NEVADA ASSISTED LIVING, LLC.

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: Based on interview and record review, the facility staff failed to ensure the required two step tuberculosis (TB - a communicable disease that affects the lungs characterized by fever, cough, and difficulty in breathing) screening test was administered as required when the facility failed to complete the second step of the TB test for three of five sampled staff members (Level One | Medication Aide (LIMA) A, LIMA B, and Support Staff C). The facility census was 21. General requirements for Tuberculosis testing for employees in Long Term Care Facilities, 19 CSR 20-20.100, reads as follows: -Long-term care facilities shall screen their two-step tuberculin test within one month prior to starting employment; -If the initial test is negative, the second test should be given as soon as possible within three weeks after employment begins unless documentation is provided indicating a Mantoux _ PPD test in the past and at least one subsequent annual test within the past two years; -It is the responsibility of the facility to maintain documentation of each employee's tuberculin status. Review showed the facility did not provide a PRINTED: 11/12/2024 FORM APPROVED The Joe Clark Residential Care will continue to ensure all employees have completed the two step Tuberculosis screening. Joe Clark Residential Care Home 41/17/24 has developed a TB policy please see attached. LIMA A starts totake twoset TB screening the week of November 17, 2024. Which will complete the screening on or before December 6, 2024. LIMA B started to take _first step of the two step process and has since notice and will not be Support Staff C.startstoretake =. Two Step TB screening the week ot _ November 17th, 2024. Will be completed on or before December 6th, 2024. Manager/Administrator will post on calendar appointment schedule of each staff member A and C next two step appointment to ensure staff will be reminded when second step can be done and follow up with them on completing the process. This will be the process for all future hire as well. PRINTED: 11/12/2024 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: COMPLETED Cc 23419C I 10/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1495 EAST ASHLAND STREET NEVADA, MO 64772 (x4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) JOE CLARK RESIDENTIAL CARE HOME A4724| Continued From page 1 1. Review of LIMAA's personnel file showed the following: -Hire date of 02/29/24: -Start date of 03/11/24: -On 02/02/24, staff documented the first step of the two-part TB screening test was administered with a negative result noted on 02/05/24; -Staff did not document a second TB test. 2. Review of LIMA B's personnel file showed the following: -Hire date of 06/30/24; -Start date of 07/05/24; -On 06/17/24, staff documented the first step of the two-part TB screening test was administered with a negative result noted on 06/20/24; -Staff did not document a second TB test. 3. Review of Support Staff C's personnel file showed the following: -Hire date of 09/26/24; -Start date of 10/05/24; -On 09/25/24, staff documented the first step of the two-part TB screening test was administered with a negative result noted on 09/27/24; -Staff did not document a second TB test. 4. During an interview on 10/31/24, at 2:41 P.M., the Administrator said the following: -Staff get their TB tests done at the county health department; -Staff do not have resident contact until after the first TB step is read; -Staff are supposed to return to the health department for the second step; Missouri Department of Health and Senior Services STATE FORM e200 DH2R11 if continuation sheet 2 of 3 PRINTED: 11/12/2024 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 Cc 23419C I 10/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1495 EAST ASHLAND STREET NEVADA, MO 64772 (x4) ID SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) JOE CLARK RESIDENTIAL CARE HOME A4724| Continued From page 2 -LIMAA, LIMA B, and Support Staff C have not returned to the health department for their second step; -He/She is responsible for making sure staff have their second step TB test completed. STATE FORM e800 DH2R11 if continuation sheet 3 of 3