Arizona Care L.L.C.

Based on record review and interview, the manager failed to ensure a resident's representative was designated for a resident who was unable to direct self-care. Findings include: 1 . A review of R2's medical record revealed service plan reviews for directed care from September 2024, December 2024, March 2025, and May 2025. However, R2 signed for each service plan update listed while R2 received directed care services. 2 . In an interview, E3 acknowledged a resident's representative was not designated for a resident who was unable to direct self-care. E3 reported E3 would talk to the nurse to make sure R2 did require directed care services, as R2 was still cognitive, just needed assistance with various services, and was able to inform staff of needs.

Based on observation and interview, the manager failed to ensure there is 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 which provides access to an outside area which controls or alerts 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 an environmental inspection of the facility, the Compliance Officer observed a door leading to the backyard with no control and alerts along the door frame. However, the alerts were not functioning at the time of inspection. E2 restarted the system, and the door alert functioned briefly, but then stopped due to a low battery. E2 was unable to determine how long the back door alert had not been functioning correctly. 2 . In an interview, E3 acknowledged the back door was not controlled and did not alert employees of the egress of a resident from the facility.

Based on documentation review, record review, and interview, the manager failed to ensure the health care institution developed and administered a training program for all staff regarding fall prevention and fall recovery that included initial training and continued competency training. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. Review of facility documents revealed a training program for all staff regarding fall prevention and fall recovery. 2. Review of E1's personnel record revealed E1 worked as a caregiver and had a hire date of October 1, 2021. The personnel record revealed documentation of fall prevention training dated October 11, 2021. However, current documentation was not available indicating E1 completed fall prevention and fall recovery training. 3. Review of E2's personnel record revealed E2 worked as a caregiver and had a hire date of October 1, 2021. The personnel record revealed documentation of fall prevention training dated January 27, 2022. However, current documentation was not available indicating E2 completed fall prevention and fall recovery training. 4. Review of E3's personnel record revealed E3 worked as a caregiver and had a hire date of August 23, 2018. The personnel record did not include documentation that showed E3 completed fall prevention and fall recovery training. 5. In an interview, E1 acknowledged documentation was not available that showed E1, E2, and E3 had completed initial training and continued competency training for fall prevention and fall recovery.

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with A.R.S. \'a7 36-411, for one of four employees, which required an employee to have a valid fingerprint card. The deficient practice posed a risk if the employee was a danger to a vulnerable population. Findings include: 1. A.R.S. \'a7 36-411 states, "A... as a condition of licensure or continued licensure of a residential care institution, a nursing care institution or a home health agency and as a condition of employment in a residential care institution, a nursing care institution or a home health agency, employees and owners of residential care institutions, nursing care institutions or home health agencies or contracted persons or volunteers who provide medical services, nursing services, behavioral health services, health-related services, home health services or supportive services and who have not been subject to the fingerprinting requirements of a health professional's regulatory board pursuant to title 32 shall have valid fingerprint clearance cards that are issued pursuant to title 41, chapter 12, article 3.1 or shall apply for a fingerprint clearance card within twenty working days of employment or beginning volunteer work..." 2. Review of E2's personnel record revealed E2 worked as a caregiver and had a hire date of October 1, 2021. The personnel record revealed a fingerprint clearance card with an expiration date of April 19, 2023. 3. Review of the Department of Public Safety (DPS) fingerprint clearance card database on October 6, 2023, revealed E2's fingerprint clearance card had expired. 4. Review of the October 2023 personnel schedule revealed E2 worked the 7am - 7pm and shift Monday - Friday. 5. In an interview, E1 and E2 acknowledged E2's fingerprint clearance card had expired and E2 had not reapplied.

