Ridge at the Stratford

Based on record review and interview, the manager failed to ensure a written service plan was updated at least once every three months, for two of two residents sampled receiving directed care services. Findings include: 1. A review of R1's medical record revealed a written service plan for directed care services, dated January 18, 2025. However, there were no further required service plan updates available for review. 2. A review of R2's medical record revealed a written service plan for directed care services, dated January 18, 2025. However, there were no further required service plan updates available for review. 3. In an interview, E1 acknowledged that R1’s and R2's service plans were not updated every three months as required. This is an uncorrected deficiency from the complaint investigation conducted on July 29, 2024, and the compliance inspection and complaint investigation conducted on May 20, 2025.

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 service plan dated January, 2025. The service plan reported the following: - "daily rounds and safety checks - check in on once each night and provide assistance as needed. 2. Review of R1's medical record revealed an ADL record for the month of May 2025. There was no documentation of the nightly checks as indicated in the service plan. 3. In an interview, E1 acknowledged that the caregiver did not document the services provided in R1's medical record. This is a repeat deficiency from the compliance inspections and complaint investigations conducted on March 16, 2023, and February 12, 2024, and the complaint investigations conducted on September 19, 2023, February 16, 2024, and March 27, 2024.

Based on record review and interview, the manager failed to ensure the service plan for two of two sampled residents receiving directed care services included coordination of communications with the resident's representative, family members, or other individuals identified in the resident's service plan. Findings include: 1. A review of R1's medical record revealed a service plan January, 2025. R1's service plan did not include coordination of communication with R1's representative, family members, or other individual identified in R1's service plan. 2. A review of R2's medical record revealed a service plan January, 2025. R2's service plan did not include coordination of communication with R2's representative, family members, or other individual identified in R2's service plan. 3. In an interview, E1 acknowledged R1 and R2's service did not include coordination of communication with the representative, family members, or other individual identified in R1 and R2's service plan.

Based on documentation review, record review, and interview, for one of three residents reviewed, the manager failed to ensure medication was administered to a resident in compliance with a medication order. The deficient practice posed a health and safety risk to a resident who was not administered a medication, as prescribed. Findings include: 1. In record review, R1's medical record (received directed care and medication administration services) included documentation of a medication order, for Permethrin 5% cream, "apply topically once for scabies on all skin from head to toe except around the eyes on day 1, day 2, day 8, day 9, and day 15, for scabies infection." 2. In record review, R1's medication administration record (MAR) included documentation R1 received the medication on July 24, July 25, (day 1, and day 2), August 1, (day 9), and August 8, 2024 (day 16). There was no documentation R1 received the medication on July 31, (day 8) or August 7, 2024 (day 15), as ordered. 3. During in interview, E1 and E2 acknowledged R1's MAR did not include documentation R1 was administered the Permethrin medication as ordered.

Based on documentation review, record review, and interview, the administrator failed to ensure a personnel member provided evidence of freedom from infectious tuberculosis (TB), as specified in Arizona Administrative Code (A.A.C.) R9-10-113(B)(1)(a)(i), for two of five sampled personnel members. The deficient practice posed a potential TB infection risk to residents. Findings include: 1. A.A.C. R9-10-113(B)(1)(a)(i) states: "B. A health care institution's chief administrative officer shall: 1. For an individual for whom baseline screening and documentation of freedom from infectious tuberculosis is required by an Article in this Chapter, as specific in subsection (A)(2)(a), obtain one of the following as evidence of freedom from infectious tuberculosis: a. Documentation of a negative Mantoux skin test or other tuberculosis screening test that: i. Is recommended by the U.S. Centers for Disease Control and Prevention (CDC)..." 2. A review of the CDC website revealed a web page titled "TB Screening and Testing of Health Care Personnel." The web page stated "If the Mantoux tuberculin skin test (TST) is used to test health care personnel upon hire (preplacement), two-step testing should be used." The web page indicated two-step testing involves an initial TST, and if negative, a second TST administered one to three weeks after the initial TST. 3. A review of E3's personnel records (hired in 2023) revealed no documentation of completed initial TSTs for employee. 4. A review of E5's personnel records (hired in 2023) revealed no documentation of completed initial TSTs for employee. 5. In an interview, E1 acknowledged no documentation of evidence of freedom from infectious TB, as specified in A.A.C. R9-10-113(B)(1)(a)(i), for E3 or E5 was available for review.

Based on record review and interview, the manager failed to ensure a resident's written service plan was reviewed and updated at least once every three months, for one of two residents sampled who received directed care services. The deficient practice posed a risk if 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 dated March 19, 2024, for directed care services. No more recent service plan for R2 was available for review at the time of the inspection. 2. In an interview, E1 acknowledged there was no updated service plan for R2 available for review at the time of the inspection.