Life Care Center of Scottsdale

Based on observation, the facility failed to maintain several doors in the building. Failing to maintain doors in the facility could allow heat and/or smoke to transfer, which will cause harm to the patients and for staff.

Based on observation, the facility failed to test the alarm system monthly in the facility.

Violation cited

Violation cited

Violation cited

Violation cited

Based on review of personnel files, staff and resident interviews, and policy review, the facility failed to ensure one Registered Nurse ' s (RN/#33) personnel records were maintained and included copies of a current and valid Fingerprint Clearance Card. The deficient practice could result in potential harm to residents due to a lack of safety and security. Findings include: Review of the personnel files for staff #33 on September 10, 2024 revealed that staff #33 was hired on May 2, 2023, and she did not have a current and valid Fingerprint Clearance Card. Further review of the personnel files revealed that staff #33 was denied a Fingerprint Clearance Card by the Arizona Department of Public Safety on August 20, 2024, and she applied for a Good Cause Exception on September 1, 2024. Review of the punch details for staff #33 on September 10, 2024 revealed she worked 14 shifts from August 24, 2024 to September 8, 2024 without a current and valid fingerprint card. Review of the Fingerprint Clearance Card denial letter on September 11, 2024 revealed that "a residential care institution, nursing care institution or home health agency shall not allow a person to continue to provide direct care, home health services, or supportive services if the person has been denied a Fingerprint Clearance Card pursuant to Arizona Revised Statutes (ARS) 41-12-3.1 and 36-411 unless they meet the requirements of 36-411(F)". At 9:19 a.m. on September 9, 2024, an interview was conducted with resident #339 who stated there was a cruel nurse (RN/#33) who could be mean and made resident #339 upset and uncomfortable. On September 10, 2024, a follow-up interview was conducted with resident #339 who stated that the nurse (RN/#33) gave her a shower in the evening and was left alone with her. Resident #339 stated that the nurse she was referring to was a nurse manager or supervisor who was older, and resident #339 stated it was staff #33. At 10:42 a.m. on September 11, 2024, an interview was conducted with the Executive Director (ED/Staff#102) who stated that staff may or may not have a fingerprint clearance card when they were onboarded, but they should have a fingerprint clearance card if they work on the floor. She stated that the risk of staff not having a current and valid fingerprint card was that the facility would not know the background of that staff, causing the resident to be at a potential risk for harm. Staff #102 also stated that the majority of the facility ' s concern would depend upon if staff was denied a fingerprint card. Review of the Arizona Revised Statutes (ARS) 41-12-3.1 and 36-411 and requirements of 36-411(F) revealed that "an employee, volunteer or contractor of a residential care institution, nursing care institution or home health agency who is eligible pursuant to section 41-1758.07, subsection C to petition the board of fingerprinting for a good cause exception and who provides documentation of having applied for a good cause exception pursuant to s

Based on clinical record reviews, staff interviews, and review of facility policy, the facility failed to ensure one of one sampled resident's (#148) and/or their representatives were informed of the resident's care and treatment when requested. Findings include: Resident #148 was admitted on March 23, 2023 with diagnoses that included subdural hemorrhage, cognitive communication deficit, and atrial fibrillation. Review of a Health Care Power of Attorney, dated March 15, 2006, included the resident's signature and indicated that her son was designated as her agent for all matters relating to her healthcare. Review of the admission information dated March 23, 2023, revealed that Resident #148 was her own responsible party, and her emergency contact was her son, Chad Emerson. A care plan initiated on March 24, 2023, revealed a focus on rehospitalization, with interventions that included discuss with resident/family history of hospitalization. Review of a nursing alert note dated March 25, 2023, revealed that the Resident's daughter-in law called requesting information regarding the resident's plan of care, medication list and health in general, and requested a call from a case manager as soon as possible (ASAP). The note further revealed that Resident #148 gave verbal consent agreeing for her son and daughter-in-law to receive information regarding her care/treatment. Further review of clinical record revealed no evidence that a case manager returned the call to the resident's family per their request. A Health Status Note dated March 25, 2023 at 13:17, revealed that the resident's son called and was upset that no one reached out to him regarding his mother's care plan. The nurse called the resident's son back and left a message that included setting up a care conference with the interdisciplinary team (IDT). Review of the clinical record revealed an IDT late entry dated March 26, 2023, indicating a team of qualified clinicians met to determine the patient's usual performance during the look-back period. Further review of the clinical record revealed no evidence that the resident's son/family had been included in the IDT meeting, or attended the meeting, per their request. Review of an Event Note dated March 27, 2023 at 10:37, revealed that the resident's daughter-in-law and the resident requested nursing interventions, and "demanded" that the resident be transferred to a higher level of care, related to a decline in cognition. Review of a 5-day Medicare Minimum Data Set (MDS) assessment dated March 27, 2023, revealed no evidence of a Brief Interview for Mental Status (BIMS) assessment. A Cognitive Skills for Daily Decision Making assessment indicated that Resident #148, was independent with decisions regarding daily life, with decisions consistent/reasonable. An interview was conducted on September 10, 2024, with a Licensed Practical Nurse, Case Manager (LPN/staff #52), who stated that resident's and their representatives are invited to meet for I