Based on documentation review, record review, and interview, the manager failed to ensure policies and procedures were implemented that covered in-service education, for one of four employees reviewed. The deficient practice posed a risk as the caregiver received no organized instruction or information related to physical health services provided to residents. Findings include: 1. Review of the facility's policies and procedures revealed a policy titled "Orientation and In-service Training" reviewed and signed by E4 October 1, 2021. This policy stated "....Before the end of each year, employees and volunteers providing assisted living services to a resident will be retrained and oriented for 6 hours of continuing education. Such training will be documented in the personnel record of the employee or volunteer record." 2. Review of E3's personnel record revealed E3 worked as a caregiver and had a hire date of August 23, 2018. The personnel record revealed E3 completed 3 hours of in-service education for the 2022 calendar year. No other documentation of completing in-service education during the calendar year of January 1, 2022 to December 31, 2022 was available. 3. In an interview, E1 acknowledged E3's personnel record did not include documentation of completing 6 hours of in-service education annually, as required by the facility's policies and procedures.

Based on documentation review and interview, the manager failed to submit a documented report to the governing authority per the frequency established in the facility quality management program. The deficient practice posed a risk as a quality management program documents the necessary information required to effectively manage services provided. Findings include: 1. Review of the facility's policies and procedures revealed a policy titled "Quality Management Program, including incident reports" reviewed and signed by E4 October 1, 2021. This policy stated "...10. At least once a month the Manager will report to the governing authority/licensee all the concerns about the delivery of services related to resident care and change made or action taken as a result of the identification of a concern about the delivery of services related to resident care." 2. Review of the quality management program documentation revealed the last quality management report was completed June 2023. 3. In an interview, E1 acknowledged the quality management report was not submitted per the frequency established in the quality management program.

Based on documentation review, record review, observation, and interview, the manager failed to ensure a caregiver provided current documentation of first aid and cardiopulmonary resuscitation (CPR) training, for one of four caregivers. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency. Findings include: 1. Review of the facility's policy and procedure revealed a policy titled "First Aid and CPR training" reviewed and signed by E4 October 1, 2021. This policy stated "...7. The time in retraining is determined by the training agency used, or the expiration date shown on the card. The employee or volunteer will be reminded in a timely manner of an expiring card as condition of employment." 2. Review of E3's personnel record revealed E3 worked as a caregiver and had a hire date of August 23, 2018. The personnel record revealed a first aid and CPR card with an expiration date of April 5, 2023. There was no other documentation of first aid and CPR training in E3's record. 3. During the inspection E3 was observed providing services to the residents. 4. Review of the October 2023 personnel schedule revealed E3 worked the 7pm - 7am shift Monday - Friday. 5. In an interview, E1 acknowledged E3 did not have current documentation of first aid and CPR training.

Based on record review and interview, the manager failed to ensure a resident accepted by the assisted living facility submitted documentation signed by a medical practitioner or a registered nurse stating whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, for one of two residents reviewed accepted by the assisted living facility on or after October 1, 2013. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. Review of R1's medical record revealed no documentation stating whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints. Based on R1's acceptance date, this documentation was required. 2. In an interview, E1 acknowledged R1 did not provide documentation signed by a medical practitioner or a registered nurse stating whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints.

Based on record review and interview, the manager failed to ensure the caregiver documented the services provided in the resident's medical record, for two of two residents reviewed. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. Review of R1's medical record revealed a current written service plan for personal care services dated June 12, 2023. This service plan stated "Incontinent Both, Change every two hours/PRN". However, documentation was not available indicating this service was provided October 1st - present. 2. Review of R2's medical record revealed a current written service plan for personal care services dated September 15, 2023. This service plan stated "Catheter, Caregiver empties PRN" and "Requires positioning Q 2-3 hrs". However, documentation was not available indicating these services were provided October 1st - present. 3. In an interview, E1 acknowledged R1's and R2's medical records did not include documentation of the above listed services and reported the services were provided as indicated in the service plan. 4. This is a repeat deficiency from the compliance inspection conducted December 13, 2022.

