Anna's Angels Assisted Living Home

Based on record review and interview, the manager failed to ensure a residency agreement contained provisions allowing a manager to terminate a resident in compliance with A.A.C. R9-10-807(G) for one of three residents sampled. Findings include: R9-10-807(G): 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 deposit; 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. Subsection C states: C. A manager shall not accept or retain an individual if: 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 primary condition for which the individual needs assisted living services is a behavioral health issue; 3. The 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. 1. A review of R2 ' s medical record revealed a residency agreement with a section titled "Terminations". The section stated "13. The facility has the right to terminate the Residency agreement after providing 14 days written notice to a resident ...for any of the following reasons: i. Documented failure to pay fees or charges; ii. Documented non-compliance with the Residency Agreement or Internal Facility requirements;". 2. In an interview E1 reported R2 did not have documentation stating a manager may terminate residency of a resident with a 14-calendar-day written notice of termination of residency under any of the conditions in subsection (C).

Based on the record review and interview, the manager failed to ensure a caregiver or assistant caregiver provided assistance with, supervised, or directed a resident ' s personal hygiene according to the resident ' s service plan for two of three residents sampled. Findings include: 1. A review of R1 ' s medical record revealed a service plan dated February 9, 2023. The service plan indicated R1 was expected to receive personal care services and was expected to be provided assistance with seven bed baths weekly. 2. A review of R1 ' s medical record revealed documentation of Activities of Daily Living (ADLs) for May 2023 and June 2023. The ADLs stated R1 was expected to receive partial bathing as needed (PRN), and indicated R1 did not receive assistance with partial bathing on May 3-5, May 7-8, May 10, May 12, May 14-15, May 17-19, May 21-31, June 2, June 4-5, June 7, and June 9. 3. A review of R3 ' s medical record revealed a service plan dated February 5, 2023. The service plan indicated R3 was expected to receive personal care services, and was expected to be provided assistance with two showers weekly, five bed baths weekly, combing hair once daily, washing face twice daily, and oral/denture care twice daily. 4. A review of R3 ' s medical record revealed documentation of ADLs for May 2023 and June 2023. The ADLs indicated R3 did not receive assistance with showering twice weekly on May 9, May 11, May 13-15, May 17-20, May 22-26, May 28-30, June 2-4, June 6-12, June 14-18. The ADLs stated R3 was expected to receive assistance with partial bathing PRN, and indicated R3 did not receive assistance with partial bathing in May 1-31. The record indicated R3 was not provided assistance with combing hair, washing face, and oral/denture care for May 1-31 and June 1-18. 5. In an interview E1 reported R1 and R3 were not provided assistance with, supervised, or directed a resident ' s personal hygiene according to the resident ' s service plan.

Based on documentation review, record review, and interview, the manager failed to ensure a resident ' s medical record contained documentation of notification of the resident of the availability of vaccination for influenza and pneumonia, according to A.R.S. 36-406(1)(d) for one of three residents sampled. The deficient practice posed a potential illness risk to residents. Findings include: 1. A review of facility documentation revealed policies and procedures (approved November 2022). The review of policies and procedures revealed a policy titled "Scope of Services". The policy stated " The facility will make influenza and pneumonia vaccination available on site to residents, on an annual basis, through ancillary services or primary care providers. The facility will document compliance with this requirement, including documentation for the residents who refuse to be immunized". 2. A review of R3 ' s medical record revealed documentation of notification of the resident of the availability of vaccination for influenza and pneumonia for 2022. However, the record does not contain current documentation of notification of the resident of the availability of vaccination for influenza and pneumonia. 3. In an interview E1 reported R3 did not have current documentation of notification of the resident of the availability of vaccination for influenza and pneumonia in R3 ' s medical record.

Based on observation and interview, the manager failed to ensure medication stored by an assisted living facility was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication used only for medication storage. The deficient practice posed a risk to residents who were unable to self-administer medications. Findings include: 1. During the environmental inspection, the Compliance Officers observed a medication cup sitting on top of a drawer in the kitchen of the facility. The cup had three tablets of medication in the cup. The Compliance Officers observed there were no residents sitting in the kitchen awaiting medication administration. The medication was not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication used only for medication storage. 2. In an interview E1 acknowledged the medication was prepared prior to administering to one of the residents at the facility. E1 confirmed the medication was left unmonitored and the resident was not in the kitchen awaiting medication administration.