Kristal Bell Care Home of Glendale

Based on record review, documentation review, and interview, the manager failed to ensure the health care institution developed and administered a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk if a staff member was not properly trained to assist a resident who had fallen and was unable to recover independently. Findings include: 1. A record review of E3's personnel record revealed that the employee did not receive any Fall Prevention or Fall Recovery training at initial hire. 2. A record review of E1, E2, and E3's personnel records revealed that there was no continued Fall Prevention and Fall Recovery competency training for any of the employees. 3. A documentation review of the facility's policies and procedures, revealed that there was no Fall Prevention and Fall Recovery training section. 4. In an interview, E1 reported not believing that E2 needed training because E2 was hired as a housekeeper. E1 stated that "although ARS 36-420.01 says all staff, it only refers to caregivers." E1 acknowledged that the health care institution did not develop and administer a training program for all staff regarding fall prevention and fall recovery.

Based on observations, documentation review, and interview, the manager failed to ensure the means of exiting the facility for a resident who does not have a key, special knowledge for egress, or the ability to expend increased physical effort, 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. During the environmental inspection, the Compliance Officer observed that none of doors in the facility alerted or alarmed to alert employees that a person was entering or exiting the facility. In order to confirm the lack of alarm, the Compliance Officer opened and closed the front door, kitchen door, and back door multiple times. 2. The Compliance Officer reached up and switched on the alarm at the back door and it alerted. 3. A review of Department documentation revealed the facility was authorized to provide directed care services. 4. A documentation review of the facility's Policies and Procedures "Policy Topic: Wandering Residents", 5. stated " if alarms are being used on doors and/or windows, the caregivers will check them daily for operation and security." 5. A documentation review of Department notes revealed that the facility received technical assistance (TA) during the August 23, 2021 and December 11, 2023 Compliance inspections, regarding the use of alerts/alarms on points of egress. 6. In an interview, E1 revealed that the alarms were purposely turned off because a resident got scared and almost fell when the alarm scared the resident. E1 acknowledged that personnel would not be alerted to a resident exiting the facility due to the alarm or alert on the doors being switched off.

Based on observation and interview, the manager failed to ensure that poisonous or toxic materials stored by the assisted living facility were maintained in labeled containers in a locked area separate from food preparation and storage, dining area and medications are inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During the environmental inspection, the Compliance Officer observed a bottle of Studio 35 Beauty Nail Polish remover and a bag full of nail polish inside an unlocked kitchen sink cabinet. All read keep out of reach of children. In the unlocked laundry room, there was a cabinet with a key in it. Upon opening the unlocked cabinet, there were bottles of laundry detergent, bleach, toilet bowl cleaner, and fabric softener. E1 immediately locked the cabinet and removed the key. 2. In an interview, E1 acknowledged that the manager failed to store the poisonous or toxic materials in a locked separate area from food preparation and storage that was inaccessible to residents.

Based on documentation review and interview, the manager failed to ensure an employee disaster drill was conducted on each shift at least once every three months and documented. The deficient practice posed a risk if employees were unable to implement the disaster plan. Findings include: 1. Review of the December 2023 personnel schedule revealed three shifts; 6am - 2:30pm (day shift), 2pm - 10:30pm (evening shift), and 10pm - 6:30am (night shift). 2. Review of the facility's employee disaster drills revealed the most current disaster drill conducted August 27, 2023 on the day, evening, and night shift. No other employee disaster drills were available after August 27, 2023. 3. In an interview, E1 acknowledged the employee disaster drills were not conducted on each shift at least once every three months.

Based on documentation review, record review, and interview, the manager failed to ensure the policy and procedure and a residency agreement contained provisions allowing a manager to terminate residency of a resident in compliance with A.A.C. R9-10-807(G), for one of one resident reviewed accepted by the assisted living facility on or after October 1, 2019. The deficient practice posed a health and safety risk to the residents. Findings include: 1. Rule review of R9-10-807(G) on or after October 1, 2019 stated: "A manager may terminate residency of a resident as follows: 1. Without notice, if the resident exhibits behavior that is an immediate threat to the health and safety of the resident or other individuals in an assisted living facility; 2. With a 14 calendar day written notice of termination of residency: a. For nonpayment of fees, charges or deposits; or b. Under any of the conditions in subsection (C); or 3. With a 30 calendar day written notice of termination of residency, for any other reason." Review of subsection (C) stated: "1. The individual requires continuous: a. Medical services; b. Nursing services unless the assisted living facility complies with A.R.S.36-401(C); or c. Behavioral Health Services; 2. The primary condition for which the individual needs assisted living services is a behavioral health issue; 3. The assisted living services needed by the individual are not within the assisted living facility's scope of services and a home health agency or hospice service agency is not involved in the care of the individual; 4. The assisted living facility does not have the ability to provide the assisted living services needed by the individual; or 5. The individual requires restraints, including the use of bedrails." 2. Review of the facility's policy and procedure revealed a policy titled "Termination of Residency Agreements" reviewed and signed by E1 April 28, 2023. The policy and procedure did not include the correct provisions allowing a manager to terminate residency without notice. This policy stated "...a. The management will terminate the resident's Residency Agreement without notice if:...c. The resident's urgent medical or health needs require immediate transfer to another health care institution d. The resident's care and service needs exceed the services the facility is licensed to provide..." In addition, the policy and procedure did not include the following terms for a 14 day termination: -The primary condition for which the individual needs assisted living services is a behavioral health issue; and -The assisted living services needed by the individual are not within the assisted living facility's scope of services and a home health agency or hospice service agency is not involved in the care of the individual. 3. Review of R1's medical record revealed a residency agreement. This residency agreement did not include the correct provisions allowing a manager to terminate residency of a resident. The residency agreem

Based on documentation review and interview, the manager failed to ensure an evacuation drill for employees and residents was conducted at least once every six months. The deficient practice posed a risk if employees were unable to implement the evacuation plan. Findings include: 1. Review of the facility's employee and resident evacuation drills revealed the most current drill conducted May 26, 2023. No other employee and resident evacuation drills were available after May 26, 2023. 2. In an interview, E1 acknowledged the employee and resident evacuation drills were not conducted at least once every six months.

Based on documentation review, record review, and interview, the health care institution failed to implement tuberculosis (TB) infection control activities that included annual 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 risk as the caregiver received no organized instruction or information related to TB surveillance. Findings include: 1. Review of facility's documentation revealed a policy titled "Tuberculosis Infection Controls" that stated "...C. Each individual who is employed by the Facility or providing volunteer services for the Facility received annual training and education related to recognizing the signs and symptoms of tuberculosis..." 2. Review of E1's personnel record revealed E1 worked as a manager and had a hire date of May 26, 2009. The personnel record revealed documentation of TB training dated October 3, 2022. However, current training and education related to recognizing the signs and symptoms of TB was not available. 3. In an interview, E1 acknowledged E1 had not completed annual training and education related to recognizing the signs and symptoms of TB. 4. Technical assistance was provided on this Rule during the compliance inspection conducted November 1, 2022.