HIGHLAND CREST MEMORY CARE.

Missouri Department of Health and Senior Services AND PLAN OF CORRECTION IDENTIFICATION NUMBER: 23608C B. WING STATEMENT OF DEFICIENCIES. (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION A, BUILDING: PRINTED: 05/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE ARBORS AT HIGHLAND CREST-ALZASSIST, 920 GILASPY ROAD (X4) 1D! SUMMARY STATEMENT OF DEFICIENCIES PREFIX ! (EACH DEFICIENCY MUST BE PRECEDED BY FULL TAG: REGULATORY OR LSC IDENTIFYING INFORMATION) A4724) 19 CSR 30-86.047(19) TB Screen Residents & Staff : The facility shall screen residents and staff for , tuberculosis as required for long-term care facilities by 19 CSR 20-20.100. II This regulation is not met as evidenced by: Class Il : Based on interview and record review, the facility : failed to ensure a two step tuberculosis (TB - a : communicable disease that affects the lungs | Characterized by fever, cough, and difficulty in breathing) test was completed as required upon hire for four of five sampled employees (Housekeeper A, Certified Medication Aide (CMA) : B, Cook C and Personal Care Attendant D). The : facility census was 15. Review of the facility's employee handbook dated January 2020 showed the following: | TB Testing: i -All new employees, including temporary staff and ; Volunteers, who come in contact with residents { must be screened for TB; : ~TB screening may be conducted on a continuing : basis throughout employment according to _ corporation standards or state requirements. : Review of the undated facility policy Employee TB : Testing showed the following: -It is the Administrator's responsibility to assure the TB test is administered and results read prior to an employee beginning employment, and to assure annual testing is completed; -Purpose: To assure that employee have been tested for TB prior to working and do not have : active disease along with annual surveillance in : order to be in compliance with state regulations; ' -All prospective employees will have the first TB Missouri Department of Health and Senior Services LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE OC arsd STATE FORM 6899 KIRKSVILLE, MO 63501 EOBP11 PROVIDER'S PLAN OF CORRECTION FORM APPROVED (X3) DATE SURVEY COMPLETED 04/23/2024 (x5) (EACH CORRECTIVE ACTION SHOULD BE COMPLETE CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) TITLE Admunstrate (X6) DATE 05.14. 24 {f continuation sheet 1 of 3 PRINTED: 05/06/2024 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 23608C B. WING 04/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 620 GILASPY ROAD KIRKSVILLE, MO 63501 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (x5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) ARBORS AT HIGHLAND CREST- ALZ ASSIST L A4724| Continued From page 1 test administered prior to day one of employment. The TB test result may be read on the first day of employment. 1. Revieww of Housekeeper A's employee file showed the following: -Date of hire: 6/13/23; -FirstTST administered 6/13/23; -First TST read: 6/15/23 (two days after first date of resident contact). 2. Review of CMA B's employee file showed the following: -Date of hire: 11/9/23: -First TST administered: 11/9/23; -First TST read: 11/11/23 (two days after first date of resident contact). 3. Review of Cook C's employee file showed the following: -Date of hire: 3/11/24: -First TST administered: 3/26/24; -First TST read: 3/28/24 (17 days after first date of resident contact). 4, Review of Personal Care Attendant D's employee file showed the following: -Date of hire: 4/15/24; -First TST administered: 4/22/24 (administered seven days after first date of resident contact). During an interview on 4/23/24 at 4:30 P.M. the Director of Nursing (DON) said the following: -The first day of orientation is the first day of compensation; -The first TST is administered on the first day of orientation; -She wasn't aware the first TST had to be read by the first date of compensation/date of orientation. During an interview on 04/23/24 at 4:30 P.M., the | Missouri Department of Health and Senior Services STATE FORM B99 EOBP11 if continuation sheet 2 of 3 PRINTED: 05/06/2024 FORM APPROVED Missouri Department of Health and Senior Services STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2}) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED 23608C B. WING 04/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 620 GILASPY ROAD KIRKSVILLE, MO 63501 ARBORS AT HIGHLAND CREST- ALZ ASSIST L (X4) ID SUMMARY STATEMENT OF DEFICIENCIES i PROVIDER'S PLAN OF CORRECTION {X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL i (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) A4724; Continued From page 2 Assistant Administrator said she was not aware that the TB test had to be done and read prior to an employee being in the facility or having contact with the residents. During an interview on 04/30/24 at 1:45 P.M., the Administrator said the following: -The DON is responsible for obtaining the two-step TB tests for new employees; -The DON is responsible for reading the results of the two-step TB tests for new employees; -She was not aware that new employees had been in contact with residents prior to the first TB test being completed and read; -She was not aware that the facility policy indicated that the administrator was responsible “to assure the TB test is administered and results read prior to an employee beginning employment, and to assure annual testing is completed"; -It was her expectation that the first TB test be completed prior to the first contact with residents, | and that a second TB test be completed within 30 days of hire. Missouri Department of Health and Senior Services STATE FORM 6899 EOBP11 If continuation sheet 3 of 3 Provider/Supplier Name: | Arbors at Highland Crest ALZ Assisted Living by Americare Street Address, City, Zip: | 620 Gillaspy Road Kirksville, MO 63501 PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION: (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED 10 THE APPROPRIATE DEFICIENCY] oe are ION The filing of this plan of correction does not constitute any admission of the facility regarding the alleged violation stated in the summary Statement of Deficiencies dated May 6, 2024 by the Department of Health and Senior Services. This plan of correction is filed as evidence of our continuing commitment to provide care in compliance with applicable law. On the initial employment offer date, the DON or assigned designee will administer the first step test of the two-step (Mantoux Method). After a minimum of seventy-two hours and a negative TB test result, the new employee will be allowed to begin their on-site orientation and first day of compensation. The DON will conduct the second part of their TB testing one to three weeks after the new employee's first day and ensure that test result is negative as well. Annual TB testing and result determination for all employees will be conducted by the DON and monitored by the Administrator on an on-going basis. 05/15/2024 To prevent reoccurrence, a systemic onboarding change has been made beginning May 15, 2024 to ensure compliance. Upon an offer being made to the new hire, the DON will conduct a TB test and complete an orientation schedule. The first date of on-site orientation will be scheduled for seventy-two hours after the first step of the initial administration of the TB test to ensure the DON can determine a negative TB result prior to beginning their orientation and training. The Administrator will hold an in- service on the new TB timing policy for all administrative staff including but not limited to the DONs and the Assistant Administrator. The Administrator signing and dating the first page of the CMS-2567/State Form is indicating their approval of the plan of correction being submitted on this form.