Kierland Care Assisted Living, LLC

Based on observation, documentation review, and interview, the manager failed to ensure documentation was maintained of the caregivers and assistant caregivers working each day, including the hours worked by each. The deficient practice posed a risk as there was no documentation to identify the staff that was present each day to ensure the health and safety of residents. Findings include: 1. When the Compliance Officer arrived, E1 and E4 were the only personnel working at the facility. 2. Review of the posted personnel schedule dated June 2024 revealed E1 and E2 were scheduled to work the 7am - 7pm shift June 3rd. E4 was not listed on the schedule. 3. During an interview, E2 reported that E4 does not work regularly, only when needed, so was not scheduled. E2 acknowledged documentation was not maintained of the caregivers working each day, including the hours worked.

Based on observation, record review, and interview, the manager failed to ensure a personnel record was available for one of four employees reviewed. The deficient practice posed a risk as required information could not be verified for E4. Findings include: 1. When the Compliance Officer arrived, E4 was present at the facility and observed working in the kitchen. 2. Review of the personnel records revealed no record for E4. 3. During an interview, E2 reported E4 did not have a record because E4 was only called in to work when needed, and was not at the facility "regularly". E2 acknowledged a personnel record was not available for E4.

Based on record review and interview, the manager failed to ensure the assisted living home maintained a standardized form for each resident that included the information prescribed in subsection A of this section for two of two residents reviewed. Findings include: 1. Review of R1's medical record revealed a document titled "Resident Face Sheet". This document contained some of the information required in subsection A of ARS 36-420.04, however it was missing the following: -Whether the resident receives medication services and a list of all the resident's prescription and over-the-counter medications, their dosages and how frequently they are administered; -The name, address and telephone number of the resident's current pharmacy; -A list of any known allergies to any medications, additives, preservatives or materials like latex or adhesive; -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; -A copy of the resident's advance directives, if any, on file at the assisted living center or assisted living home. 2. Review of R2's medical record revealed a document titled "Resident Face Sheet". This document contained some of the information required in subsection A of ARS 36-420.04, however it was missing the following: -Whether the resident receives medication services and a list of all the resident's prescription and over-the-counter medications, their dosages and how frequently they are administered; -The name, address and telephone number of the resident's current pharmacy; -A list of any known allergies to any medications, additives, preservatives or materials like latex or adhesive; -The name and contact information for the resident's primary care physician -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; -A copy of the resident's advance directives, if any, on file at the assisted living center or assisted living home. 3. In an interview, E2 reported that the "Resident Face Sheet" document was the documentation meant to comply with ARS 36-420.04, and that other documentation to comply with ARS 36-420.04 was not available. E2 acknowledged that the required documentation had not been completed for 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 one of two residents reviewed. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. Review of R2's medical record revealed a current written service plan dated September 2, 2023. This service plan stated the following services were needed: -Shampoo/conditioner twice a week; -Sponge bath on non-shower days; -Bed bath "2X weekly"; -Dressing: Full assist; -Grooming: Dependent, comb hair, daily; -Brush teeth, daily -Skin care, PRN lotion, monitor skin integrity, Peri-care as needed with every brief change -Catheter, empty PRN -Colostomy, empty PRN 2. A review of R2's medical record revealed a document titled "Activity of Daily Living" dated January 2024. However, none of the services from R2's service plan were documented as provided January 3rd-18th. 3. During an interview, E2 acknowledged R2's medical record did not include documentation of the above listed services and reported the services were provided as indicated in the service plan.

Based on record review and interview, the manager failed to ensure a resident's medical record contained the date of termination of residency, for one of two terminated residents reviewed. Findings include: 1. A review of R2's medical record revealed R2's date of termination of residency was not available for review. 2. In an interview, E2 reported R2 was no longer a resident at this facility. 3. In an interview, E2 acknowledged that R2's termination date was not included in the medical record.

Based on observation and interview, the manager failed to ensure foods requiring refrigeration were maintained at 41\'b0 F or below. The deficient practice posed a health risk to the residents. Findings include: 1. During the facility tour with E4, the Compliance Officer observed the following in a kitchen cabinet: -an opened bottle of yellow mustard; -an opened bottle of relish; - an opened bottle of "Creamy Caesar"; -an opened bottle of ketchup; and -an opened jar of "Classic alfredo pasta sauce" These containers stated "Refrigerate after opening". 2. The Compliance Officer observed a refrigerator in the kitchen that contained food items. However, the thermometer in the refrigerator measured the temperature of the refrigerator at 55\'b0F. 3. In an interview, E2 acknowledged that foods requiring refrigeration were not maintained at 41\'b0 F or below.

