A-z Assisted Living Homes, INC

Based on documentation review, record review and interview, the health care institution failed to implement a training program regarding fall prevention and fall recovery training to include initial training and continued competency, for one of two personnel members sampled. The deficient practice posed a risk as organized instruction and information related to resident care and safety was not implemented. Findings include: 1. A review of facility documentation revealed an undated fall prevention and recovery program which included initial training and continued competency in fall prevention and fall recovery. 2. A review of E2's personnel record revealed E2 was hired as a caregiver on February 19, 2024 as a caregiver. Evidence E2 received initial training in fall prevention and fall recovery was unavailable for review. 3. In an interview E2 acknowledged not receiving initial training in fall prevention and fall recovery. 4. In an interview E1 acknowledged E2's personnel record did not contain evidence E2 completed initial fall prevention and fall recovery training as required.

Based on document review, record review and interview, the manager of an assisted living center who contacted an emergency responder on behalf of a resident failed to provide to the emergency responder a written document that included all required documentation, for one of two residents sampled. Findings include: 1. A review of facility quality management reports revealed one incident in March involving the facility calling 911 on behalf of a resident. 2. A review of facility documentation revealed one incident report involving R3 in which a caregiver noticed R3 "was not alert," and when the caregiver "wasn't able to get a reading" of R3's vitals, 9-1-1 was called. R3 was ultimately "transported to the hospital." 3. A review of R3's medical record revealed evidence of the standardized form and documented information provided to the emergency responder was not available for review. 4. In an interview, E1 reported being aware of the implementation of A.R.S. 36-420.02, however E1 acknowledged they had not yet updated the facility documentation to include the standardized form or required information.

Based on documentation review, and interview the manager failed to ensure a caregiver's or assistant caregiver's skills and knowledge were verified and documented before providing physical health services, for two of two caregivers sampled. The deficient practice posed a risk if employees were unable to meet the needs of residents. Findings include: 1. A review of E2's personnel record revealed E2 was hired as a caregiver on February 19, 2024. Evidence indicating E2's skills and knowledge were verified and documented before providing physical health services was unavailable for review. 2. A review of E3's personnel record revealed E3 was hired as a caregiver on October 15, 2022. Evidence indicating E3's skills and knowledge were verified and documented before providing physical health services was unavailable for review. 3. A review of the facility's policies and procedures, updated January 2023 revealed a policy covering verification and documentation of a caregiver's or assistant caregiver's skills and knowledge prior to providing physical health services or behavioral health services was unavailable for review. 4. In an interview, E1 reported not having a policy regarding the verification and documentation of a caregiver's or assistant caregiver's skills and knowledge prior to providing services. E1 agreed evidence of documentation of verification of E2's or E3's skills and knowledge was unavailable for review.

Based on record review and interview, the manager failed to ensure medication administered to a resident is administered in compliance with a medication order for one of two residents sampled. Findings include: 1. A review of R1's medical record revealed a service plan which indicated R1 received personal care and administration of medication. The medical record contained a doctor's order, dated March 5, 2024, directing R1 take "Lorazepam [1 MG] Tablet, 1 Tablet 1 times a day," and "Pregabalin [75 MG] Capsule, 1 Capsule Oral 1 times a day." 2. A review of R1's Medication Administration Record (MAR) for March 2024 revealed a section documenting the administration of Lorazepam was unavailable for review. The MAR did contain a section for documenting "Pregabalin Cap 75 MG," however the section reflected the medication was being administered every twelve hours at "8AM" and "8PM." 3. In an interview E1 acknowledged R1's medication was not being administered as ordered.

Based on observation, documentation review, and interview, the manager failed to ensure policies and procedures were implemented for discarding medication. The deficient practice posed a risk if medications were not properly disposed of and if the standards expected of employees were not followed. Findings include: 1. During a tour of the facility the Compliance Officer observed a cabinet in the kitchen which was not secured and able to be opened with little effort. Inside, the Compliance Officer observed a plastic bin filled with numerous medication bottles with labels identifying R1, R2, or R3, which contained the following medications: "Mirtazapine 30 MG Tabs, amLODIPine Besyl 10 MG Tabs, Atorvastatin 40 MG Tabs, Acetaminophen 500 MG Tabs, Tylenol PM, Melatonin 5 MG Chew, Dextromethorphan HBr, 30 mg with Guaifenesin, 600 mg Tabs, Triamcinolone Acetonide Cream USP, 0.5%, Losartan Pot Tab 50MG, Sertraline Tab 50MG, Diphenhydramine 25MG, Hydroxyzine Pam 25 mg, Diphenhydramine 25MG, Tramadol HCL Tab 50MG, DULoxetine HCL 60 MG." Also in the plastic bin were two medication organizers, with sections "am," or "pm" for each day of the week. Each section contained unidentified medications. The Compliance Officer observed a drawer under a kitchen counter which was unsecured and able to be opened with little effort. Inside the Compliance Officer observed a medication bottle with a label identifying R2. The bottle contained "Atorvastatin 20 MG." 2. A review of facility policy and procedures, reviewed January, 2023, revealed a policy titled, "Medications Left Behind by a Resident." The policy stated, "When a resident moves out of the home, all medications, including over-the-counters, should go with resident if possible." The policy further stated, "1. If the resident dies, prescriptions medications are to be destroyed." 3. In an interview, E1 reported reported E1, E2, and E3 were no longer residents at the facility. E1 advised R1 had left the facility on March 15, 2024, and R3 had left the facility on December 17, 2023. R1 indicated R2 had passed away at the facility on December 24, 2023. E1 acknowledged the medication had not been transferred or discarded according to the facility's policy.

Based on observation and interview, the manager failed to ensure the hot water temperature was maintained between 95 \'b0F and 120 \'b0F in areas of the assisted living facility used by residents. Findings include: 1. During a tour of the facility the Compliance Officer observed the hot water temperature measured at 145.6 \'b0F in a shared bathroom. The Compliance Officer observed the hot water temperature in the shower of a bathroom used to bathe residents measured 139.5 \'b0F. 2. In an interview, E1 acknowledged the hot water temperatures were not maintained between 95 \'b0F and 120 \'b0F.