Julian's Assisted Living Home

Based on record review and interview, the manager failed to ensure a caregiver's and assistant caregiver's skills and knowledge were verified and documented before the caregiver and assistant caregiver provided physical health services, for two of two caregivers or assistant caregivers sampled. The deficient practice posed a risk if the caregiver and assistant caregiver were unable to meet a resident's needs. Findings include: 1. Review of E2's personnel record revealed E2 was hired as a caregiver. 2. Review of E3's personnel record revealed E3 was hired as an assistant caregiver. 3. Review of the personnel work schedule for August 2024 revealed E2 worked on the following dates and times: -August 1 6am-6am; -August 2 6am-6pm; -August 4-8 6am-6am; -August 9 6am-6pm; -August 11-15 6am-6am; -August 16 6am-6pm; -August 18-22 6am-6am; -August 23 6am-6pm; and -August 25-28 6am-6am. 4. Review of the personnel work schedule for August 2024 revealed E3 worked on the following dates and times: -August 2-3 6am-6am; -August 4 6am-6pm; -August 9-10 6am-6am; -August 11 6am-6pm; -August 16-17 6am-6am; -August 18 6am-6pm; -August 23-24 6am-6am; and -August 25 6am-6pm. 5. Review of E2's and E3's personnel records revealed no documentation that E2's and E3's skills and knowledge were verified. 6. In an interview, E1 acknowledged documentation was not available that showed E2's and E3's skills and knowledge were verified and documented before the caregiver provided physical health services.

Based on record review and interview, the manager failed to ensure an employee provided documentation of freedom from infectious tuberculosis (TB) on or before the date the individual began providing services at or on behalf of the assisted living facility, as specified in R9-10-113, for one of three employees reviewed. 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 E3's personnel record revealed one negative TB skin test that was less than 12 months old at the time E3 started providing services at the facility, however a second negative TB skin test was not available for review. 4. In an interview, E1 reported not understanding the rule, and acknowledged E3 did not provide documentation of freedom from infectious TB as specified in R9-10-113 on or before the date the individual began providing services at or on behalf of the assisted living facility.

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. Review of Department documentation revealed the facility was authorized to provide directed care services. 2. During the facility tour with E1, the Compliance Officer observed the door leading out to the backyard. The outside area, in the backyard, allowed residents to be at least 30 feet away from the facility. The door leading out to the backyard had a device that was intended to alert employees to the egress of a resident to the outside area. However, the device was switched off. 3. In an interview, E1 acknowledged there was not a means of exiting the facility that controlled or alerted employee of the egress of the resident.

Based on observation and interview, the manager failed to ensure a current drug reference guide was available for use by personnel members. Findings include: 1. The Compliance Officer observed the facility's drug reference guide was the "Nursing 2022 Drug Handbook". 2. Review of the publisher's website revealed the "Nursing 2025-2026 Drug Handbook" was the most recent edition. 3. In an interview, E1 acknowledged that a current drug reference guide was not available for use by personnel members.