Angels Paradise Care Home 2

Based on observation, interview, and documentation review, 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. When the Compliance Officer arrived, E3 and E4 were the only personnel working at the facility. 2. During the environmental tour, the Compliance Officer observed a June 2025 work schedule with E3 and E4’s names listed, but no shifts were assigned. 3. A review of facility documentation revealed a May 2025 work schedule with E3 and E4’s names listed, but no shifts were assigned. 4. In an interview, E3 acknowledged that the facility's personnel work schedule did not include documentation of the hours worked by each caregiver. This is a repeat deficiency from the inspections conducted on July 22, 2022, and on August 15, 2023.

Based on documentation review and interview, the health care institution failed to establish, document, and implement tuberculosis (TB) infection control activities, including annually assessing the health care institution's risk of exposure to infectious TB. The deficient practice posed a TB exposure risk to residents and staff. Findings include: 1. A review of facility documentation revealed that no documentation of annually assessing the health care institution's risk of exposure to infectious TB was available. 2. In an interview, E2 acknowledged that an assessment of the health care institution's risk of exposure to infectious TB was not available for review during the inspection.

Based on documentation review and interview, the manager failed to ensure that 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. Findings include: 1. A review of the facility's policy and procedure revealed no documentation indicating that the policies and procedures were reviewed and updated as needed. 2. In an interview, E3 acknowledged there was no documentation available during the inspection showing that the policies and procedures were reviewed at least once every three years.

Based on documentation review, observation, and interview, the manager failed to ensure a resident's medical record was protected from loss, damage, or unauthorized use. The deficient practice posed a risk of protected and sensitive resident health information being disclosed without the resident's consent or knowledge. Findings include: 1. A.R.S. § 12-2291(6) "Medical records" means all communications related to a patient's physical or mental health or condition that are recorded in any form or medium and that are maintained for purposes of patient diagnosis or treatment, including medical records that are prepared by a health care provider or by other providers. 2. During the environmental tour, the Compliance Officer observed medical records for R1, R2, and other residents stored on top of a desk near the common kitchen area, where multiple ambulatory residents and visitors were seen walking through. 3. In an interview, E3 acknowledged that resident medical records were not protected from loss, damage, or unauthorized use.

Based on documentation review, observation, record review, and interview, the governing authority failed to notify the Department according to A.R.S. § 36-425(I), which required immediate notification to the Department in writing, identifying the name and qualifications of the new manager when there was a change in the manager. The deficient practice posed a risk as the Department was unable to ensure the facility maintained a qualified manager. Findings include: 1. A.R.S. § 36-425(I) states, "A health care institution shall immediately notify the department in writing when there is a change of the chief administrative officer..." 2. A review of Department records revealed that E5 was listed as the last known manager of the facility and submitted a notice of resignation, effective immediately, on September 11, 2023. 3. During the environmental tour, the Compliance Officer observed E1's manager's certificate posted near the front door of the facility. 4. A review of E1's personnel record revealed a hire date of May 01, 2025. 5. In an interview, E3 reported that after E5 resigned E3 hired E2 as a manager. 6. A review of E2's personnel record revealed a hire date of September 19, 2023, and a termination date of May 01, 2025. 7. A review of Department records revealed that no immediate written notification was provided to the Department identifying the name and qualifications of the new manager when E2 or E1 were hired as managers. 8. In an interview, E3 acknowledged that the Department was not notified in writing of the successive managerial changes from E2 to E1.

Based on documentation review, observation, and interview, the manager failed to ensure that an evacuation path was conspicuously posted in each hallway of the assisted living facility. 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. R9-101.54 states, "Conspicuously posted" means placed: a. At a location that is visible and accessible; and b. Unless otherwise specified in the rules, within the area where the public enters the premises of a health care institution." 2. During the environmental tour, the Compliance Officer observed that an evacuation path was not conspicuously posted in the hallway leading to the resident rooms and garage. 3. In an interview, E3 acknowledged that an evacuation path was not conspicuously posted in each hallway of the assisted living facility.

