Arizona Premier Adult Care II, LLC

Based on record review and interview, the manager failed to ensure that the assisted living facility made vaccinations for influenza or pneumonia available to residents on site on a yearly basis. Findings include: 1 . During a review of R1's medical record the Compliance Officer found no evidence that the influenza or pneumonia vaccinations were offered to the resident. 2 . In an interview, E1 acknowledged that the vaccines for influenza and pneumonia was not offered to all residents.

Based on record review, documentation review and interview, the manager failed to provide training and education related to recognizing the signs and symptoms of tuberculosis to individuals employed and annually assess the health care institution's risk of exposure to infectious tuberculosis. Findings include: 1 . A review of E3's personnel record revealed no training certificate for the Compliance Officer to review, at the time of inspection. 2 . A review of facility documents revealed no facility risk assessment for infectious tuberculosis, for the Compliance Officer to review, at the time of inspection. 3 . In an interview, E1 acknowledged that an employee was missing their training for infectious tuberculosis and missing the facility risk assessment for infectious tuberculosis.

Based on record review and interview, the manager failed to ensure that an employee had documentation of a negative Tuberculosis screening per Centers for Disease Control and Prevention (CDC). Findings include: 1 . A review of E3's employee file revealed a test for tuberculosis, however, the Compliance Officer only found one test and not the two-step testing required by the regulation. 2 . In an interview, E1 acknowledged that E3 had one of two test for infectious tuberculosis.

Based on record review and interview, the licensee failed to ensure that at the time of acceptance , an individual submitted a document dated within 90 calendar days, if a resident was expected to receive supervisory, personal or directed care services and include if the individual required - Continuous medical services, continuous or intermittent nursing services or Restraints. Findings include: 1 . During a review of R3's medical record, the Compliance Officer found no evidence or a 90 day determination form completed prior to admission. 2 . In an interview, E1 acknowledged that the licensee failed to obtain a 90 day determination form prior to the resident moving into the assisted living facility.

Based on record review and interview, the manager failed to ensure that a resident had a service plan that was signed and dated by the resident or resident's representative. Findings include: 1 . During a review of R3's records, the Compliance Officer found a current service plan, however, the service plan was not signed by the resident or resident's representative. 2 . In an interview, E1 acknowledged that the service plan for R3 was not signed by the resident or resident's representative.

Based on observation and interview, the manager failed to ensure that the premises were in a clean condition. Findings Include: 1 . During the environmental tour of the facility, the Compliance Officer observed a bathroom with a shower that had black, cracked caulking in a shower. 2 . In an interview, E1 acknowledged that the premises were not in a clean condition, for a shower, in the assisted living facility.

Based on documentation review, record review, and interview, the manager failed to ensure the health care institution administered a training program for all staff regarding fall prevention and fall recovery that included initial training and continued competency training for two of two personnel sampled. The deficient practice posed a health and safety risk for residents. Findings include: 1. A review of the facility's policies and procedures revealed a policy titled, "Fall and Fall Prevention." The policy stated, "(b) All new caregivers will have a training on fall prevention one month after hire date. c) All caregivers will have a fall prevention training every year or every six months if there are at least 2 incidents of resident falls for the quarter." 2. A review of E1's personnel record revealed documentation of Fall Prevention and Fall Recovery Training dated February 16, 2022. However, no documentation of further fall prevention and fall recovery training was available for Compliance Officer review. 3. A review of E2's personnel record revealed documentation of Fall Prevention and Fall Recovery Training dated November 10, 2021. However, no documentation of further fall prevention and fall recovery training was available for Compliance Officer review. 4. In an interview, E1 acknowledged E1, E2, and E3 have not participated in annual fall prevention and fall recovery training per the facility's policies and procedures. E1 acknowledged the facility failed to administer a training program for staff regarding fall prevention and fall recovery that included continued competency training.

Based on record review, documentation review, and interview, the manager failed to ensure that medication administered to a resident was accurately documented in the resident's medical record for one of two residents sampled. Findings include: 1. A review of R2's medical record revealed R2 received medication administration. 2. A review of the facility's policies and procedures revealed a policy titled, "Opioids (Narcotics) Administration." The policy stated, "Opioid medications will be documented/monitored in the resident Medication Administration Report (MAR), resident Vitals Log and resident Progress Notes for any reaction to medication." 3. A review of R2's medical record revealed a signed medication order (dated August 10, 2024) for Lorazepam 2mg/ml 0.25mg/ml, by mouth (po) every two hours (q2hr) as needed (PRN). 4. A review of R2's Controlled Substance (Narcotics) Inventory for September 2024 revealed documentation that Lorazepam 2 mg/ml, 0.25 mg/ml po was administered on the following dates: - September 1, 2024 at 6:20 PM; - September 2, 2024 at 6:43 PM; - September 3, 2024 at 6:30 PM; - September 3, 2024 at 10:18 PM; - September 5, 2024 at 6:42 PM; - September 7, 2024 at 9:23 PM; - September 8, 2024 at 6:04 PM; - September 8, 2024 at 8:54 PM; - September 9, 2024 at 7:18 AM; - September 9, 2024 at 8:AM [sic]; - September 9, 2024 at 6:PM [sic]; - September 11, 2024 at 10:25 PM; - September 15, 2024 at 6:42 PM; and - September 16, 2024 at 8:54 PM. However R2's medication administration (MAR) documentation for September 2024 did not include documentation of administration. 5. In an interview, E1 acknowledged R2's MAR did not contain accurate documentation of medication administered to the resident.