Ark of Angel Assisted Living

Based on documentation review and interview, the manager of an assisted living home failed to maintain a copy of the document provided to the emergency responder which included the items listed in Arizona Revised Statutes (A.R.S.) § 36-420.04(A)(1) through (9), for one of one applicable residents reviewed. Findings include: 1. A review of Department documentation revealed an intake that reported R1 had been transported from the facility to the hospital by Emergency Medical Services (EMS) on April 30, 2025. 2. A review of R1's medical record revealed a progress report dated April 30, 2025, that stated "...911 came and brought R1 to the hospital..." 3. In an interview, E1 reported E1 did not have a copy of the documents provided to the emergency responders, which included the items listed in Arizona Revised Statutes (A.R.S.) § 36-420.04(A)(1). 4. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on documentation review, record review, and interview, the manager failed to ensure when a resident had an incident resulting in the resident needing medical services, a caregiver documented the date and time of the incident; a description of the incident; the names of individuals who observed the incident; the action taken by the caregiver; the individuals notified by the caregiver; and any action taken to prevent the incident from occurring in the future, for one of three residents reviewed. The deficient practice posed a health and safety risk. Findings include: 1. A review of Department documentation revealed 911 was called for R1 following an accident, emergency, or injury to R1 on April 30, 2025. 2. A review of R1's medical record revealed a document titled "Care Giver Notes". The document included the following: -date and time of the accident, emergency, or injury; -the names of individuals who observed the accident, emergency, or injury; -a description of the accident, emergency; -the actions taken by the caregiver; -the individuals notifed by the caregiver; However, documentation did not include a description of any action taken to prevent the accident, emergency, or injury from occurring in the future. 3. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on documentation review, record review, and interview, the manager of an assisted living center who contacted emergency responders on behalf of a resident failed to provide to the emergency responders a written document that included all information required in A.R.S. § 36-420.04, for one of one applicable residents sampled. The deficient practice posed a risk if the emergency responder was not aware of critical health information for the resident. Findings include: 1. A review of facility documentation revealed a progress note dated April 30, 2024. The progress note revealed R1 had been transported to the hospital. 2. A review of R1's medical record revealed a standardized form which failed to include all information required in A.R.S. § 36-420.04, including basic information about the resident's physical and mental conditions, as well as dates of recent episodes. 3. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on documentation review and interview, the manager failed to ensure a disaster plan review required in (A)(2) was documented. The deficient practice posed a risk to the health and safety of residents if the disaster plan was not current to meet the needs in a disaster. Findings include: 1. A review of facility documentation revealed a disaster plan dated September 4, 2020. However, no disaster plan review completed within the last 12 months was provided for review. 2. In an interview, E2 acknowledged a review of the disaster plan had not been completed at least once every 12 months.

Based on documentation review and interview, the manager failed to ensure as part of the policies and procedures required in R9-10-803(C)(1)(h), a plan was established and documented to ensure the manager or a caregiver was available as back-up to provide assisted living services to a resident if the manager or a caregiver assigned to work was not available or not able to provide the required assisted living services. The deficient practice posed a risk as there were no policies and procedures to reinforce and clarify the health care institution's standards. Findings include: 1. A review of the facility policies and procedures revealed a policy titled "Staffing Policy,"updated September 4, 2020. The policy did not include a plan to ensure the manager or a caregiver was available as back-up to provide assisted living services to a resident if the manager or a caregiver assigned to work was not available or not able to provide the required assisted living services. 2. A review of the facility's daily staffing schedules (dated May 1, 2023-June 30, 2023) revealed no back-up caregiver or manager was included. 3. In an interview, E2 reported the manager established a plan to ensure the manager or a caregiver was available as back-up if needed; however, the plan was not documented. The plan included E1 and E2 being on-call and available to provide the assisted living services needed by residents if the manager or a caregiver assigned to work was not available or not able to provide the services. E2 acknowledged the daily staff schedules did not include on-call personnel members. E2 recalled receiving technical assistance regarding this Rule at the inspection conducted on September 13, 2021. E2 thought the facility's plan was documented; however, no plan was available for review as requested by the Department.

Based on record review, documentation review, and interview, the manager failed to ensure the facility's residency agreement contained provisions allowing a manager to terminate residency of a resident in compliance with A.A.C. R9-10-807(G), for two of two sampled residents accepted by the assisted living home. The deficient practice posed a health and safety risk to the residents Findings include: 1. A review of R1's and R2's medical records revealed documents titled, "Admission Agreements." residency agreements. E2 verbally confirmed these documents were R1's and R2's residency agreements. R1's residency agreement was dated March 2022, and R2's was dated April 2020. Their residency agreements stated, "The residency agreement may be terminated by the home, upon 14 days written notice for "...Care and service needs exceed our license or our ability to provide needed services ..." 2. Rule review of R9-10-807(G) indicated, "A manager may terminate residency of a resident as follows: "...With a 14 calendar day written notice of termination of residency: ...[If the] assisted living 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 ..." 3. During an interview, E2 acknowledged R1's and R2's residency agreements did not include the correct policy and procedure for an assisted living facility to terminate residency. E2 did not remember receiving technical assistance on this Rule at the compliance inspection conducted on September 13, 2021.