Tbi Care, INC

Based on record review, documentation review, and interview, the manager failed to ensure that a manager, a caregiver, assistant caregiver, or a volunteer provide documentation of freedom from infectious Tuberculosis (TB) as specified in R9-10-113. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. A record review of E3’s personnel record revealed, E3 provided one negative TB test on May 13, 2025. A second negative TB skin test was not available for review. 2. A documentation review of the facility's Policies and Procedure titled, "Amendment to Policy and Procedure" stated, “we are modifying the policy and procedures effective 01/01/2025. Our annual TB screening for new hires and current employees will be per state guidelines code R9-10-113-(B)(1)." 3. In an interview, E1 acknowledged documentation of freedom from infectious Tuberculosis (TB) was not provided for E3.

Based on record review, documentation review, and interview, the manager failed to ensure that before or at the time of acceptance of an individual, the individual submits documentation that is dated within 90 calendar days before the individual is accepted by an assisted living facility and: If an individual is requesting or is expected to receive supervisory care services, personal care services, or directed care services: includes whether the individual requires: continuous medical services, continuous or intermittent nursing services, or restraints; and is dated and signed by a: Physician, Registered nurse practitioner, Registered nurse, or Physician assistant. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A record review of R1's medical records revealed, based on the resident's admission dates, the initial or continuation medical authorization form was required. However, it was not provided. 2. A documentation review of the facility's Policies and Procedures titled "Facility Acceptance and Termination of Residency and Resident Rights Policies and Procedures, stated, "The admission process will be completed by the Manager or designee (as appropriate) This process includes: f. Appropriate placement statement signed by a Physician, Physician's assistant, Nurse Practitioner, or Registered Nurse." 3. In an interview, E1 acknowledged an initial physician statement was not available for R1 that indicated if the resident was eligible for assisted living services and if the resident received supervisory care services, personal care services, or directed care services.

Based on record review and interview, the manager failed to ensure that the service plan for a resident receiving directed care services included documentation of the resident's weight, or a statement from a medical practitioner stating that weighing the resident is contraindicated. The deficient practice posed a risk as the service plan to direct services was not followed. Findings include: 1. A record review of R1's service plan revealed, the resident received Directed Care services. Page six of R1's service plan revealed , the section titled “Recent Weights” was blank. A physician statement indicating weighing the resident would be contraindicated was not available for review. 2. In an interview, E1 acknowledged the manager did not ensure R1's service plan contained the resident's weight as required for Directed Care residents.

Based on documentation review, record review, and interview, the health care institution failed to develop and administer a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the documentation was not available during the inspection, and the documentation was not provided within two hours after a Department request. Findings include: 1. A review of facility documentation revealed an undated policy and procedure titled "Evaluating Your Fall Prevention Program". The policy stated: "Evaluation should begin while the program is in the earliest development stages, not after the program is complete. The earlier evaluation begins, the easier it is to collect the data needed to showcase your program's success...Promoting your fall prvention program...Step 1: assess your current situation. Take a realistic look at your community and ask pertinent questions. Is your community concerned about fall prevention or will you need to lay some educational groundwork? Do you believe your local media (radio, tv, newspaper, websites) would support your campaign?" The document was signed by E3 and E4. However, the policy did not include initial training and continued competency training in fall prevention and fall recovery for all staff. 2. A review of facility documentation revealed an undated policy and procedure titled "Fall Prevention" The policy stated "Introduction...Falls are the leading cause of fatal and nonfatal injuries among adults 65 and older...CBOs who want to prevent falls recognize that they must offer effective evidence-based fall prevention programs...The purpose of this guide is to provide information to help CBOs choose and implement evidence-based fall prevention programs based on their organization's goals and clients' needs. It also describes the organizational resources and partners needed to support and sustain the program..." The document was signed by E3 and E4. However, the policy did not include initial training and continued competency training in fall prevention and fall recovery for all staff. 3. In an interview, E1 reported E3 and E4 signed the documents to indicate E3 and E4 received fall prevention and fall recovery training. The Compliance Officer reviewed the two aforementioned policies with E1. E1 acknowledged the facility did not develop a training program for all staff regarding fall prevention and fall recovery.

Based on documentation review, observation, and interview, the manager failed to ensure the means of exiting the facility for a resident who does not have a key, special knowledge for egress, or the ability to expend increased physical effort, controlled or alerted employees of the egress of a resident from the facility to the outside area allowing the resident to be at least 30 feet away from the facility. The deficient practice posed a risk if the facility was unaware of a resident's general or specific whereabouts. Findings include: 1. A review of Department documentation revealed AL10823 was authorized to provide directed care services. 2. A review of the facility's policies and procedures revealed a policy titled "Wandering Resident Checks Policy and Procedure" dated January 25, 2023. The policy stated: "2. The manager or designee will check locks and alarms to ensure they are in working order." 3. During the environmental inspection of the facility, the Compliance Officer observed a shared bedroom occupied by R3 and R4. The bedroom contained a door leading out to the back yard. The Compliance Officer observed the outside area in the back yard allowed residents to be a least 30 feet away from the facility. The Compliance Officer observed the outside area contained a locked gate. However, the door leading to the outside area did not control or alert employees of egress when the door leading out to the backyard was opened. 4. During the environmental inspection of the facility, the Compliance Officer observed a sliding door in the living room area, leading out to the back yard. The Compliance Officer observed the outside area in the back yard allowed residents to be a least 30 feet away from the facility. The Compliance Officer observed the outside area contained a locked gate. However, the door leading to the outside area did not control or alert employees of egress when the door leading out to the backyard was opened. 5. In an interview, E1 acknowledged the doors leading to the outside areas did not control or alert employees of the egress of a resident.