review of R2's medical record revealed the following: -An incident report dated December 28, 2023 that indicated the time of incident was 5:14pm and stated "...(R2) did not feel good. (R2) was taken to ER for a checkup on ambulance with 911..." This document indicated R2's primary care provider was notified of this event on December 30, 2023 at 11:26am. 3. In an interview, E1 acknowledged R1's and R2's medical records did not include documentation that showed a caregiver immediately notified the resident's emergency contact and primary care provider when R1 and R2 had an incident the resulted in the residents needing medical services.

Based on record review and interview, the manager failed to ensure when a resident had an incident that resulted in the resident needing medical services, a caregiver documented the date and time of the incident; a description of the incident; the names of individuals who observed the incident; the action taken by the caregiver; the individuals notified by the caregiver; and any action taken to prevent the incident from occurring in the future, for one of two residents reviewed who had an incident that resulted in the resident needing medical services. The deficient practice posed a health and safety risk. Findings include: 1. Review of R1's medical record revealed a document titled "After Visit Summary" from Honor Health indicating a hospital stay January 1, 2024 - January 6, 2024. However, documentation was not available that included the date and time of the incident; a description of the incident; the names of individuals who observed the incident; the action taken by the caregiver; the individuals notified by the caregiver; and any action taken to prevent the incident from occurring in the future. 2. In an interview, E1 acknowledged R1's medical record did not include documentation of the date and time of the incident; a description of the incident; the names of individuals who observed the incident; the action taken by the caregiver; the individuals notified by the caregiver; and any action taken to prevent the incident from occurring in the future. This is a repeat deficiency from the compliance inspection and complaint investigation conducted on April 13, 2023.

Based on observation and interview, the manager failed to ensure toxic materials stored by the facility were stored in a locked area and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental inspection of the facility with E2, the Compliance Officer observed Krud Kutter latex paint remover, Suavitel, Fabuloso, and Purex laundry detergent unlocked in the laundry room. The laundry room door had a locking device, however the door was not locked. 2. During an observation, the caregivers were not accessing the toxic materials at the time of arrival. 3. In an interview, E1 and E2 acknowledged toxic materials were stored unlocked.

Based on documentation review, observation, and interview, the manager failed to ensure a food menu included any food substitutions no later than the morning of the day of meal service with a food substitution. Findings include: 1. Review of the facility's posted menu revealed a menu dated June 18th - June 24th. The Friday, June 23rd lunch menu stated: "Slow Roasted BBQ Ribs served with Sweet Potatoes and Sweet Corn, Apple Pie or choice of Ice Cream" 2. During an observation, the lunch meal served on Friday, June 23rd included the following: Fried chicken, mashed potatoes, mixed vegetables, and pudding. 3. During an interview, E1 acknowledged the lunch meal served on Friday, June 23rd was not the same as stated on the menu and the substitutions were not documented.