Adobe Country Gables

Based on observation, documentation review, and interview, the manager failed to designate, in writing, a caregiver who was present on the assisted living facility’s premises and accountable for the assisted living facility when the manager was not present on the assisted living facility premises. Findings include: 1 . When the Compliance Officer arrived at the facility at approximately 9:15 AM, the Compliance Officer observed E3 was the only personnel member on site. 2 . A review of facility documentation revealed a "Delegation of Authority." However, the "Delegation of Authority" did not include E3 as a designated caregiver when E1 was not present at the assisted living facility premises. 3 . 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 a resident provided evidence of freedom from infectious tuberculosis (TB) before or within seven calendar days after the resident's date of occupancy and as specified in R9-10-113, for two of two residents sampled. Findings include: 1 . A review of R1's medical record revealed documentation of a negative TB blood test. However, documentation of a TB signs and symptoms screening and risk assessment was not available for review at the time of inspection. 2 . A review of R2's medical record revealed documentation of a negative TB test or documentation of a TB signs and symptoms screening and risk assessment was not available for review at the time of inspection. 3 . 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 the signature of the resident or the resident's representative was on the residency agreement before or within five working days after the resident's acceptance, for one of two residents sampled. Findings include: 1 . A review of R2's medical record revealed a residency agreement. The residency agreement was signed by the manager. However, the residency agreement was not signed by the resident or the resident's representative. 2 . In an exit interview, the findings were discussed with E1 and no additional information was provided.

Based on observation, documentation review, and interview, the manager failed to ensure there was a means of exiting the facility for a resident that monitors or alerts employees of the egress of a resident from the facility. The deficient practice posed a risk if the facility was unaware of the general or specific whereabouts of a resident. Findings include: 1 . During an environmental inspection of the facility, the Compliance Officer observed an alert placed on the back door of the facility leading to the backyard. However, when the Compliance Officer opened the back door, the alert was not functional. 2 . A review of facility documentation revealed no monitoring system for the back door. 3 . In an exit interview, the findings were discussed with E1 and no additional information was provided.

Based on observation and interview, the manager failed to ensure at least the manager or a caregiver was present at an assisted living home when a resident was present in the assisted living home. The deficient practice posed a risk as no qualified employee was present to meet a resident's needs. Findings include: 1. In an on-site complaint investigation, the Compliance Officer observed six residents residing at the facility. 2. In an interview, O1 reported the caregiver on shift, E2, was removed from the facility and the facility had no caregiver on-site. O1 reported a caregiver from a neighboring facility came in to support while O1 contacted E1 to come to the facility. E1 did not have a vehicle available; however, O1 was able to pick up and transport E1 to the facility. 3. In an interview, E1 reported E1 received a call from O1 while at home and did receive a ride to the facility to come and take care of the residents after E2's sudden removal. 4. In an interview, E1 acknowledged at least a manager or caregiver was not present at an assisted living home when a resident was present in the assisted living home.

Based on documentation review, record review and interview, the manager failed to ensure a written service plan included the correct level of service the resident received for two of two residents reviewed. The deficient practice posed a risk as the service plan did not reinforce and clarify services to be provided to a resident. Findings include: 1. A.R.S. \'a7 36-401.50 defines "Supervisory care services" to mean general supervision, including daily awareness of resident functioning and continuing needs, the ability to intervene in a crisis and assistance in the self-administration of prescribed medications. 2. A.R.S. \'a7 36-401.41 defines "Personal care services" to mean assistance with activities of daily living that can be performed by persons without professional skills or professional training and includes the coordination or provision of intermittent nursing services and the administration of medications and treatments by a nurse who is licensed pursuant to title 32, chapter 15 or as otherwise provided by law. 3. R9-10-101.135 defines "Medication administration" means restricting a patient's access to the patient's medication and providing the medication to the patient or applying the medication to the patient's body, as ordered by a medical practitioner. 4. A review of R3's medical record revealed a written service plan for supervisory care services dated July 9, 2024. However, the service plan had "Medications/Treatments... Provides Medication Administration" checked as a service provided to R3. 5. A review of R5's medical record revealed a written service plan for supervisory care services dated January 4, 2024. However, the service plan had "Medications/Treatments... Provides Medication Administration" checked as a service provided to R5. 6. In an interview, E1 reported E1 administers all residents' medications, including R3's and R5's medication. 7. In an interview, E1 acknowledged R3's and R5's service plan did not include the correct level of service.

Based on record review and interview, the manager failed to ensure a resident received orientation to the exits from the assisted living facility and the route to be used when evacuating the assisted living facility within 24 hours after acceptance, for one of two residents sampled. Findings include: 1. A review of R1's medical record revealed an orientation form signed on June 21, 2024. However, the signed date was not within 24 hours after acceptance. 2. In an interview, E2 acknowledged documentation was not completed showing R1 was oriented to the facility's evacuation routes and plans 24 hours after acceptance.

