Sunrise Adult Care Home #2

Based on interview and record review, the manager failed to ensure a resident's medical record contained the name, address, and contact individual, including contact information, of the hospice agency, any information provided by the hospice agency, or a copy of resident follow-up instructions provided to the resident by the hospice agency, for one of two sampled residents receiving services from a hospice agency. Findings include: 1. In an interview, E2 reported R1 was on hospice. 2. A review of R1's medical record revealed no hospice records were available for review. 3. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on observation and interview, the manager failed to ensure that hot water temperatures were maintained between 95º F and 120º F in areas of an assisted living facility used by residents. The deficient practice posed a health and safety risk for residents. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed a water temperature of 88º F in the south hall bathroom. 2. During an environmental tour of the facility, the Compliance Officer observed a water temperature of 88º F in hall bathroom 2, at sink 1 and 89.4º F at sink 2. 3. In an interview, E2 reported that the facility did not want the residents to burn themselves and turned down the water heater. E2 acknowledged that the hot water temperatures were not maintained between 95º F and 120º F in areas used by residents.

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with A.R.S. \'a7 36-411, for one of five employees. The deficient practice posed a risk if the employee was a danger to a vulnerable population. Findings include: 1. A.R.S. \'a7 36-411 states, "A... as a condition of licensure or continued licensure of a residential care institution, a nursing care institution or a home health agency and as a condition of employment in a residential care institution, a nursing care institution or a home health agency, employees and owners of residential care institutions, nursing care institutions or home health agencies or contracted persons or volunteers who provide medical services, nursing services, behavioral health services, health-related services, home health services or supportive services and who have not been subject to the fingerprinting requirements of a health professional's regulatory board pursuant to title 32 shall have valid fingerprint clearance cards that are issued pursuant to title 41, chapter 12, article 3.1 or shall apply for a fingerprint clearance card within twenty working days of employment or beginning volunteer work... C. Owners shall make documented, good faith efforts to: ...2. Verify the current status of a person's fingerprint clearance card..." 2. Review of E4's personnel record revealed E4 worked as a caregiver and had a hire date of December 1, 2023. The personnel record revealed a fingerprint clearance card issued on April 16, 2018. However, the record did not contain documentation that showed the card was verified with DPS. 3. Review of the Department of Public Safety (DPS) fingerprint clearance card database on February 1, 2024, revealed E4's fingerprint clearance card was valid. 4. In an interview, E1 acknowledged E4's fingerprint clearance card was not verified with DPS.

Based on record review and interview, the manager failed to ensure an employee provided documentation of freedom from infectious tuberculosis (TB) as specified in R9-10-113, for two of five caregivers. 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. Review of the Centers for Disease Control and Prevention 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." 3. Review of E3's personnel record revealed a negative TB skin test that was less than 12 months old, however no additional documentation of freedom from infectious TB was available for review. Based on E3's hire date, this documentation was required. 4. Review of E4's personnel record revealed a negative TB skin test that was less than 12 months old, however no additional documentation of freedom from infectious TB was available for review. Based on E4's hire date, this documentation was required. 5. In an interview, E1 acknowledged E3 and E4 did not provide documentation of freedom from infectious TB as specified in R9-10-113.

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 progress note from Hospice dated December 9, 2023. This document stated "instruct on need to turn patient every two hours, positioning techniques with proper body mechanics...instruct on use of elbow/heel protectors to prevent skin friction". However, documentation was not available indicating these services were provided December 9th - December 12, 2023. 2. In an interview, E1 acknowledged R1's medical record did not include documentation of the above listed services and reported the services were provided.

Based on record review and interview, the manager failed to ensure when a resident had an incident that resulted in the resident needing medical services, a caregiver documented any action taken to prevent the incident from occurring in the future, for one of two residents reviewed who had an incident that resulted in the resident needing medical services. The deficient practice posed a health and safety risk. Findings include: 1. Review of R1's medical record revealed a progress note dated December 13, 2023. The progress note revealed 911 was called for "shortness of breath". E1 reported 911 was called and transported R1 to the hospital. Documentation was not available that showed any action taken to prevent the incidents from occurring in the future. 2. In an interview, E1 acknowledged R1's medical record did not include documentation of any action taken to prevent the incidents from occurring in the future.

Based on record review and interview, the manager failed to ensure the facility did not accept or retain a resident who was confined to a bed or chair because of an inability to ambulate even with assistance, unless the facility obtained a written determination from a medical practitioner, every six months, that stated the resident's needs could be met by the facility and the resident's needs were within the facility's scope of services, for one of two residents reviewed who were confined to a bed or chair. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. Review of R1's medical record revealed a current written service plan for directed care services dated October 20, 2023. This service plan stated "Transfer: with assist of 1 Caregiver". 2. Review of R1's medical record revealed a written determination from R1's medical practitioner signed and dated January 21, 2023. However, documentation was not available that stated R1's needs could be met by the facility and R1's needs were within the facility's scope of services, at least once every six months. 3. In an interview, E1 reported R1 was unable to ambulate even with assistance since acceptance and acknowledged R1's medical practitioner did not provide a written determination at least once every six months.

Based on record review and interview, the manager failed to ensure a service plan included coordination of communications with the resident's representative, family members, and, if applicable, other individuals identified in the resident's service plan, for one of one resident reviewed receiving directed care services. The deficient practice posed a risk if the resident's representative and other individuals identified were unable to participate in decisions concerning the assisted living services the resident was to receive. Findings include: 1. Review of R1's medical record revealed current written service plans for directed care services dated July 20, 2023 and October 20, 2023. These service plans revealed no documentation of coordination of communications with the resident's representative, family members, and, if applicable, other individuals identified in the resident's service plan. 2. In an interview, E1 acknowledged R1's service plans did not include coordination of communications with the resident's representative, family members, and, if applicable, other individuals identified in the resident's service plan. 3. Technical assistance was provided on this Rule during the compliance inspection conducted November 22, 2022.

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 E1, the Compliance Officer observed Windex, Comet, and Lysol toilet bowl cleaner unlocked in the cabinet under R3's bathroom sink. This cabinet did not have locking device. 2. During an observation, the caregivers were not accessing the toxic materials at the time of arrival. 3. In an interview, E1 reported the toxic materials were stored unlocked by the caregiver.

Based on documentation review, record review, and interview, the health care institution failed to establish, document, and implement tuberculosis (TB) infection control activities as specified in R9-10-113. The deficient practice posed a risk as the caregiver received no organized instruction or information related to TB surveillance and posed a TB exposure risk to residents and staff. 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)...c. Annually providing training and education related to recognizing the signs and symptoms of tuberculosis to individuals employed by or providing volunteer services for the health care institution; d. Annually assessing the health care institution's risk of exposure to infectious tuberculosis..." 2. Review of the Centers for Disease Control and Prevention 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." 3. Review of facility documentation revealed a policy titled "TB Testing and Screening". However, this policy did not address an annual training and education related to recognizing the signs and symptoms of TB to individuals employed by or providing volunteer services for the health care institution; or an annual assessment of the health care institution's risk of exposure to infectious TB. 4. Review of R1's medical record revealed no documentation of a risk assessment of prior exposure to infectious TB or a determination if R1 had signs or symptoms of TB. Based on R1's acceptance date, this documentation was required. 5. Review of E1's personnel record revealed E1 worked as a caregiver and had a hire date of July 1, 2017. The personnel record did not include documentation of training and education related to recognizing the signs and symptoms of TB. 6. Review of E2's personnel record revealed E2 worked as a caregiver and had a hire date of August 1, 2021. The personnel record did not include documentation of training