Rutledge Ranch Retreat, L L C

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with Arizona Revised Statutes (A.R.S.) \'a7 36-411(C)(1), for one of three personnel members sampled. The deficient practice posed a risk if the personnel member was unfit to work in a residential care institution. Findings include: 1. A.R.S. \'a7 36-411(C)(1) states: "C. Owners shall make documented, good faith efforts to: 1. 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." 2. A review of facility documentation revealed a policy and procedure titled "Staffing Documentation and Recordkeeping" dated December 20, 2013. The policy and procedure stated, "Before an employee is hired the following items will be collected: a. Application...iv. References - VERIFIED." 3. A review of E3's personnel record revealed an application for employment which included work history for E3. However, the review revealed no documentation demonstrating the governing authority made documented, good faith efforts to contact previous employers to obtain information or recommendations that may have been relevant to E3's fitness to work in a residential care institution. 4. In an interview, E1 reported E1 hired E3 through a friend. E1 reported E1 contacted individuals E3 worked with at other assisted living facilities but did not document the contact. E1 reported E1 contacted friends and co-workers of E3, but not E3's previous employers as required by rule. E1 stated, "[It] wasn't really former employers."

Based on documentation review and interview, the manager failed to ensure documentation was maintained for at least 12 months after the last date on the documentation of the caregivers and assistant caregivers working each day, including the hours worked by each. The deficient practice posed a risk as there was no documentation to identify whether qualified staff were present each day to ensure the health and safety of residents. Findings include: 1. A review of facility documentation revealed a series of personnel schedules dated between December 1, 2022, and December 7, 2023. However, the review revealed no personnel schedules dated between January 1, 2023, and February 28, 2023. The schedules for March 2023 and April 2023 revealed E1 worked with an assistant on multiple shifts. However, the schedules did not include the name(s) of the assistant(s). 2. In an interview, when the Compliance Officer notified E1 of the missing schedules for January and February 2023, E1 reported not having them. E1 stated, "I don't know what happened to them" and "That's an oversight."

Based on documentation review, record review, and interview, the manager failed to ensure an employee 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, for two of three personnel members sampled. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. A review of facility documentation revealed a policy and procedure titled "Staffing Documentation and Recordkeeping" dated December 20, 2013. The policy and procedure stated, "Before an employee is hired the following items will be collected: a. Application...v. Tuberculosis Clearance." 2. A review of facility documentation revealed a series of personnel schedules dated between March 1, 2023, and September 29, 2023. The schedules revealed the following: -E3 worked several shifts providing physical health services each month between March 2023 and August 2023; and -E4 worked several shifts providing physical health services each month between May 2023 and September 2023. 3. A review of the personnel records of E3 and E4 revealed a negative TB blood test for E3 dated August 9, 2023, and a negative TB skin test for E4 dated as read on September 29, 2023. No prior documentation of TB tests was provided for E3 or E4. Based on E3's and E4's hire dates, the tests were not provided on or before E3 and E4 began providing services at or on behalf of the facility. 4. In an interview, E1 stated "[E3] didn't get [E3's] TB until later." E1 reported E4 had a TB test done before working at this facility. E1 and E4 reported E1 and E4 tried to obtain the test documentation from E4's previous employer but E4's previous employer would not give E1 or E4 the test documentation.

