Kiko's Ranch

Based on record review and interview, the manager failed to ensure a resident provided evidence of freedom from infectious tuberculosis (TB) before or within seven calendar days after the resident's date of occupancy and as specified in R9-10-113, for two of two sampled residents. R9-10-113(A)(2)(a) states: 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, baseline 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); Findings include: 1. A review of R1's medical record revealed a TB baseline screening form and a negative chest x-ray. However, the screening form had been left blank. 2. A review of R1's medical record revealed a skin test or blood test for TB was not available for review. However, based on R1's date of admission, completed TB baseline screening was required. 3. A review of R2's medical record revealed a negative skin test for TB. However, a baseline screening form to include an assessment of R2's risks of prior exposure to TB and a determination if R2 had signs or symptoms of TB, was not available for review. Based on R2's date of admission, completed TB baseline screening was required. 4. In an exit interview with E1, the findings were reviewed and no additional information was provided.

Based on documentation review, and interview, the manager failed to ensure documentation was maintained for at least 12 months after the last date on the documentation of the caregivers and assistant caregivers working each day, including the hours worked by each. Findings include: 1. A review of the facility work schedule, for October, 2024, revealed no staff had worked on the "7p-7a" shift on Sunday, October 6, Sunday, October 13, Sunday, October 20, or Sunday, October 27. 2. A review of the facility work schedule, for September, 2024, revealed no staff had worked on the "7p-7a" shift on Sunday, September 1, Sunday, September 8, Sunday, September 15, Sunday, September 22, or Sunday, September 29. 3. In an interview, E1 acknowledged documentation of the caregivers and assistant caregivers who worked during September and October, 2024, including the hours worked by each, had not been provided for review. E1 reported E4 worked every Sunday night but had been accidentally omitted from the schedule.

Based on record review and interview, the manager failed to ensure a resident's written service plan was reviewed and updated no later than 14 calendar days after a significant change in the resident's physical, cognitive, or functional condition, for one of two residents sampled. Findings include: 1. A review of R1's medical record revealed a service plan, dated August 6, 2024, for personal care services. The service plan did not include wound care or document any skin conditions. 2. A review of R1's medical record revealed an order, dated October 10, 2024, which stated, "Diagnosis for order; L buttock..Clean peri-wound with: No rinse cleanser.. clean wound bed with: Hypoclorous salt, Dressing needed: Primary Dressing: Wet Gauze, Secondary Dressing: Foam, How to apply: Cleanse, dry, apply santyl, cover with dressing..change dressings: 2x weekly..may leave open to air 1 hr/day..[Home Health] Thursday - [Hospice] Tuesday - Kiko's Ranch - other days + PRN." 3. A review of R1's medical record revealed an updated wound care order, dated October 24, 2024, indicating the skin condition had continued for more than 14 days. The order stated, "Has collagen placed today. Wait for collagen to dissolve before applying Santyl." 4. In an interview, E1 acknowledged R1's service plan had not been updated within 14 calendar days after R1 had a significant change in skin condition requiring wound care services.

Based on record review and interview, the manager failed to ensure, for one of two sampled residents, a resident's medical record contained the name, address, and telephone number of a hospice service agency involved in the care of the resident. Findings include: 1. A review of R1's medical record revealed a face sheet which included the name and contact information for a hospice service agency. However, when the Compliance Officer requested to review R1's hospice plan of care and follow up instructions, E1 reported R1 was no longer enrolled with that hospice agency and was instead enrolled with a different hospice agency. 2. A review of R1's medical record revealed no documentation which included the name, address, or telephone number of R1's current hospice service agency. 3. In an interview, E1 acknowledged R1's medical record did not contain the name, address, and telephone number of R1's hospice service agency.