Based on observation, documentation review and interview, the manager failed to ensure a dog or cat allowed in the facility was vaccinated against rabies. The deficient posed a risk if a dog allowed into the facility did not meet the vaccination requirements. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed a dog walking around the facility. 2. A review of facility documentation revealed documentation of vaccination against rabies for the dog was not available for review at the time of inspection. 3. In an interview, E2 reported being sure they had the documentation but was unable to locate it. E2 acknowledged not having documentation of vaccination against rabies for the dog.

Based on interview and record review, the manager failed to ensure a resident's medical record contained a medication order from a medical practitioner for each medication administered to the resident, for one of two residents sampled. The deficient practice posed a risk as administered medication could not be verified against a medication order. Findings include: 1. In an interview, E2 reported all residents receive medication administration. 2. The Compliance Officer observed a bottle of Lorazepam, a bottle of Senna, and a box of Morphine Sulfate Oral Solution in R2's medication box. 3. A review of R2's medical record revealed signed medication orders for Lorazepam, Senna, and Morphine Sulfate were not available for review at the time of inspection. 4. In an interview, E2 acknowledged R2's medical record did not contain medication orders for each medication being administered for R2.

Based on record review and interview, the governing authority failed to ensure compliance with A.R.S. \'a7 36-411(A), for one of two personnel members sampled. The deficient practice posed a risk if E2 was a danger to a vulnerable population, and the Department was unable to determine substantial compliance during the inspection. Findings include: 1. A review of E2's personnel record revealed a fingerprint clearance card. However, the card expired on June 14, 2012. 2. In an interview, E1 acknowledged E1 failed to ensure E2 had a valid fingerprint clearance card.

Based on documentation review and interview, the manager failed to ensure policies and procedures were reviewed at least once every three years and updated as needed. The deficient practice posed a risk as policies and procedures reinforce and clarify standards expected of employees, and the Department was unable to determine substantial compliance during the inspection. Findings include: 1. A review of the facility documentation revealed the facility was licensed on July 7, 2016. 2. A review of the facility documentation revealed an undated policy and procedure manual. However, documentation of policies and procedures reviewed at least once every three years and updated as needed was not available for review. 3. In an interview, E1 acknowledged E1 failed to ensure policies and procedures were reviewed at least once every three years and updated as needed.

Based on record review and interview, the manager failed to ensure a resident's written service plan was reviewed and updated at least once every three months, for one resident sampled who received directed care services. The deficient practice posed a risk as a service plan reinforces and clarifies services to be provided to a resident, and the Department was unable to determine substantial compliance during the inspection. Findings include: 1. A review of R2's medical record revealed two service plans for directed care services, dated February 2022 and November 2022. However, a reviewed and updated service plan every three months for R2 between February 2022 and November 2022 was not available for review. 2. In an interview, E1 acknowledged E1 failed to ensure a resident's written service plan was reviewed and updated at least once every three months.

Based on documentation review, observation, and interview, the manager failed to ensure the means of exiting the facility for a resident who does not have a key, special knowledge for egress, or the ability to expend increased physical effort, controlled or alerted employees of the egress of a resident from the facility to the outside area allowing the resident to be at least 30 feet away from the facility. The deficient practice posed a risk if the facility was unaware of the general or specific whereabouts of a resident, and the Department was unable to determine substantial compliance during the inspection. Findings include: 1. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. The Compliance Officer observed the back door of the facility allowed a resident to be at least 30 feet away from the facility. However, the door did not control or alert employees of the egress of a resident from the facility. 3. In an interview, E1 acknowledged E1 failed to ensure the means of exiting the facility controlled or alerted employees of the egress of a resident from the facility to the outside area allowing the resident to be at least 30 feet away from the facility.

Based on documentation review and interview, the manager failed to ensure policies and procedures for medication administration were reviewed and approved by a medical practitioner, registered nurse, or pharmacist. The deficient practice posed a risk as policies and procedures reinforce and clarify a facility's standards, a policy and procedure was not reviewed at least once every three years, and the Department was unable to determine substantial compliance during the inspection. Findings include: 1. A review of the facility's policies and procedures revealed a policy titled "Medication" (dated in July 2016). However, the policy did not include a signature from a physician, registered nurse, or pharmacist indicating the policy had been reviewed and approved. 2. In an interview, E1 acknowledged E1 failed to ensure policies and procedures for medication administration were reviewed and approved by a medical practitioner, registered nurse, or pharmacist.