Based on documentation review, record review, and interview, the manager failed to ensure a caregiver provided current documentation of first aid training and cardiopulmonary resuscitation (CPR) training certification specific to adults before providing assisted living services to a resident, for one of three personnel members sampled. The deficient practice posed a risk if a personnel member was unable to meet a resident's needs during an emergency. Findings include: 1. A review of facility documentation revealed a policy and procedure titled "Cardiopulmonary Resuscitation and First Aid Requirements" dated December 20, 2013. The policy and procedure stated, "Each manager, caregiver, and other applicable employees shall: Obtain CPR training specific to adults which includes a demonstration of the individual's ability to perform CPR. (On-line programs do not meet this requirement unless they include a demonstration of the individual's ability to perform CPR.)" 2. A review of E3's personnel record revealed a photocopy of E3's first aid and CPR training certification specific to adults from "NationalCPRFoundation" dated June 4, 2023. The review further revealed a first aid and CPR training certification specific to adults from "New Life" dated October 14, 2023. 3. A review of the NationalCPRFoundation website revealed a page titled "CPR & First-Aid Certification Class (AED)." The page stated, "Help Save Lives Today with Your Online CPR Certification Training!...The CPR and First-Aid certification program covers all of the necessary information and can be completed in as little as 25 minutes. While it may seem like a lot of information to cover in a short amount of time, the step-by-step instruction and helpful illustrations make the entire process a breeze...CPR and First-Aid certification test: A total of ten questions are presented, seven of which must be answered correctly to receive certification. If you fail the test, no problem, as you can retry as many times as necessary before purchasing your certification...Each of our available courses offer the option of skipping straight to the final exam portion." 4. A review of facility documentation revealed a series of personnel schedules dated between March 1, 2023, and October 14, 2023. The schedules revealed the following: -E3 worked several shifts providing physical health services each month between March 1, 2023, and June 3, 2023, without first aid training; and -E3 worked several shifts providing physical health services each month between March 1, 2023, and October 13, 2023, without valid CPR training. 5. In an interview, E1 reported E3 had first aid and CPR training before June 4, 2023. However, E1 reported not having documentation of the training for E3. E1 acknowledged E3's "NationalCPRFoundation" CPR certification was done online and did not include a demonstration of the E3's ability to perform cardiopulmonary resuscitation as required by rule.

Based on documentation review, record review, and interview, the manager failed to ensure a personnel record for each employee was maintained for at least 24 months after the last date the individual provided services in or for the assisted living facility, for one of one former employee sampled. The deficient practice posed a risk as required information could not be verified for E5. Findings include: 1. A review of facility documentation revealed a policy and procedure titled "Staffing Documentation and Recordkeeping" dated December 20, 2013. The policy and procedure stated, "A facility manager shall ensure that all records required above are maintained throughout the individual's period of employment or service and for at least two (2) years from the individual's last date of employment or service." 2. A review of facility documentation revealed a personnel schedule dated December 1-31, 2022. The schedule revealed E5 worked multiple shifts in December 2022. 3. A review of facility personnel records revealed no personnel record for E5. 4. In an interview, E1 reported E5 was hired as a caregiver but no longer worked at the facility. E1 reported E1 did not have E5's personnel record. E1 reported E5 took E5's personnel record when E5's employment was terminated.

Based on documentation review, record review, and interview, the manager failed to ensure medication administered to a resident was administered in compliance with a medication order, for one of two residents sampled. The deficient practice posed a risk if a resident experienced a change in condition due to improper administration of medication. Findings include: 1. Arizona Administrative Code (A.A.C.) R9-10-811(A)(2)(b) states: "A. A manager shall ensure that: 2. An entry in a resident's medical record is: b. Dated, legible, and authenticated;" 2. A.A.C. R9-10-101(26) states "Authenticate" means: "to establish authorship of a document or an entry in a medical record by: a. A written signature; b. An individual's initials, if the individual's written signature appears on the document or in the medical record; c. A rubber-stamp signature; or d. An electronic signature code." 3. A review of facility documentation revealed a policy and procedure titled "Medications" dated December 20, 2016. The policy and procedure stated, "A medication administered to a resident: Is administered in compliance with a medication order." 4. A review of R1's medical record revealed a current service plan which reflected R1 received medication administration services. The review further revealed two medication administration records (MAR) for R1 dated December 2023. The MARs revealed R1 received medication administration for five medications between December 1, 2023, and December 7, 2023. However, R1's medical record contained no authenticated medication orders. The medication orders in R1's medical record included a line stating "Electronically signed by:" with a name typed in, but the typed name did not include an electronic signature code. 5. In an interview, E1 confirmed R1 received medication administration services. E1 reported R1 was on hospice and R1's hospice company sent R1's medication orders without signatures. E1 acknowledged R1's medical record did not contain authenticated medication orders, and therefore, the medications were not administered in compliance with an order.