Alert Adult Care, INC

Based on documentation review and interview, the manager failed to ensure a disaster drill for employees was conducted on each shift at least once every three months and documented. The deficient practice posed a risk if employees were unable to implement the disaster plan. Findings include: 1. Review of the October 2024 personnel schedule revealed two shifts: 7:00 am-7:00 pm and 7:00 pm -7:00 am. 2. Review of the facility's employee disaster drills revealed disaster drills conducted on the following dates and times: -October 4, 2024 at 10:00 am -September 4, 2024 at 8:00 am -August 5, 2024 at 8:00 am 3. In an interview, E1 acknowledged a disaster drill for employees was not conducted on each shift at least once every three months and documented.

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 two of three residents sampled. Findings include: 1. A review of R1's medical record revealed no documentation of R1's orientation being provided within 24 hours after acceptance. 2. A review of R3's medical record revealed an orientation form. Based on R3's acceptance date, the orientation was not provided within 24 hours after acceptance. 3. In an interview, E1 acknowledged R1 and R3 did not have proper documentation of being oriented 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.

Based on documentation review and interview, the manager failed to ensure a pest control program compliant with Arizona Administrative Code (A.A.C.) R3-8-201(C)(4) was implemented. Findings include: 1. A.A.C. R3-8-201(C)(4) states: "4. An individual may not provide pest management services at a...health care institution...unless the individual is a certified applicator in the certification category for which services are being provided." 2. A review of facility documentation revealed no documentation was available at the time of inspection to reflect pest control service was conducted by a certified applicator. 3. In an interview, E1 reported pest control services were completed by a certified applicator; however, documentation was not available for review.

Based on documentation review and interview, the governing authority failed to administer a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk if facility staff were not properly trained to assist a resident who had fallen and was unable to recover independently. Findings include: 1. A review of facility documentation revealed an incomplete training program for all staff regarding fall prevention and fall recovery. 2. In an interview, E1 reported that a training program for fall prevention was created; however, it did not include fall recovery. 3. In an interview, E1 acknowledged a documented training program for all staff regarding fall prevention and fall recovery was not available for review at the time of the inspection. This is a repeat deficiency from the compliance inspection and complaint investigation conducted on January 24, 2024.

Based on record review and interview, the manager failed to ensure that for three of three residents sampled, a standardized emergency responder patient information form that included the information as described in subsection A, was completed and maintained for each resident. The deficient practiced posed a risk as required patient information was not prepared in case of an emergency. Findings include: 1. A review of R1's, R2's, and R3's medical records revealed they did not contain the completed emergency responder patient information documentation required in Arizona Revised Statute (A.R.S.) \'a7 36-420.04(A)(1) through (9). 2. In an interview, E1 acknowledged the information required in A.R.S. \'a7 36-420.04 was not prepared in a standardized emergency responder patient information form as required.

Based on record review and interview, the manager failed to ensure a resident or resident's representative received a complete written copy of the requirements in subsection (B) and the resident rights in subsection (C) at the time of admission, for two of three sampled residents. The deficient practice posed a risk if the resident was not informed of their rights. Findings include: 1. A review of R2's medical record revealed documentation to indicate R2 or R2's representative received a written copy of the requirements in subsection (B) and the resident rights in subsection (c); however, it was not signed at the time of admission. 2. A review of R3's medical record revealed documentation to indicate R3 or R3's representative received a written copy of the requirements in subsection (B) and the resident rights in subsection (c); however, it was not signed at the time of admission. 3. In an interview, E1 acknowledged there was documentation to indicate R2 and R3 and/or their representatives were given a written copy of the resident rights; however, it was not provided on the date of admission.

Based on documentation review, observation, and interview, the manager failed to ensure a means of exiting the facility for a resident who did 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 the facility was 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 observed the front door and backdoor to have alerts installed on them; however, the alerts were not functioning at the time of the inspection. Upon opening each of the two doors, the Compliance Officer did not hear an alert. 3. In an interview, E1 reported that the alerts were purchased approximately a year ago and maintenance was out to repair them months ago; however, E1 was unsure why they were not working. 4. In an interview, E1 acknowledged the front and back doors of the facility did not alert employees of the egress of a resident from the facility.

