Amanda's Care Home

Based on observation and interview, the licensee failed to ensure that a 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, was monitored 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 general or specific whereabouts of a resident. Findings include: 1 . During the environmental tour of the facility, the Compliance officer observed monitoring devices on the front door and the back door of the facility, however, the monitoring devices were turned off. 2 . In an interview, E1 acknowledged that the licensee failed to ensure that a 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, was monitored or alerted employees of the egress of a resident from the facility.

Based on documentation review and interview, the licensee failed to ensure that the health care institution was annually assessing the health care institution's risk of exposure of infectious tuberculosis. Findings include: 1 . A review of facility documents revealed no Annual Facility assessment for the risk of infectious tuberculosis. The Compliance Officer provided the location for the health care institution to find an example of the annual facility risk assessment for infectious tuberculosis. 2 . In an interview, the licensee failed to ensure that the health care institution was annually assessing the health care institution's risk of exposure of infectious tuberculosis.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance there was a documented residency agreement with the assisted living facility to include whether the manager or a caregiver is awake during nighttime hours, for two of two residents sampled. The deficient practice posed a risk if the resident was not informed of the terms of residency. Findings include: 1. A review of R1's medical record revealed a residency agreement (dated October 2023). However, the residency agreement did not include whether the manager or a caregiver was awake during nighttime hours. 2. A review of R2's medical record revealed a residency agreement (dated March 2023). However, the residency agreement did not include whether the manager or a caregiver was awake during nighttime hours. 3. In an interview, E2 acknowledged the documented residency agreements for R1 and R2 did not include whether the manager or a caregiver was awake during nighttime hours.

Based on record review and interview, the manager failed to ensure a resident's medication was administered in compliance with a medication order for one of two residents sampled. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. A review of R1's medical record revealed a service plan dated October 5, 2023. The service plan indicated R1 received medication administration. 2. A review of R1's medical record revealed a medication order dated September 20, 2023 for Diltiazem 300 milligrams (mg), one tablet daily, hold for systolic blood pressure < 100 and heart rate < 60 beats per minute (BPM). Notify MD. 3. A review of R1's medical record revealed a blood pressure chart that documented R1's vital signs each day. R1's heart rate measured below 60 BPM on the following days with the following readings: -November 4, 2023: 55; and -November 9, 2023: 55. 4. A review of R1's medication administration record (MAR) for the month of November 2023 revealed R1 received medication administration of Diltiazem 300 mg every day from November 1, 2023 to November 13, 2023, including the aforementioned dates where R1's heart rate measured below 60 BPM. 5. In an interview, E2 reported the Diltiazem was held on November 4, 2023 and November 9, 2023 but was documented incorrectly. However, E2 did not believe R1's doctor was notified as directed. 6. In an interview, E2 acknowledged R1 did not receive medication administration for Diltiazem 300 mg in compliance with a medication order.

Based on documentation review, record review, and interview, the manager failed to ensure the facility's policy and procedure and a residency agreement contained provisions allowing a manager to terminate residency of a resident in compliance with A.A.C. R9-10-807.G.2, for one of two residents accepted by the assisted living home. Findings include: 1. A review of the facility's policies and procedures revealed a policy titled, "Termination of Residency Agreement," reviewed and approved January 1, 2023. The policy stated, "The management will provide the resident or resident's representative 30 days written notice before terminating the Residency Agreement except in the following circumstances: ... 2. With a 14 day written notice of termination of residency, for ...documented resident or resident representative noncompliance with the Residency Agreement or Internal Facility Requirements..." 2. A review of R1's medical record revealed a residency agreement. The residency agreement stated the manager may terminate the agreement with 14 days notice for "documented resident or resident representative noncompliance with the Residency Agreement or Internal Facility Requirements..." 3. Rule review of R9-10-807.G.2 stated, "A manager may terminate residency of a resident as follows: 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)" 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. \'a7 36-401(C); or c. Behavioral Health Services; 2. The assisted living services needed by the individual are not within the assisted living facility's scope of services; 3. The assisted living facility does not have the ability to provide the assisted living services needed by the individual; or 4. The individual requires restraints, including the use of bedrails." 4. In an interview, E2 acknowledged the facility's policy and procedure and R1's residency agreement did not include the correct provisions for an assisted living facility to terminate residency with a fourteen day notice.