Based on observation, documentation review, record review, and interview, the manager failed to ensure a personnel record for each employee included documentation of the individual's qualifications, including skills and knowledge applicable to the individual's job duties, for four of five caregivers sampled. Findings include: 1. The Compliance Officer observed E4 and E5 on site and providing physical health services to residents during the course of the compliance inspection. 2. A review of facility documentation revealed a staff schedule dated September 2023. The staffing schedule indicated E2, E3, E4, and E5 were scheduled to work as caregivers every day in September 2023. 3. A review of facility policies and procedures revealed a policy titled "Employees and Volunteers Qualifications, Job Descriptions, and Requirements" which stated, "The hiring person or manager will ensure, check and document that each caregiver and assistant caregiver providing physical health services have the required skills and knowledge before providing any services." 4. A review of E2's personnel record revealed a caregiver certificate. However, documentation of E2's qualifications, including skills and knowledge applicable to E2's job duties as a caregiver, were not available for review. 5. A review of E3's personnel record revealed a caregiver certificate. However, documentation of E3's qualifications, including skills and knowledge applicable to E3's job duties as a caregiver, were not available for review. 6. A review of E4's personnel record revealed E4 was hired as a caregiver. However, documentation of E4's qualifications, including skills and knowledge applicable to E4's job duties as a caregiver, were not available for review. 7. A review of E5's personnel record revealed E5 was hired as a caregiver. However, documentation of E5's qualifications, including skills and knowledge applicable to E5's job duties as a caregiver, were not available for review. 8. In an interview, E2 reported E1 and E2 had verified all scheduled caregivers' skills and knowledge prior to the caregivers providing physical health services. However, E2 acknowledged E2's, E3's, E4's, and E5's personnel records did not contain documentation of qualifications, including skills and knowledge.

Based on documentation review, record review, and interview, the manager failed to ensure a personnel record for each employee included documentation of the individual's education and experience applicable to the individual's job duties, for two of five personnel records sampled. The deficient practice posed a risk if the employees were unable to meet a resident's needs. Findings include: 1. A review of facility policies and procedures revealed a policy titled "Employees and Volunteers Qualifications, Job Descriptions and Requirements." The policy stated, "A Caregiver: Has a minimum of three months healthcare related experience. To receive manager delegation of authority to act as manager when the manager is not present at the facility, a caregiver must be at least 21 years or older and has to have at least three years of experience and prove skills and knowledge to act on manager's behalf." 2. A review of facility documentation revealed a staff schedule dated September 2023. The schedule indicated E2 and E3 were scheduled to work as caregivers every day in September 2023. 3. A review of E2's personnel record revealed a caregiver certificate. E2's personnel record also revealed E2 was a manager's designee for when the manager was not present at the facility. However, no documentation of education or experience applicable to E2's job duties was available for review. 4. A review of E3's personnel record revealed a caregiver certificate. E3's personnel record also revealed E3 was a manager's designee for when the manager was not present at the facility. However, no documentation of education or experience applicable to E3's job duties was available for review. 5. In an interview, E2 acknowledged documentation of education and experience applicable to E2's and E3's job duties was not available for review. E2 reported E2 and E3 were the facility's owners and had forgotten to fill out an employment application, or otherwise document education and experience. This is a repeat citation from the previous compliance inspection conducted on September 1, 2022.

Based on documentation review, record review and interview, the manager failed to ensure a personnel record for each employee or volunteer included documentation of compliance with the requirements in Arizona Revised Statutes (A.R.S.) \'a7 36-411(C), for four of five personnel records sampled. Findings include: 1. Arizona Revised Statutes (A.R.S.) \'a7 36-411(C) states "C. Owners shall make documented, good faith efforts to: 1. Contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in a residential care institution, nursing care institution or home health agency..." 2. A review of facility policies and procedures revealed a policy titled "STAFFING AND RECORD KEEPING" which stated, "The facility manager shall insure [sic] that a personnel record for each employee and volunteer includes documentation of compliance with the requirements in A.R.S.\'a7 36-411 (A) and (C) (DPS fingerprinting clearance requirements)." 3. A review of facility documentation revealed a staff schedule dated September 2023. The schedule indicated E2, E3, E4, and E5 were scheduled to work every day in September 2023. 4. A review of E2's, E3's, E4's, and E5's personnel records revealed no documented, good faith efforts to contact previous employers to obtain information or recommendations relevant to E2's, E3's, E4's or E5's fitness to work in a residential care institution. 5. In an interview, E2 reported E2 made good faith efforts to contact previous employers to obtain information or recommendations that may be relevant to E2's, E3's, E4's, and E5's fitness to work in a residential care institution. However, E2 acknowledged no documentation of these efforts was available for review. This is a repeat citation from the previous compliance inspection conducted on September 29, 2023.