Based on observation, record review and interview, the manager failed to ensure medication administered to a resident was administered in compliance with a medication order, for two of three sampled residents. Findings include: 1. A review of R1's medical record revealed a medication order dated May 13, 2024 for Losartan 50 mg to be administered one tablet once daily. R1's pre-packaged medication reflected Losartan 100 mg. R1's MAR dated October 2024 revealed R1 was administered Losartan 100 mg from October 1, 2024 through October 21, 2024 at 8:00 a.m. daily. 2. A review of R1's MAR dated October 2024 revealed R1 was administered Amlodipine 10 mg one tablet once daily from October 1, 2024 through October 21, 2024 at 8:00 a.m. daily. There was no medication order or discontinued order for Amlodipine 10 mg to be administered once daily. 3. A review of R3's medical record revealed a medication order dated July 16, 2024 and authorized by the Physician Assistant Certified (PA-C) on October 21, 2024 during this inspection for Gabapentin 300 mg one tablet twice daily. R3's pre-packaged medication reflected Gabapentin 100 mg one tablet twice daily. R3's MAR dated October 2024 revealed Gabapentin 300 mg was discontinued and was administered to R3 at 8:00 pm on October 1, 2024. R3's MAR also revealed that Gabapentin 100 mg one tablet twice daily was administered to R3 from October 1, 2024 through October 20, 2024 at 8:00 am and 8:00 pm, and 8:00 am on October 21, 2024. There was no documentation of a discontinued order for Gabapentin 300 mg one tablet twice daily. There was no medication order for Gabapentin 100 mg one tablet twice daily. 4. A review of R3's medication revealed the following medication in R3's medication bin: Nitrofurantoin Mono-MCR 100 mg one tablet twice daily for 10 days filled on October 21, 2024. R3's pre-packaged Nitrofurantoin revealed one dose was administered to R3. 5. A review of R3's medical record revealed there was no documentation of a medication order for Nitrofurantoin Mono-MCR 100mg, and there was no documentation in R3's record of a verbal order. R3's October 2024 MAR did not reflect any dose of Nitrofurantoin Mono-MCR 100mg was given. 6. A review of R3's medical record revealed a medication order dated July 16, 2024 and authorized by the PAC on October 21, 2024 during this inspection for Arthritis Pain ER 650 mg (generic for Tylenol) two tablets every eight hours as needed which was discontinued. Observation of R3's pre-packaged medication for Arthritis Pain ER 650 mg two tablets every eight hours as needed was filled on October 15, 2024. A review of R3's MAR dated October 2024 reflected R3 was given Tylenol 1,000 mg three times a day at 8:00 am, 12:00 pm, and 8:00 pm; however, there was no documentation of a medication order for Tylenol 1,000 mg. 7. A review of R3's MAR dated October 2024 revealed R3 was administered Fiber-Lax 625 mg two tablets four times a day for ten days from October 1, 2024 through October 10, 2024

Based on observation, record review, documentation review, and interview, the manager failed to implement policies and procedures for discarding medication that was no longer being given to one resident.. The deficient practice posed a risk as policies and procedures reinforce and clarify the health care institution's standards. Findings include: 1. Observation of R3's medication revealed the following medication in R3's medication bin: Miconazole Nitrate 2% Cream to be applied topically to the affected area twice daily for 14 days. This medication was filled on April 11, 2024. 2. A review of R3's Medication Administration Record (MAR) revealed that Miconazole Nitrate 2% Cream was not administered to R3 in the month of October. 3. A review of facility documentation revealed a policy and procedure titled "Medications" which stated, "such medication will be disposed of by the facility manager or manager designee the last day of the month, as follows: a. offered back to the resident's representative, b. returned to the pharmacy or c. disposed of by mixing the pills with hot water and cooking flour (coffee grinds, or kitty liter may be used if cooking flour is not available), closing the container's lid on securely, and shake. Then scrape the label off the container and toss in the trash. The medication disposal will be recorded in the Medication Disposal Form." 4. In an interview, E1 acknowledged that the policies and procedures were not implemented for discarding or returning medications.

Based on observation and interview, the manager failed to ensure a food menu was prepared at least one week in advance. Findings include: 1. The Compliance Officer observed a food menu was posted on a bulletin board located in the kitchen area; however, the food menu was dated October 7, 2024 through October 13, 2024. 2. In an interview, E1 acknowledged a current food menu was not prepared at least one week in advance.