Based on closed record review, staff interviews, and review of facility policy, the facility failed to ensure care and services were provided to prevent pressure ulcers from developing and worsening for one (#144) of one resident. Findings include: Resident #144 was admitted to the facility on April 18, 2023 with diagnoses including major depressive disorder, paraplegia, and multiple sclerosis. Review of the care plan revealed a focus dated April 18, 2023 that the resident was at risk for breaks in skin integrity. The goal of this area was to maintain intact skin with no skin breaks, and interventions including weekly skin checks. Review of the Admission/Readmission Collection Tool completed on April 18, 2023 revealed that on admission, the resident had an open wound to the left heel and blanchable redness to the coccyx. These were the only skin impairments documented in this tool. Review of physician orders revealed an order dated April 18, 2023 that instructed daily wound care for the resident's left heel wound. There is no mention of wound care for any other wounds, indicating the left heel was the only open wound at this time. Further review of physician orders revealed an order dated April 19, 2023 that instructed to complete a weekly skin assessment every Tuesday night. Review of the Minimum Data Set (MDS) dated April 21, 2023 revealed a Brief Interview for Mental Status (BIMS) score of 14, indicating intact cognition. The MDS also revealed that the resident needed maximal assistance to roll and to move from sitting to lying, indicating the resident was largely reliant on staff for repositioning. Further review of the MDS revealed the resident had one unstageable pressure injury present at admission, and he was at risk at developing pressure ulcers. Treatments in place included pressure reducing device for bed, pressure ulcer care, and application of dressings to feet. Further review of the care plan revealed a focus dated April 24, 2023 that indicated the resident had an impairment to skin integrity on the left heel due to pressure. One of the interventions for this focus included weekly treatment documentation, which included measurement of each area of skin breakdown and any other notable changes. There was no mention in the care plan of any other wounds or pressure ulcers. Review of the task "Turn and Reposition" revealed opportunities to chart turning or repositioning a resident every two hours. Review of this task revealed lapses in documentation of turning/repositioning. For example, on April 24, 2023, there was no evidence of the resident being turned or repositioned past 4:00PM, no evidence of turning or repositioning on April 25, 2023, and no evidence of turning or repositioning until 6:00 AM on April 26, 2023. This documentation reflects that the resident was not turned or repositioned from approximately 4:00PM on April 24, 2023 until approximately 6:00AM on April 26,2024. Further review of physician orders revealed an order date