Based on documentation review, record review, and interview, the manager failed to ensure a resident medical record contained documentation of notification of the resident of the availability of vaccination for influenza (flu) and pneumonia, according to A.R.S. \'a7 36-406(1)(d), to one of one resident reviewed. The deficient practice posed a potential illness risk to residents. Findings include: 1. A.R.S. \'a7 36-406(1)(d) states "The department shall: Require as a condition of licensure that nursing care institutions and assisted living facilities make vaccinations for influenza and pneumonia available to residents on site on a yearly basis. The department shall prescribe the manner by which the institutions and facilities shall document compliance with this subdivision, including documenting residents who refuse to be immunized. The department shall not impose a violation on a licensee for not making a vaccination available if there is a shortage of that vaccination in this state as determined by the director." 2. Review of R2's medical record revealed R2 refused the flu and pneumonia vaccinations March 2, 2022. However, current documentation was not available that showed the flu and pneumonia vaccinations were offered or received. Based on R2's acceptance date, this documentation was required. 3. In an interview, E1 acknowledged R2's medical record did not include current documentation that showed the flu and pneumonia vaccinations were offered or received. 4. This is a repeat deficiency from the compliance inspection conducted December 13, 2022.

Based on record review and interview, the manager failed to ensure the facility did not retain a resident who was confined to a bed or chair because of an inability to ambulate even with assistance, unless the facility obtained a written determination from a medical practitioner, every six months, stating the resident's needs could be met by the facility and the resident's needs were within the facility's scope of services, for one of two residents reviewed who were confined to a bed or chair. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. Review of R2's medical record revealed a current written service plan for personal care services dated September 15, 2023. This service plan stated "Non-Ambulatory". 2. Review of R2's medical record revealed a written determination from R2's medical practitioner signed and dated March 2, 2022. However, documentation was not available stating R2's needs could be met by the facility and R2's needs were within the facility's scope of services, at least once every six months. 3. In an interview, E1 reported R2 was unable to ambulate even with assistance since acceptance and acknowledged R2's medical practitioner did not provide a written determination at least once every six months. 4. This is a repeat deficiency from the compliance inspection conducted December 13, 2022.

Based on observation and interview, the manager failed to ensure medications stored by the facility were stored in a separate locked room, closet, cabinet, or self-contained unit. The deficient practice posed a risk to residents who could access the medication. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed Haloperidol and Acetaminophen suppositories unlocked in the dairy bin of the refrigerator in the kitchen. The bin had a had a locking device, however the device was not locked. In addition, DayQuil and Tums were observed siting on top of a storage cabinet in the dining room unlocked. 2. During an observation, the caregiver was not accessing the medications at the time of arrival. 3. In an interview, E1 acknowledged medications were stored unlocked.

Based on documentation review and interview, the manager failed to ensure an employee disaster drill 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 2023 personnel schedule revealed two shifts; 7am - 7pm (day shift) and 7pm -7am (night shift). 2. Review of the facility's employee disaster drills revealed the most current disaster drill conducted June 20, 2023 on the day and night shift. No other employee disaster drills were available after June 20, 2023. 3. In an interview, E1 acknowledged the employee disaster drills were not conducted on each shift at least once every three months.

Based on documentation review, record review, and interview, the health care institution failed to establish, document, and implement tuberculosis (TB) infection control activities as specified in R9-10-113. The deficient practice posed a risk as the caregiver received no organized instruction or information related to TB surveillance and posed a TB exposure risk to residents and staff. Findings include: 1. Review of facility's documentation revealed no policy and procedure that covered TB infection control activities. 2. Review of E1's personnel record revealed E1 worked as a caregiver and had a hire date of October 1, 2021. The personnel record did not include documentation of training and education related to recognizing the signs and symptoms of TB. 3. Review of E2's personnel record revealed E2 worked as a caregiver and had a hire date of October 1, 2021. The personnel record did not include documentation of training and education related to recognizing the signs and symptoms of TB. 4. Review of E3's personnel record revealed E3 worked as a caregiver and had a hire date of August 23, 2018. The personnel record did not include documentation of training and education related to recognizing the signs and symptoms of TB. 5. Review of facility documentation revealed no documentation of an annual assessment of the health care institution's risk of exposure to infectious TB. 6. In an interview, E1 acknowledged the facility had not established, documented, and implemented a TB infection control program as specified in R9-10-113. 7. Technical assistance was provided on this Rule during the compliance inspection conducted December 13, 2022.