Based on record review and interview, the manager failed to ensure a resident's written service plan was signed and dated by the resident or resident's representative, and the manager, for three of three residents sampled. Findings include: 1. A review of R1's medical record revealed a service plan for personal care services updated on July 7, 2023. However, the service plan was not signed and dated by R1 or R1's representative, or the facility manager. 2. A review of R2's medical record revealed a service plan for personal care services updated on September 2, 2023. However, the service plan was not signed and dated by R2 or R2's representative, or the facility manager. 3. A review of R3's medical record revealed a service plan for personal care services updated on April 10, 2023. However, the service plan was not signed and dated by R3 or R3's representative, or the facility manager. 4. In an interview, E2 acknowledged R1's, R2's, and R3's written service plans were not signed and dated by the residents or residents' representatives, or the facility manager.

Based on record review and interview, the manager failed to ensure a resident's medical record contained documentation of notification of the resident of the availability of vaccinations for influenza and pneumonia, according to Arizona Revised Statutes (A.R.S.) \'a7 36-406(1)(d), for two of three residents sampled. Findings include: 1. A.R.S. \'a7 36-406(1)(d) states: "1. The department shall...(d) 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." 2. A review of R1's medical record revealed documentation of notification of R1 of the availability of vaccination for flu and pneumonia was offered on March 10, 2022. However, no documentation to indicate R1 was notified of the availability of influenza and pneumonia vaccinations after March 10, 2022 was available for review. 3. A review of R2's medical record revealed a document titled "Pneumonia and Influenza Shots" which stated, "The department requires that a resident's record contain documentation of vaccination administration that includes the date the vaccine was offered or administered...The department does not require documentation of vaccination administration if: 1. The resident or the representative refuse the vaccination and signs and dates documentation that the resident has received information in [sic] the risk and benefits." The document contained a section for residents or representatives to sign to accept or refuse the vaccinations, however the document in R2's medical record was blank. R2's medical record contained no documentation to indicate R2 was notified of the availability of influenza and pneumonia vaccinations. 3. In an interview, E1 reported E1 believed R1 and R2 were notified of the availability of the vaccinations for influenza and pneumonia in 2023. However, E1 acknowledged documentation of this notification was not available in R1's or R2's medical record. Technical assistance was provided on this rule during the compliance inspection conducted on September 1, 2022.

Based on record review and interview, the manager failed to ensure the facility did not accept or retain a resident who was confined to a bed or chair because of an inability to ambulate even with assistance, unless the resident's primary care provider or other medical practitioner examined the resident within 30 calendar days before acceptance, reviewed the assisted living facility's scope of services, and signed and dated a determination stating the resident's needs can be met by the assisted living facility, for one of two sampled residents who were confined to a bed or chair because of an inability to ambulate even with assistance. Findings include: 1. A review of R2's medical record revealed a service plan dated September 2, 2023. The service plan revealed R2 received personal care services and stated "Medical Diagnosis: Paraplegic...Ambulation: Non-Ambulatory...Mobility: Complete Bed Rest...use of HOYER...Self Propels w/c, if out of bed." 2. Further review of R2's medical record revealed a document titled "Certificate for Non-Ambulatory Resident to Reside in the Group Home." The document stated, "PRIMARY CARE PHYSICIAN, This is to certify the following: 1. That I am the primary care physician of (blank) who is wheelchair/bed confined and cannot ambulate, has approved his/her continued stay in Kierland Care Assited Living LLC 2. That Mr./Ms. (blank) was last seen by undersigned physician last (blank) 3. That I have reviewed the Scope of Service being rendered by said facility 4. That it is therefore determined by the undersigned that said Resident's needs can be met/are being met by the facility within their Scope of Services." The document contained a line for R2's primary care physician to sign, however the line was blank and the document was signed only by R2. 3. In an interview, E2 acknowledged documentation to indicate whether R2's primary care provider or other medical practitioner examined the resident within 30 calendar days before acceptance, reviewed the assisted living facility's scope of services, and signed and dated a determination stating the resident's needs could be met by the assisted living facility was not available for review.