Arbor Ridge

Based on documentation review, record review, and interview, the assisted living center failed to maintain a standardized form for each resident that included the information prescribed in A.R.S. § 36-420.04.A., for three of three residents sampled. 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, R2’s, and R3’s medical records revealed no documentation of a standardized form with the prescribed information filled out. 3. In an interview, E3 showed the Compliance Officer a blank “Assisted Living Resident Transfer Checklist”. E3 reported this checklist was filled out once EMS was called. There was no standardized form for R1, R2, and R3 at the time of the inspection with the information prescribed prior to EMS being called. 4. In an exit interview, the findings were reviewed with E1 and E3 and no additional information was provided.

Based on documentation review and interview, the manager failed to ensure that a caregiver’s skills and knowledge was verified and documented before the caregiver provided physical health services, according to policy and procedure. The deficient practice posed a risk if the employees were unable to meet a resident's needs. Findings include: 1. A review of facility documentation revealed no policy and procedure for verifying skills and knowledge of a caregiver or an assistant caregiver. 2. In an interview, E1 reported they have a process to verify skills and knowledge of employees. However, E1 reported E1 does not know if there is a policy. E1 acknowledged a policy was not provided at the time of the inspection. 3. In an exit interview, the findings were reviewed with E1 and E3 and no additional information was provided.