Based on observation, staff interviews, and facility policy, the facility failed to ensure that refrigerated food was not expired. During the initial tour of the kitchen on September 09, 2024 at 8:39AM, conducted with the Dietary Manager (Staff #9), during an observation of the refrigerator, one container of Horseradish was labeled with a received date of 11/8/2023 and opened on 11/10/23. Further observed revealed that the best used by date from the manufacture was April 06, 2024. The Dietary Manager stated that they can use the Horseradish condiment after the used by the date for up to a year. The Dietary Manager immediately throw the horseradish condiment into a trashcan. An interview was conducted on September 11, 2024 at 09:12 AM with the Dietary Manager (Staff #9) and Consultant Dietitian (Staff #185). The Consultant Dietitian stated that the facility process for the expired food is that it should be discarded and thrown away. She further stated that the food can be used after the "best if used by/before". The Consultant Dietitian also stated that the horseradish could be used after the used by date depending on quality and flavor. She further stated that she has not taste tested the flavor or the quality of the horseradish condiment. The Dietary Manager further stated that she does not know when the horseradish condiment was last used. An interview was conducted on September 11, 2024 at 11:33 AM with the Administrator (Staff #102) . who stated that the facility process for expired food is to throw way after the expiration date. She also stated that she expects the Dietary Manager to follow the policy item on how long they should keep the food after the used by date. She further stated that she does not see horseradish condiment on the list and it should not have been used. She Stated that Horseradish condiment should been thrown away. Review of the facility policy titled, Food Storage, revealed that "Best if Used By/before"-gives the recommended shelf life for best flavor or quality. The food can be used safely past this date." It has also revealed that "Date of pack or Manufacture Date refers to when the food was packed or processed for sale, these are not "use by date", however horseradish was not one of the items listed.

Based on clinical records, facility documents, staff interviews, and facility policy, the facility failed to ensure residents wounds were assessed and treated per professional standards for 3 residents. (#11, 4, 19). This deficient practice can result in significant increases in morbidity and mortality related to wounds. Findings include: Regarding Resident #11: -Resident #11 was admitted to the facility on 6/30/2023 with diagnoses of osteomyelitis of the vertebra, sacral and sacrococcygeal region, paraplegia and encounter for surgical aftercare. A care plan initiated 7/2/2023 included that the resident has a break in skin integrity with interventions to provide treatment as ordered and a pressure reducing mattress. An admission Minimum Data Set (MDS) dated 7/20/2023 included this resident is cognitively intact, has 1 stage 4 pressure ulcer and a surgical wound. A CAA(Care Area Assessment) Worksheet included "(Resident #11) has a (history of pressure injury) which has now been treated surgically with flap closure. She is at risk for skin break down (related to) decreased mobility and incontinence. Staff will educate on causative factors for skin breakdown and how to prevent it. Staff will assist within continent care as needed. Staff will perform routine skin assessments to ensure skin integrity. Staff will encourage (patient) to change position at least every two hours to help reduce risk for breakdown (information obtained from hospital notes, clinical note, MARs (Medication Administration Records) /TARs (Treatment Administration Records), and therapy notes added to record in look back period 6/30/2023-7/4/2023)." A hospital record dated 6/30/2023 included that the "The patient may be discharged to (Skilled Nursing Facility) on a low air loss bed. Once transferred the patient is to remain in a lateral (side) or prone position. Follow up in wound clinic in 1 week for repeat exam and suture removal." An admission collection tool dated 6/30/2023 included that the resident had "sutures to the back of left and right leg" and notes that the resident has a "surgical incision" but did not contain measurements. Review of the physician's orders did not find an order for a low air loss bed. Review of the clinical record did not find that a low air loss bed had been implemented. A physician's order dated 7/1/2023 included Cleanse wound with normal saline. Apply Xeroform to wound and wrap with Kerlix every day shift for Wound Care which included that wound care was performed 5 times of 9 opportunities. A physician's order dated 7/1/2023 included to complete weekly skin and Braden assessment UDAs every night shift every Saturday, which included that a skin assessment was performed 1 of 2 assessments. A weekly skin integrity data collection dated 7/7/2023 included that this resident has a surgical incision, however no notes were made regarding the condition of the surgical incision. Review of the clinical record did not find that an assessment was completed o

