Advanced Care Alh LLC

Based on record review and interview, the manager failed to ensure a personnel record for each employee was maintained throughout the individual’s period of providing services in or for the assisted living facility, for one of four employees. The deficient practice posed a risk as required information could not be verified for E4. Findings include: 1. During the review process, the Compliance Officer observed E4 attending to the needs of the residents. 2. A personnel record was not provided for E4 3. In an interview, E2 acknowledged that a personnel record was not maintained for E4.

Based on record review, documentation review and interview, the governing authority failed to ensure compliance with A.R.S. § 36-411, for four of four employees reviewed. The deficient practice posed a risk if employees were a danger to a vulnerable population. Findings include: 1. A.R.S. § 36-411.C states: "C. Owners shall make documented, good faith efforts to: 1. Contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in a residential care institution, nursing care institution or home health agency. 2. Verify the current status of a person's fingerprint clearance card. 3. Beginning January 1, 2025, verify that a potential employee is not on the adult protective services registry pursuant to section 46-459. If a potential employee is found to be on the adult protective services registry, the residential care institution, nursing care institution or home health agency may not hire the potential employee. 4. On or before March 31, 2025, verify that each employee is not on the adult protective services registry pursuant to section 46-459. If an employee is found to be on the adult protective services registry, the residential care institution, nursing care institution or home health agency shall take action to terminate the employment of that employee. 5. Beginning March 31, 2025, annually reverify that each employee is not on the adult protective services registry pursuant to section 46-459." 2. A review of E1, E2, and E3, personnel records, revealed no APS Central Registry checks completed for any of the employees. E4 did not have a personnel record for review. 3. A review of the APS Central Registry revealed that E1, E2, E3, and E4 were not listed on the registry. 4. A review of the Arizona Department of Public Safety (DPS) web portal at https://psp.azdps.gov/services/cardStatusRequest conducted on on July 2, 2025 revealed that E3’s fingerprint card expired on June 19, 2025. 5. Documentation of the caregivers and assistant caregivers working each day was requested but not provided for review. 6. In an interview, E2 acknowledged that the manager failed to ensure that a personnel record for each employee or volunteer included documentation of compliance with the requirements in A.R.S. § 36-411(C).

Based on observation, record review, documentation review, and interview, the manager failed to verify and document an assistant caregiver's skills and knowledge before the assistant caregiver provided physical health services, for one of three caregivers and assistant caregiver reviewed. The deficient practice posed a risk if the employees were unable to meet a resident's needs. Findings include: 1. During the compliance inspection, E3 was observed working in the facility attending to the needs of the residents. 2. A review of E3's personnel record revealed that on the application for employment, the employee applied to work as a caregiver. 3. E3's personnel record did not contain documentation that skills and knowledge were verified. 4. A review of the facility's Policies and Procedures revealed a section titled, "Employees and Volunteers" which stated, "The hiring individual or manager shall ensure, check and document that each caregivers or assistant caregiver, providing physical health services or behavioral health services have the required skills and knowledge before providing any services to the residents." 5. In an interview, E2 acknowledged that E3's skills and knowledge were not verified and documented before E3 provided physical health services.

Based on record review and interview, the manager failed to ensure that documentation was maintained for at least 12 months after the last date on the documentation of the caregivers and assistant caregivers working each day, including the hours worked by each. The deficient practice posed a risk as required information could not be verified for any of the nine sampled employees. Findings include: 1. The Compliance Officer requested documentation of the caregivers and assistant caregivers working each day, including the hours worked by each. However, documentation of the caregivers and assistant caregivers working each day, including the hours worked by each was not available for review. 2. In an interview, E2 acknowledged that there were no employees schedules available for review for at least the past 12 months because they did not exist.

Based on record review, documentation review, and interview, the manager failed to ensure that an employee provided documentation of freedom from infectious Tuberculosis (TB) as specified in R9-10-113, for two of four employees. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. R9-10-113.A states "If a health care institution is subject to the requirements of this Section, as specified in an Article in this Chapter, the health care institution's chief administrative officer shall ensure that the health care institution establishes, documents, and implements tuberculosis infection control activities that...2. Include: a. For each individual who is employed by the health care institution, provides volunteer services for the health care institution, or is admitted to the health care institution and who is subject to the requirements of this Section, screening, on or before the date specified in the applicable Article of this Chapter, that consists of: i. Assessing risks of prior exposure to infectious tuberculosis, ii. Determining if the individual has signs or symptoms of tuberculosis, and iii. Obtaining documentation of the individual's freedom from infectious tuberculosis according to subsection (B)(1)..." 2. Review of the Centers for Disease Control and Prevention website revealed a web page titled "TB Screening and Testing of Health Care Personnel." The web page stated, "If the Mantoux tuberculin skin test (TST) is used to test health care personnel upon hire (preplacement), two-step testing should be used." 3. A review of E2's personnel record revealed no documentation of freedom from infectious Tuberculosis. 4. A personnel record, including documentation of freedom from infectious Tuberculosis, was not provided for E4 5. A review of the facility's Policies and Procedure titled, "Infection Control" stated "Employment of facility personnel, volunteers, and admission of new residents will be contingent upon compliance with the screening parameters of the policy and AZ DHS Rules and Regulations in regards to TB screening." 6. In an interview, E2 acknowledged that E2 and E4 did not provide documentation of freedom from infectious Tuberculosis.

