A Dignified Adult Care Home LLC

Based on documentation review and interview, the assisted living home failed to maintain a standardized form for each resident that included the information prescribed in subsection A of this section, except for the information prescribed in subsection A, paragraph 1 of this section, which shall be provided at the time the emergency responder is contacted, for three of three residents sampled. Findings include: 1 . A review of R1's, R2's, and R3's medical records revealed documentation of an emergency medical services (EMS) standardized form was not available for review at the time of inspection. 2 . In an exit interview, the findings were discussed with E1 and no additional information was provided.

Based on record review and interview, the manager failed to ensure one of four sampled employees' or volunteer records contained current medical documentation of freedom from infectious tuberculosis (TB), as specified in R9-10-113; which posed a health and safety risk. Finding Include: 1. Review of the sampled personnel records revealed that E2's record, who lives at the facility, contained no medical documentation of a skin test or any other test that determined if the E2 was free from infectious TB at the time of hire nor anytime since. Based on the start date this was required. 2. In an interview, E1 acknowledged there was no documentation of TB screening for E2 as required.

Based on record review and interview, the manager failed to ensure a resident provided documentation of freedom from infectious tuberculosis (TB) as specified in R9-10-113, for one of six residents' medical records reviewed. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. Review of R2's medical record contained no documentation of freedom from TB as specified in R9-10-113. Based on the date of acceptance this documentation was required. 2. In an interview, E1 acknowledged R2's record had no documentation of freedom from TB as required.

Based on resident record review and interview, the manager failed to ensure that a resident had a written service plan that included the level of service the resident was expected to receive; for one of seven sampled residents. Findings include: 1. A.R.S. \'a7 36-401.16 defines "Directed care services" means programs and services, including supervisory and personal care services, that are provided to persons who are incapable of recognizing danger, summoning assistance, expressing need or making basic care decisions. 2. Review of R3's current service plan dated April 19, 2024 stated the resident required directed care and medication administration services. 3. In interviews, R3 was able to articulate and communicate clearly information when interviewed. E1 stated R3 can recognize danger, summon assistance, express need and make basic care decisions. 4. In an interview, E1 acknowledged that R3 required personal care and the service plan stated the wrong level of care that the resident required.

Based on observation and interview, the manager failed to ensure there was a current drug reference guide that was available for use by personnel members which posed a health and safety risk to the resident if the caregiver was unable to reference a medication a resident was taking. Findings include: 1. During the compliance officer observed the facility was providing medication administration services. The compliance officer requested and was not provided with a current drug reference guide. 2. In an interview, E1 acknowledged there was no current facility drug reference guide available.

Based on documentation reviewed and interview, the manager failed to ensure an employee disaster drill was conducted on each shift every three months and documented which posed a safety risk. Findings include: 1. During an interview, E1 reported the facility had two shifts: First shift from 6:00 AM to 6:30 PM, the second shift from 6:00 PM to 6:30 AM. 2. Based on the documentation provided for the last 12 months, the first shift had three of the four required employee disaster drills conducted June 5, 2023, September 4, 2023, and December 4, 2023. 3. The second shift had two of the four required employee disaster drills conducted on September 4, 2023 and March 2, 2024. 4. In an interview, E1 acknowledged employee disaster drills were not conducted on each shift every three months as required.