Nicolette Assisted Living Home

Based on record review and interview, the health care institution failed to administer a training program regarding fall prevention and fall recovery, for three of three personnel members sampled. The deficient practice posed a risk as organized instruction and information related to resident care and safety was not implemented. Findings include: 1. Arizona Revised Statutes (A.R.S.) \'a7 36-420.01. states: "A. Each health care institution shall develop and administer a training program for all staff regarding fall prevention and fall recovery. The training program shall include initial training and continued competency training in fall prevention and fall recovery. A health care institution may use information and training materials from the department's Arizona falls prevention coalition in developing the training program." 2. A review of E1's personnel record revealed a fall prevention and Fall recovery training certificate dated August 7, 2023. 3. A review of E2's and E3's personnel record revealed a fall prevention and fall recovery training certificate dated September 5, 2023. 4. In an interview, E1 acknowledged fall prevention and fall recovery was to be a continued competency training program. E1 also acknowledged there were no fall prevention and fall recovery training for 2024 at the time of the inspection.

Based on observation, record review, documentation review, and interview, the manager failed to ensure medication stored by the assisted living facility was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed a risk to residents who were unable to self-administer medications. Findings include: 1. The Compliance Officer observed three pills and an Albuterol Sulfate HFA inhaler 200m on R1's night stand. 2. A review of R1's medical record revealed a service plan dated September 20, 2024. The service plan stated "Medications are locked at all times," and "Staff controls, secures and administers meds." 3. The Compliance Officer observed Mucus Relief 1200mg in the closet of R4's room. 4. A review of R4's medical record revealed a service plan dated July 31, 2024. The service plan stated "Medications are locked at all times," and "Staff controls, secures and administers meds." 5. A review of the facility's policy and procedures revealed a policy titled "Part III- Receiving storing, Inventorying, Tracking and Dispensing Medication" that stated "2. Medication will be locked in the medication storage area." 6. In an interview, E1 acknowledged R1 and R4 received medication administration. E1 acknowledged medications were not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. This is a repeat deficiency from the compliance inspection conducted August 1, 2023.

Based on documentation review, record review, and interview, the health care institution failed to implement tuberculosis (TB) infection control activities including annually providing 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. A review of E1's personnel record revealed a certificate of attendance for "Annual Tuberculosis Risk Education," dated August 7, 2023. However, current training and education related to recognizing the signs and symptoms of TB was not available. 2. A review of E2's and E3's personnel record revealed a certificate of attendance for "Annual Tuberculosis Risk Education," dated September 5, 2023. However, current training and education related to recognizing the signs and symptoms of TB was not available. 3. In an interview, E1 acknowledged current training and education related to recognizing the signs and symptoms of TB was not available for E1, E2, and E3.

Based on record review and interview, the manager failed to ensure the 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 R1's medical record revealed a current written service plan for personal care services dated May 6, 2023. This service plan stated R1 was "Bed Bound" and required "Turn(ing) every 2-3 hours in bed". However, documentation was not available indicating this service was provided July 1st - present. 2. In an interview, E1 acknowledged R1's medical record did not include documentation of turning the resident and reported the service was provided as indicated in the service plan.

Based on record review, observation, and interview, the manager failed to ensure a medication was administered in compliance with a medication order, for one of two residents reviewed. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. Review of R2's medical record revealed a current written service plan dated July 12, 2023. This service plan indicated R2 received medication administration. 2. Review of R2's medical record revealed a signed medication order dated June 26, 2023. This medication order stated "Clonidine HCL 0.1mg tablet, take 1 tablet(s) oral as needed for a SBP over or equal to 160; may repeat an hour later". Review of R2's medical record revealed R2's systolic blood pressure (SBP) was only documented July 3, 2023, July 10, 2023, and July 17, 2023. 3. Review of R2's medical record revealed a July and August 2023 medication administration record (MAR). These MAR's did not include documentation Clonidine HCL 0.1mg was administered. 4. During an observation of R2's medications, Clonidine HCL 0.1mg was observed. 5. In an interview, E1 reported R2's blood pressure was not taken daily. E1 acknowledged it was unknown if R2's medication was administered in compliance with the available medication order due to not taking R2's blood pressure daily.

Based on observation and interview, the manager failed to ensure medications stored by the facility were stored in a separate locked room, closet, cabinet, or self-contained unit. The deficient practice posed a risk to residents who could access the medication. Findings include: 1. During an environmental inspection of the facility with E2, the Compliance Officer observed Lantus, Morphine Sulfate, Lorazepam, and Humalog unlocked in a box in the kitchen refrigerator. This box had a locking device, however the device was not locked. 2. During an observation, E2 was the only employee at the facility when the Compliance Officer arrived and was not accessing the medications at the time of arrival. 3. In an interview, E1 and E2 acknowledged medications were stored unlocked.

Based on observation and interview, the manager failed to ensure toxic materials stored by the facility were stored in a locked area and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental inspection of the facility with E2, the Compliance Officer observed Great Value toilet bowl cleaner, Clorox bleach, Great Value glass cleaner, and Tide laundry detergent unlocked in the laundry room. The laundry room door had a locking device, however the device was not locked. 2. During an observation, E2 was the only employee at the facility when the Compliance Officer arrived and was not accessing the toxic materials at the time of arrival. 3. In an interview, E1 and E2 acknowledged toxic materials were stored unlocked.