Orchid Living LLC

Based on documentation review, record review, and interview, the manager failed to ensure that a caregiver who was expected to have more than eight hours per week of direct interaction with residents, provided evidence of freedom from infectious tuberculosis (TB) on or before the date the individual began providing services at or on behalf of the assisted living facility as specified in R9-10-113, for one of two employees sampled. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. R9-10-113.A states "If a health care institution is subject to the requirements of this Section, as specified in an Article in this Chapter, the health care institution's chief administrative officer shall ensure that the health care institution establishes, documents, and implements tuberculosis infection control activities that...2. Include: a. 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, 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)..." 2. A review of the Centers for Disease Control and Prevention website revealed a web page titled, "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005." The web page stated, "If TST (Mantoux Skin Test) is used for baseline testing, two-step testing is recommended for HCWs (Health Care Workers) whose initial TST results are negative. If the first-step TST result is negative, the second-step TST should be administered 1-3 weeks after the first TST result was read." 3. A review of E2's personnel record revealed documentation of a TB skin test that was completed before E2's date of hire, however, a second TB skin test was unavailable. Based on E2's date of hire, this documentation was required. 4. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on record review and interview, the manager failed to ensure that the caregiver documented the services provided in a resident’s medical record according to the resident’s service plan for two out of two residents sampled. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. A review of R1’s medical record revealed a service plan, which included the following: Baths, two times a week. 2. A review of R1’s activities of daily living sheet for March 2026 revealed the following: Baths only given once a week on March 8-14 and March 21-28. 3. A review of R2’s medical record revealed a service plan, which included the following: Skin checks weekly. 4. A review of R2’s activities of daily living sheet for March 2026 revealed the following: Only one skin check was documented on March 1. No other skin check was documented for the entire month. 5. In an exit interview, the findings were reviewed with E1 who reported that the services were provided but not documented properly, and no additional information was provided.

Based on documentation review, record review, and interview, the manager failed to ensure that a resident’s medical record contained documentation of notification of the resident of the availability of vaccination for influenza and pneumonia for two of two residents sampled. The deficient practice posed a potential illness risk to residents. Findings include: 1. A.R.S. § 36-406(1)(d) states "The department shall: 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. The department shall not impose a violation on a licensee for not making a vaccination available if there is a shortage of that vaccination in this state as determined by the director." 2. A review of R1's medical record revealed that a flu and pneumonia vaccine was offered on February 21, 2020. Current documentation of notification of the availability of a vaccination for influenza and pneumonia was not available. Based on R1's date of residency, this document was required. 3. A review of R2's medical record revealed that a flu and pneumonia vaccine was offered on September 15, 2024. Current documentation of notification of the availability of a vaccination for influenza and pneumonia was not available. Based on R2's date of residency, this document was required. 4. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on documentation review, record review, and interview, the manager failed to ensure a personnel record for each employee included documentation of compliance with the requirements in A.R.S. \'a7 36-411(C)(1), for one of three personnel records sampled. The deficient practice posed a risk if E1 was a danger to a vulnerable population. Findings include: A.R.S. \'a7 36-411(C)(1) Owners shall make documented, good faith efforts to: 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. 1. A review of the facility's policies and procedures revealed a policy titled "Obtaining verifications for employees" (dated June 17, 2023). The policy stated " ... All verifications will be done before the employee/volunteer start working at the facility. ... The manager or designee will call to verify the references." 2. A review of E1's (hired in June 2023) revealed E1 was hired as the manager. E1's personnel record revealed a valid fingerprint clearance card. However, documentation of compliance with the requirements in A.R.S. \'a7 36-411(C)(1) was not available for review. 3. In an interview, E1 reported E1 was waiting on the owner of AL11851 to make the documented, good faith efforts to contact E1's previous employers. E1 reported the owner lived out of state. 4. In an interview, E1 acknowledged documentation to demonstrate E1's documentation of compliance with the requirements in A.R.S. \'a7 36-411(C)(1) was not available for review.

Based on record review and interview, the manager failed to ensure a resident's written service plan included the amount, type, and frequency of assisted living services being provided to the resident, for one of two residents sampled. The deficient practice posed a risk as the service plan did not reinforce and clarify services to be provided to a resident. Findings include: 1. A review of R2's medical record revealed a service plan for directed care services (dated in April 2023). The service plan stated "Dressing: Assist in Selecting Clothes Assist in putting on clothes Assist in removing clothes." However, the service plan did not include the amount and frequency of this assisted living service being provided to R2. 2. A review of R2's medical record revealed an activities of daily living (ADL) sheet for July 2023. The ADL sheet stated "Dressing (Daily)." 3. A review of R2's service plan stated "Bladder: ... Totally Incontinent" and "Bowel: ... Totally Incontinent." However, the service plan did not include the amount and frequency of this assisted living services being provided to R2. 4. A review of R2's ADL sheet for July 2023 stated "Bowel Movement (S,M,L)" and "Must be done every 3 hours during day time hours ... Brief Check." 5. In an interview, E1 and E2 acknowledged the amount and frequency of assisted living services being provided to R2 was not included on R2's service plan.