Based on documentation review, record review, and interview, the manager of an assisted living home failed to maintain a standardized form for each resident that included the information prescribed in Arizona Revised Statute (A.R.S.) § 36-420.04(A)(1) through (9) for two of two sampled residents. The deficient practice posed a risk if the emergency responder was not aware of critical health information for a resident. Findings include: 1. A.R.S. 36-420.04.A states, "A. An assisted living center or assisted living home that contacts an emergency responder on behalf of a resident shall provide to the emergency responder a written document that includes all of the following: -1. The reason or reasons the emergency responder was requested on behalf of the resident. -2. Whether the resident receives medication services and, if the resident has provided this information to the assisted living center or assisted living home, a list of all the resident's prescription and over-the-counter medications, their dosages and how frequently they are administered. -3. The name, address and telephone number of the resident's current pharmacy. -4. A list of any known allergies to any medications, additives, preservatives or materials like latex or adhesive. -5. The name and contact information for the resident's primary care physician and power of attorney or authorized representative. -6. Basic information about the resident's physical and mental conditions and basic medical history, such as having diabetes or a pacemaker or experiencing frequent falls or cardiovascular and cerebrovascular events, as well as dates of recent episodes, if known. -7. The point-of-contact information for the assisted living center or assisted living home, including the telephone number, if available, cell phone number and email address. A point of contact must be available to respond to questions regarding the information provided twenty-four hours a day, seven days a week. -8. A copy of the resident's health insurance portability and accountability act release authorizing a receiving hospital to communicate with the assisted living center or assisted living home to plan for the resident's discharge. This paragraph does not preclude a resident from revoking the resident's health insurance portability and accountability act release authorization. -9. A copy of the resident's advance directives, if any, on file at the assisted living center or assisted living home. This paragraph does not preclude a resident from revoking or modifying the resident's advance directives." 2. A review of R1's and R2's medical records revealed no documentation of the completed emergency responder patient information documentation required in Arizona Revised Statute (A.R.S.) § 36-420.04(A)(1) through (9). 3. In an interview, E1 acknowledged that the information required in A.R.S. § 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, before or at the time of an individual's acceptance by the assisted living facility, there was a documented residency agreement with the assisted living facility to include the manager's signature and date signed, for two of two residents sampled. Findings include: 1. A review of R1's (admitted in 2022) medical record revealed a documented residency agreement. However, the residency agreement was not signed and dated by the manager. 2. A review of R2's (admitted in 2021) medical record revealed a documented residency agreement. However, the residency agreement was not signed and dated by the manager. 3. In an interview, E2 acknowledged R1's and R2's residency agreements did not include the manager's signature and the date signed.

Based on observation and interview, the manager failed to ensure oxygen containers were secured in an upright position. The deficient practice posed a potential explosion or leak of a compressed gas. Findings include: 1. The Compliance Officer observed one unsecured oxygen container stored sideways in the bathtub in R1's bathroom. 2. In an interview, E2 reported the oxygen container was not empty. E2 acknowledged there was an unsecured and sideways oxygen tank in the facility.

Based on documentation review and interview, the health care institution failed to develop and administer a training program for all staff regarding fall prevention and fall recovery to include initial training and continued competency training in fall prevention and fall recovery. The deficient practice posed a risk as organized instruction and information related to resident care and safety was not developed. Findings include: 1. A review of the facility documentation revealed a document titled "FALL PREVENTION AND FALL RECOVERY" (undated). However, the training program did not include the initial training and continued competency training requirement. 2. A review of E4's personnel record revealed documentation of fall prevention and fall recovery training was not available for review. 3. In an interview, E2 acknowledged the facility's fall prevention and fall recovery training program did not include the initial training and continued competency training requirement, and E4 had not completed fall prevention and fall recovery training.

Based on observation, documentation review, and interview, the manager failed to ensure documentation of the caregivers and assistant caregivers working each day, including the hours worked by each, was maintained for at least 12 months after the last date on the documentation. The deficient practice posed a risk if there was no record to ensure shifts and tasks were covered. Findings include: 1. The Compliance Officer observed E4 on the premises at the time of the inspection. 2. A review of facility documentation revealed a staffing schedule dated August 2023. The staffing schedule did not include E4, who was hired as an assistant caregiver. 3. In an interview, E2 acknowledged documentation of the assistant caregiver working each day, including the hours worked by each, was not maintained. This is a repeat deficiency from the complaint inspection conducted on July 22, 2022.

Based on record review and interview, the manager failed to ensure a resident had a written service plan signed and dated by the manager, for two of two residents sampled. The deficient practice posed a risk if the service plan was not developed to articulate decisions and agreements. Findings include: 1. A review of R1's medical record revealed a current written service plan dated in May 2023, for personal care services. However, the service plan was not signed and dated by the manager. 2. A review of R2's medical record revealed a current written service plan dated in July 2023, for directed care services. However, the service plan was not signed and dated by the manager. 3. In an interview, E2 acknowledged R1's and R2's service plans were not signed and dated by the manager.

Based on observation and interview, the manager failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. Findings include: 1. The Compliance Officers observed ambulatory residents on the premises. 2. The Compliance Officers observed two Bisacodyl 10 mg suppositories unlocked in the kitchen refrigerator. 3. The Compliance Officers observed an Albuterol Sulfate inhaler unlocked in R1's closet. 4. In an interview, E2 acknowledged the medications were not stored in a separate locked room, closet, cabinet, or self-contained unit.