Aging With Dignity

Based on observation, record, review, documentation review, and interview, the manager failed to ensure a designated caregiver 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. The deficient practice posed a risk as no individual was designated to act on behalf of the governing authority in the onsite management of the assisted living facility. Findings include: 1. Upon arrival at the facility, the Compliance Officer was greeted by E2. E2 was the only employee at the facility. 2. A documentation review of the manager designation form, revealed that E2 was not listed as an authorized designated manager in the absence of E1. 3. E1 acknowledged, no manager or designee 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.

Based on record review, documentation review, and interview, the manager failed to ensure that a resident provided evidence of freedom from infectious Tuberculosis before or within seven calendars after the resident's date of occupancy as specified in R9-10-113. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. A record review of R1's medical record revealed, documentation of a TB screening and risk assessment form, was not available for review for R1. 2. A documentation review of the facility's Policies and Procedure titled, "Infection Control" stated, "2. The manager shall ensure that a resident provides evidence of freedom from infectious tuberculosis before or within seven calendar days of the resident's date of occupancy. 3. Employment or admission will be contingent upon compliance with the screening parameters of the policy." 3. In an interview, E1 acknowledged documentation of freedom from infectious Tuberculosis (TB) was not provided for R1.

Based on record review and interview, the manager failed to ensure the health care institution developed and administered a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. Review of E2's and E3's personnel records revealed no documentation indicating E2 and E3 completed fall prevention and fall recovery training. 2. During an email exchange, E4 acknowledged E2 and E3 had not completed a training program for fall prevention and fall recovery.

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with A.R.S. \'a7 36-411, for one of five employees reviewed. The deficient practice posed a risk if the employee was a danger to a vulnerable population. Findings include: 1. A.R.S. \'a7 36-411 states, "A...as a condition of employment in a residential care institution...employees and owners of residential care institutions...shall have valid fingerprint clearance cards... 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..." 2. Review of E2's personnel record revealed a fingerprint card. However, documentation was not available showing a good faith effort to contact previous employers to obtain information or recommendations that may be relevant to E2's fitness to work in a residential care institution. 3. During an interview, E2 reported E2 was hired as an assistant caregiver and started approximately one month ago. 4. During an email exchange, E4 acknowledged documentation was not available showing E2's work references were obtained upon hire at the facility.

Based on observation, documentation review, and interview, the manager failed to ensure documentation was maintained of the caregivers and assistant caregivers working each day, including the hours worked by each. The deficient practice posed a risk as there was no documentation to identify the staff that was present each day to ensure the health and safety of residents. Findings include: 1. The Compliance Officer observed E2 working at the facility at the time of the inspection and E3 was observed sleeping in the garage. 2. During an interview, E2 reported E2 was hired as an assistant caregiver and started approximately one month ago. 3. Review of E3's personnel record revealed E3 was hired as an assistant caregiver and had a hire date of March 15, 2023. 4. During a facility tour, the Compliance Officer observed the posted May 2023 personnel schedule. The personnel schedule revealed no hours worked for E2 and E3. 5. During an interview, E1 reported E3 worked in the facility and the day of the inspection was E3's day off. E1 acknowledged documentation was not maintained of the caregivers and assistant caregivers working each day, including the hours worked by E2 and E3.

Based on record review and interview, the manager failed to ensure an assistant caregiver received orientation that was specific to the duties to be performed before providing assisted living services to a resident, for one of five employees reviewed. The deficient practice posed a risk if the employees were unable to meet resident's needs. Findings include: 1. Review of E2's personnel record revealed no documentation showing E2 had received orientation specific to the duties to be performed. 2. During an interview, E2 reported E2 was hired as an assistant caregiver and started approximately one month ago. 3. During an email exchange, E4 acknowledged documentation was not available showing E2 had received orientation specific to the duties to be performed.

Based on record review, documentation review, and interview, the manager failed to ensure a residency agreement contained provisions allowing a manager to terminate residency of a resident in compliance with A.A.C. R9-10-807(G), for one of one resident reviewed accepted by the assisted living facility on or after October 1, 2019. The deficient practice posed a health and safety risk to the residents. Findings include: 1. Review of R2's medical record revealed a residency agreement. This residency agreement did not include the correct provisions allowing a manager to terminate residency of a resident. The residency agreement did not include the following terms for a 14 day termination: -The primary condition for which the individual needs assisted living services is a behavioral health issue; and -The assisted living services needed by the individual are not within the assisted living facility's scope of services and a home health agency or hospice service agency is not involved in the care of the individual. Based on R2's acceptance date, this documentation was required. 2. Rule review of R9-10-807(G) on or after October 1, 2019 and the facility's policy and procedure titled "Termination of Residency Agreements" stated: "A manager may terminate residency of a resident as follows: 1. Without notice, if the resident exhibits behavior that is an immediate threat to the health and safety of the resident or other individuals in an assisted living facility; 2. With a 14 calendar day written notice of termination of residency: a. For nonpayment of fees, charges or deposits; or b. Under any of the conditions in subsection (C); or 3. With a 30 calendar day written notice of termination of residency, for any other reason." Review of subsection (C) stated: "1. The individual requires continuous: a. Medical services; b. Nursing services unless the assisted living facility complies with A.R.S.36-401(C); or c. Behavioral Health Services; 2. The primary condition for which the individual needs assisted living services is a behavioral health issue; 3. The assisted living services needed by the individual are not within the assisted living facility's scope of services and a home health agency or hospice service agency is not involved in the care of the individual; 4. The assisted living facility does not have the ability to provide the assisted living services needed by the individual; or 5. The individual requires restraints, including the use of bedrails." 3. During an interview, E1 acknowledged R2's residency agreement did not include the correct policy and procedure for an assisted living facility to terminate residency.

Based on observation and interview, the manager failed to ensure medications stored by the facility were stored in a separate locked room, closet, cabinet, or self-contained unit. The deficient practice posed a risk to residents who could access the medication. Findings include: 1. During the facility tour with E1, the Compliance Officer observed Haldol and Lorazepam unlocked in a box in the kitchen refrigerator. The box had a locking device, however was not locked. In addition, the medication cabinet that held R1's and R3's medications was observed unlocked. The cabinet door had a child safety device, however was not locked. 2. During an observation, the caregivers were not accessing the medications at the time of arrival. 3. During an interview, E1 acknowledged medications were stored unlocked.

Based on documentation review, observation, and interview, the manager failed to ensure a dog was licensed with Maricopa County. The deficient posed a risk if a dog allowed into the facility did not meet the Maricopa County licensing requirements. Findings include: 1. Review of the Maricopa County Animal Care and Control website stated "all dogs three months of age and older are required to have a license..." 2. During the facility tour, O1 was observed. O1 appeared to be older than three months of age. 3. Documentation of a license with Maricopa County was not available for O1. 4. During an email exchange, E4 acknowledged documentation was not available showing O1 had a current Maricopa County license.