Based on record review, documentation review and interview, the manager failed to ensure a resident accepted by the assisted living facility submitted documentation signed by a medical practitioner or a registered nurse that stated whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, for one of four residents reviewed. The deficient practice posed a risk if the facility was unable to meet a resident's needs. 1. A review of the “Determination and Authorization For Continued Residency” form for R1, R2, and R3, revealed the forms were not filled out, signed, or dated by a medical professional. 2. A review of the facility's Policies and Procedures titled “Scope of Services” item number 12 read, "The management will ensure that at the time of admission or earlier the resident or the resident representative is required to provide the documentation no older than 90 days for the resident's need of continuous or intermittent nursing services, restraints, or behavior care. Documentation provided has to be signed appropriately. The documentation will be maintained in the resident records." 3. In an interview, E2 acknowledged R1, R2, and R3 did not provide documentation signed by a medical practitioner or a registered nurse that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints. This is a repeat deficiency from the on-site compliance inspection conducted on February 26, 2025.

Based on observation, record review, documentation review, and interview, the manager failed to ensure when a resident has an accident, emergency, or injury that results in the resident needing medical services, a manager shall ensure that a caregiver or an assistant caregiver, documents the following: the date and time of the accident, emergency, or injury; description of the accident, emergency, or injury; the names of individuals who observed the accident, emergency, or injury; the actions taken by the caregiver or assistant caregiver; the individuals notified by the caregiver or assistant caregiver; and any action taken to prevent the accident, emergency, or injury from occurring in the future. The deficient practice posed a risk as there was no plan to ensure the health and safety of residents in an emergency. Findings include: 1. Upon entering the facility, the Compliance Officer observed a conversation between O1 and E2. O1 asked questions about the whereabouts of R1. E2 explained that R1 went by ambulance to the hospital on June 28, 2025. 2. A review of R1's medical record revealed that there was no documentation regarding the resident being transported to the hospital on June 28, 2025. 3. A review of the facility's incident report titled, "A Report of Unusual Occurrence" read, "R9-10-818.(D) When a resident has an accident, emergency, or injury that results in the resident needing medical services, a caregiver or an assistant caregiver immediately notifies the resident's emergency contact and primary care provider." 4. A review of the facility's Policies and Procedures titled, "Medical Emergency" read, "A Report of Unusual Occurrence-Accident Emergency Incident is to be completed. The form is in the facility forms folder." 5. In an interview, E2 acknowledged that the manager failed to ensure that an incident form was completed as required for R1 who needed emergency services for an accident, injury, or emergency.

Based on record review and interview, the manager accepted an individual before the individual submitted documentation, dated within 90 calendar days before the individual was accepted by the facility, to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant, for two of two residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of the medical records for R1 and R2 showed that form titled “Initial Physician Recommendation Form” was blank for R1 and only had R2’s name listed at the top and the date of “5/22/24” at the bottom. Neither form was filled out signed nor dated by a medical professional. 2. In an interview, E1 acknowledged that the “Initial Physician Recommendation Form” for R1 and R2 was not completed as required before admission of a new resident.

Based on documentation review and interview, the manager retained a resident confined to a bed or chair without meeting the requirements in R9-10-814.B.2.a.b.i-iii., including documentation to demonstrate the resident's primary care provider or other medical practitioner examined the resident at least once every six months throughout the duration of the resident's condition; reviewed the facility's scope of services; and signed and dated a determination stating the resident's needs were being met at the facility, for one of three residents sampled who were unable to ambulate and received directed care services. The deficient practice posed a risk if the facility was unable to meet a resident's needs. 1. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. A medical records review of of R1's Service Plan, revealed that that R1 was at the Directed level of care and chairbound. 3. A review of the “Determination and Authorization For Continued Residency” form for R1 was not filled out, signed, nor dated by a medical professional. It was signed by R1’s representative on “4/1/24”. 4. In an interview, E1 acknowledged that there were no valid or current continuation of residency for one of three sampled residents who received Directed Care services..

Based on 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. The deficient practice posed a risk if staff were unaware of the egress of a resident from the facility. Findings include: 1. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. During the environmental inspection of the facility, the Compliance Officer (CO) observed that the patio door in the kitchen did not alert when opened and closed numerous times during the inspection process. 3. During the environmental inspection, from the backyard, the CO opened and entered resident room number two. The door did not alarm or alert. 4. In an interview, E1 acknowledged the doors mentioned previously had either no control or alerts, or the alerts were turned off and could pose a risk to the residents.

Based on documentation review and interview, the manager failed to ensure a disaster plan was reviewed at least once every 12 months. The deficient practice posed a risk as a disaster plan reinforces and clarifies standards expected of employees. Findings include: 1, A review of the facility’s Policy & Procedures section titled “Disaster Plan, Relocation, Records, Meds, Food & Water”, revealed that the signature page was blank for the review period of 2024. The Disaster Plan was lasted reviewed on December 29, 2023. 2. On page two of the Disaster Plan policy, item number eight, stated “The disaster plan is reviewed and the review is documented at least once every 12 months and includes the date and time of the disaster plan review, the names of each employee or volunteer participating in the disaster plan review, a critique of the disaster plan view, and if applicable, recommendations for improvement.” 3. In an interview, E1 acknowledged that the Disaster Plan was not reviewed every 12 months as required.

Based on observation and interview, the manager failed to ensure that poisonous or toxic materials stored by the assisted living facility were maintained in labeled containers in a locked area separate from food preparation and storage, dining area and medications are inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During the environmental inspection, the Compliance Officer (CO) observed a bottle of Great Value multi-purpose cleaner, Sprayway Stainless Steel spray, Wizards Naturals Air Freshener Awesome Kitchen Cleaner, S.O.S. scrubbing pads, Kirkland Dish Detergent, and The Pink Stuff Cleaner, inside two unlocked kitchen sink cabinets. 2. In an interview, E1 reported that the employee thought that it was ok to have toxins in the kitchen as long as they were in spray bottles. E1 acknowledged that poisonous or toxic materials stored by the assisted living facility were not maintained in labeled containers in a locked area separate from food preparation and storage, dining area and medications are inaccessible to residents.