Based on observation and interview, the manager failed to ensure food stored by the facility was free from spoilage and was safe for human consumption. The deficient practice posed a risk for potential food borne illnesses. Findings include: 1. The Compliance Officer observed Kraft Grated Parmesan Cheese in the refrigerator with an expiration date of March 5, 2021 on the container. There was a bottle of Kraft Barbecue Sauce with an expiration date of July 16, 2021. There was a bottle of Milani 1890 French Dressing with an expiration date of March 31, 2023. 2. In an interview, E1 reported that she was not aware that expired food items were still in the refrigerator and E1 requested that staff immediately throw away any expired foods. 3. In an interview, E1 acknowledged food stored by the facility was not free from spoilage.

Based on observation and interview, the manager failed to ensure a resident's bathroom provided privacy when in use. The deficient practice posed a risk to a resident's right to privacy, per R9-10-810.C.3.a. Findings include: 1. The Compliance Officer observed a shared bedroom for R3 and R4. The shared bedroom contained a bathroom with the toilet in a small area with a door. However, the bathroom did not contain a door or curtain for the bathroom entrance to provide privacy for the shower/bathtub, when in use. 2. In an interview, R3 reported that after showering or taking a bath, R3 utilizes the toilet area with a door to get dressed for privacy; however, R3 acknowledged that there is no privacy when R3 gets out of the shower. 3. In an interview, E1 reported that R3 does not utilize the shower or bathtub in R3's bedroom and instead, R3 uses the common bathroom in the facility. E1 acknowledged R3's and R4's shared bathroom did not provide privacy when in use.

Based on record review and interview, the chief administrative officer failed to implement tuberculosis (TB) infection control activities including baseline screening consisting of assessing risks of prior exposure to infectious TB, determining if the individual had signs or symptoms of TB, and the individual's freedom from infectious TB. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. A review of R2's medical record revealed no documentation of a baseline screening which consisted of assessing R2's risks of prior exposure to infectious TB and determining if R2 had signs or symptoms of TB. Based on the resident's date of acceptance, this documentation was required. 2. A review of E3's personnel record revealed no documentation of a baseline screening which consisted of assessing E3's risks of prior exposure to infectious TB and determining if E3 had signs or symptoms of TB. 3. In an interview, E1 acknowledged baseline screening consistent with R9-10-113(A)(2)(a)(i-ii) was not available in medical and personnel files upon review. E1 reported that E1 would make corrections to these medical and personnel records while Compliance Officer was on-site.

Based on documentation review and interview, the governing authority failed to administer a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk if facility staff were not properly trained to assist a resident who had fallen and was unable to recover independently. Findings include: 1. A review of facility documentation revealed a training program for all staff regarding fall prevention and fall recovery was not available for review. 2. In an interview, E1 acknowledged a documented training program for all staff regarding fall prevention and fall recovery was not available for review at the time of the inspection.

Based on documentation review and interview, the manager failed to ensure policies and procedures were reviewed and updated at least once every three years. The deficient practice posed a risk as policies and procedures reinforce and clarify standards expected of employees. Findings include: 1. A review of facility documentation revealed a policy and procedure manual last reviewed on June 11, 2020. However, documentation to demonstrate the facility's policies and procedures were reviewed and updated at least once every three years was not available for review. 2. In an interview, E1 acknowledged the facility's policies and procedures had not been reviewed and updated at least once every three years.

Based on observation and interview, the manager failed to ensure medication stored by the facility was stored in a locked area. The deficient practice posed a risk to the physical health and safety of residents with access to the medication. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed a box of "Lantus Solostar 100UNIT/ML" (units per milliliter) sitting in the door shelf of a mini-fridge located in the kitchen. The mini-fridge was unlocked and accessible to residents. 2. In an interview, E1 acknowledged medication stored by the facility was not stored in a locked area.

Based on observation and interview, the manager failed to ensure a toxic material stored by the facility was stored in a locked area and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of residents with access to the materials. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed a can of "Oven and Grill Cleaner" in a cabinet underneath the kitchen sink. The cabinet was unlocked and was accessible to residents. 2. In an interview, E1 acknowledged toxic materials stored by the facility were not stored in a locked area and inaccessible to residents. This is a repeat deficiency from the previous compliance inspection conducted on August 4, 2022.