Tbi Care, INC

Based on record review and interview, the manager failed to ensure that when a service plan was updated it was signed and dated by the resident's representative for one of two residents sampled. The deficient practice posed a risk if the service plan was not developed to articulate decisions and agreements. Findings include: 1. A review of R2's medical record revealed a service plan dated February 1, 2025. The service plan indicated that R2 received directed care services. The service plan was signed by the resident, the resident's representative, the RN, and the manager. However, on the service plan update section for May 1, 2025, only the RN and manager had signed. 2. Further review of R2's medical record revealed that while the manager had ensured that R2's service plans were updated every three months for several years, the requirement of having the resident or resident's representative sign at each update was not met. In addition, given that R2 was determined to need directed care services and had an established guardian [representative], R2's guardian needed to sign each of the service plans. As stated above, R2's guardian signed the service plan dated February 1, 2025; however, this was the first time R2's guardian had signed the service plan since February 22, 2023. The following past services plans did not contain the guardian's signature: - May 1, 2023; - August, 1, 2023; - November 1, 2023; - February 1, 2024; - May 1, 2024; - August 1, 2024; and - November 1, 2024. 3. In an interview, E3 acknowledged the aforementioned service plans had not been signed by R2's guardian. E3 also acknowledged understanding of why the guardian needed to sign for R2 given R2's level of care. E3 explained that it was sometimes difficult to get guardians or POAs to sign the service plans in a reasonable amount of time due to distance or lack of availability. This is a repeat deficiency from the compliance inspection conducted on September 9, 2022.

Based on record review and interview, the manager failed to ensure a personnel record for each employee included documentation of compliance with the requirements in Arizona Revised Statutes (A.R.S.) \'a7 36-411(C), for one of three personnel members sampled. Findings include: 1. A.R.S. \'a7 36-411(C) 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 E4's personnel record revealed an employment application. The application included a section to provide previous work history, including "Name of company...dates worked (month/year)... name of supervisor...telephone numbers..." Additionally, the document contained the following spaces: "1st attempt to contact...2nd attempt to contact...3rd attempt to contact... " However, the spaces were blank. The document did not include documented, good faith efforts to contact E4's previous employers to obtain information or recommendations relevant to E4's fitness to work in a residential care institution, and no other documentation was provided for review. 3. In an interview, E1 acknowledged E4's personnel record did not contain the documentation required in A.R.S. \'a7 36-411(C).