Based on clinical records, facility documents, staff interviews, and facility policy, the facility failed to ensure residents pressure wounds were assessed and treated per professional standards for 1 residents. (#19). This deficient practice can result in significant increases in morbidity and mortality related to wounds. Findings include: -Resident #19 was admitted on 5/29/2024 with diagnoses of nondisplaced fracture of base of neck of right femur. Review of hospital records dated 5/29/2024 did not include pressure ulcers. An admission MDS dated 6/1/2024 included this resident does not have memory issues and was independent for making decisions for daily life. This MDS was not completed in sections on M Skin Conditions or GG Functional Abilities and Goals. A care plan dated 5/29/2024 did not include pressure ulcers or risk of developing pressure ulcers. An Admission/Readmission Collection Tool included that the resident had a right heel intact clear blister. This note included that the resident was to be seen by the wound team. A progress note dated 5/29/3024 5/29/2024 included that "Patient has large intact blister on right heel that daughter is aware of. Heels floated while in bed and she is to be seen by wound team." A progress note dated 5/30/24 included "wound team here to see and eval R heel blister with new orders for Tx, medicated as prescribed" However, review of the clinical record did not find an assessment or a physician's order for the treatment of the resident's wounds from admission until 6/4/2024. No notes were found regarding a blister/pressure ulcer on the left heel from 5/29/2024 until 6/4/2024. This would indicate that the blister on the left heel was facility acquired. A physician's order dated 6/4/2024 for Saline Wound Wash Solution (Sodium Chloride) Apply to bilateral heel topically as needed for cleansing, then apply foam dressing and to apply protective dressing. This order included to change day shift every 3 days and for soiled or damaged dressing. An observation was conducted on 6/4/2024 at 9:27 A.M. with a RN (staff #7) who greeted resident #19, explained the procedure, then removed wrapped gauze, and a bordered dressing from both heels. This nurse stated that orders should be in the Treatment Administration Record (TAR). This nurse measured a blister on the left heel at 4cm x 2.5cm and stated that it was a closed blister. This nurse then measured the right heel blister as 9cm x 4.5cm with small serosanguinous drainage. This resident's family was in the room during the measurement and stated that the resident's heel was not looked at since admission, however said that they had booties on one night. This nurse looked for the booties found in room and placed on residents' feet. An interview was conducted with a Registered Nurse (RN/staff #7) on 6/3/2024 at 3:11 P.M. who said the nurse admitting the resident is supposed to assess the wounds which would include measuring them. An interview was conducted on 6/4/2024 at 1

Based on clinical records, facility documents, staff interviews, and facility policy, the facility failed to ensure residents wounds were assessed and treated per professional standards for 3 residents. (#11, 4, 19) and failed to ensure residents pressure wounds were assessed for 1 residents. (#19). Findings include: Regarding Resident #11: -Resident #11 was admitted to the facility on 6/30/2023 with diagnoses of osteomyelitis of the vertebra, sacral and sacrococcygeal region, paraplegia and encounter for surgical aftercare. A care plan initiated 7/2/2023 included that the resident has a break in skin integrity with interventions to provide treatment as ordered and a pressure reducing mattress. An admission Minimum Data Set (MDS) dated 7/20/2023 included this resident is cognitively intact, has 1 stage 4 pressure ulcer and a surgical wound. A CAA(Care Area Assessment) Worksheet included "(Resident #11) has a (history of pressure injury) which has now been treated surgically with flap closure. She is at risk for skin break down (related to) decreased mobility and incontinence. Staff will educate on causative factors for skin breakdown and how to prevent it. Staff will assist within continent care as needed. Staff will perform routine skin assessments to ensure skin integrity. Staff will encourage (patient) to change position at least every two hours to help reduce risk for breakdown (information obtained from hospital notes, clinical note, MARs (Medication Administration Records) /TARs (Treatment Administration Records), and therapy notes added to record in look back period 6/30/2023-7/4/2023)." A hospital record dated 6/30/2023 included that the "The patient may be discharged to (Skilled Nursing Facility) on a low air loss bed. Once transferred the patient is to remain in a lateral (side) or prone position. Follow up in wound clinic in 1 week for repeat exam and suture removal." An admission collection tool dated 6/30/2023 included that the resident had "sutures to the back of left and right leg" and notes that the resident has a "surgical incision" but did not contain measurements. Review of the physician's orders did not find an order for a low air loss bed. Review of the clinical record did not find that a low air loss bed had been implemented. A physician's order dated 7/1/2023 included Cleanse wound with normal saline. Apply Xeroform to wound and wrap with Kerlix every day shift for Wound Care which included that wound care was performed 5 times of 9 opportunities. A physician's order dated 7/1/2023 included to complete weekly skin and Braden assessment UDAs every night shift every Saturday, which included that a skin assessment was performed 1 of 2 assessments. A weekly skin integrity data collection dated 7/7/2023 included that this resident has a surgical incision, however no notes were made regarding the condition of the surgical incision. Review of the clinical record did not find that an assessment was completed of the surgical repair