Armada Care Homes

Based on record review and interview, the manager failed to ensure a caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services on behalf of the facility, for one of the five reviewed caregivers. The deficient practice posed a risk if employees did not have the skills and knowledge necessary to ensure the health and safety of residents. Findings include: 1. A review of E3's personnel record revealed E3 was hired in September 2025 as a caregiver. Review of E3's personnel record revealed no documented verification of E3's skills and knowledge. 2. A documentation review of the 2024 Policy and Procedures revealed a policy titled "Skills and Knowledge Policy and Procedures." The document states: "VERIFICATION PROCESS: Skills and knowledge will be verified by Manager/Designee on date of hire through practical assessment and demonstrate their understanding by checking, sign and dated the caregiver skills and knowledge documentation before they are permitted to provide services to the residents. The signed document will be included in the employee's file. REGULAR AUDITS: Caregiver skills and knowledge documentation is completed accurately and thoroughly before the employee provides services to residents. Any lapses on verification process must be address promptly and perform a regular performance review to implement continuous education as part of the in service or refresher course training" 3. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on observation, a record review, documentation review, and interview, the manager failed to ensure that one of the five caregivers reviewed received orientation specific to the duties to be performed before providing assisted living services to a resident. The deficient practice posed a risk if the employees were unable to meet residents' needs. Findings include: 1. The Compliance Officer observed E3 with three residents upon entry. During the investigation, E3 answered the call lights, and E3 prepared lunch for three residents. 2. A review of E3’s personnel record revealed no documentation showing E3 received orientation. 3. A review of the September 2025 personnel schedule revealed E3 was not listed on the schedule. 4. In an interview, E2 reported that E2 was unaware that E3 was left off the schedule. E2 reported that orientation was not completed for this facility, but it was done at the other facility from which E3 transferred. 5. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on record review, interview, and documentation review, the manager failed to ensure a personnel record for each caregiver included documentation of cardiopulmonary resuscitation (CPR) training, which included a demonstration of the individual's ability to perform CPR, before providing assisted living services, for one of five employees reviewed. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency. Findings include: 1. A review of E2's personnel record revealed a CPR card that was obtained from "NationalCPRFoundation" issued on September 9, 2025. There was no other current documentation of CPR training available for review that included a demonstration of E2's ability to perform CPR. 2. In an email exchange, a representative from NationalCPRFoundation stated, "Our courses are online only." 3. A documentation review revealed the employee's work schedule, dated August and September 2025, showed E2 had worked every day on the day shift. 4. In an interview, E2 reported that E2 was unaware that online classes were not acceptable. 5. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with A.R.S. § 36-411, for one of the three personnel sampled. The deficient practice posed a risk if the employee was a danger to a vulnerable population. Findings include: 1. A.R.S. § 36-411.C states, "Owners shall make documented, good faith efforts to: 1. Contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in a residential care institution ..." 2. Review of E3's personnel file revealed no documentation of good faith efforts to contact previous employers. 3. In an interview, E1 acknowledged E3's personnel record contained no documentation of good faith efforts to contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in a residential care institution.

Based on the record review and interview, the manager failed to ensure an employee provided documentation of freedom from infectious tuberculosis (TB) on or before the date the individual began providing services at or on behalf of the assisted living facility, as specified in R9-10-113, for one of three caregivers reviewed. The deficient practice posed a potential risk of TB exposure to residents. Findings include: 1. A review of the Centers for Disease Control and Prevention website revealed a web page titled "TB Screening and Testing of Health Care Personnel." The web page stated, "If the Mantoux tuberculin skin test (TST) is used to test healthcare personnel upon hire (pre-placement), two-step testing should be used." 2. A review of E3's personnel record revealed documentation of a negative TB skin test dated June 8, 2025. However, there was no documentation of a second TB skin test. 3. In an interview, E1 acknowledged E3 did not provide documentation of freedom from infectious TB as specified in R9-10-113 on or before the date the individual began providing services at or on behalf of the assisted living facility.

Based on document review, record review, and interview, the manager failed to ensure a written service plan include the correct level of service the resident received for one of two residents reviewed. The deficient practice posed a risk as the service plan did not reinforce and clarify services to be provided to a resident. Findings include: 1. A.R.S. § 36-401.38 defines "Supervisory care services" to mean general supervision, including daily awareness of resident functioning and continuing needs, the ability to intervene in a crisis, and assistance in the self-administration of prescribed medications. 2. A.R.S. § 36-401.38 defines "Personal care services" to mean assistance with activities of daily living that can be performed by persons without professional skills or professional training and includes the coordination or provision of intermittent nursing services and the administration of medications and treatments by a nurse who is licensed pursuant to title 32, chapter 15 or as otherwise provided by law. 3. R9-10-101.135 defines "Medication administration" means restricting a patient's access to the patient's medication and providing the medication to the patient or applying the medication to the patient's body, as ordered by a medical practitioner. 4. Review of R1’s record revealed a written service plan with no date on it. Indicating R1 received supervisory care services. This service plan stated, "R1 will be receiving medication administration from the facility. 5. During an interview, E1 reported that R1 received medication administration from the facility and received directed care services. E1 acknowledged R1's service plan did not include the correct level of service the resident was receiving.

Based on observation and interview, the manager failed to ensure there was a current toxicology reference guide that was available for use by personnel members. This posed a health and safety risk to the resident if the caregiver was unable to reference a toxic material. Findings include: 1. The Compliance Officer requested the current toxicology reference guide. However, the toxicology reference guide was not provided to the department for review. 2. In an interview, E1 acknowledged that the facility did not have a toxicology reference guide available for use by personnel members.

Based on observation and interview, the manager failed to ensure that toxic materials stored by the assisted living facility were maintained in a locked area and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed the following materials stored in the facility's unlocked cabinet under the sink: - All-purpose powder comet bleach; - Windex Glass Cleaner; - Lysol Disinfectant wipes; and - Gain ultra clean dish soap. 2. In an interview, E1 reported that the facility locked the cabinet under the sink to prevent access; however, the cabinet was accessible at the time of inspection. E1 acknowledged that poisonous or toxic materials stored by the facility were not maintained in a locked area and inaccessible to residents.

Based on record review and interview, the manager failed to ensure a personnel record for each employee or volunteer included documentation of evidence of freedom from infectious tuberculosis (TB), if required for the individual according to subsection (A)(8), for two of four caregivers sampled. The deficient practice posed a TB exposure risk to residents. Findings include: 1. A review of E2's personnel record revealed documentation of evidence of freedom from infectious TB was not available for review. 2. A review of E3's personnel record revealed documentation of evidence of freedom from infectious TB was not available for review. 3. In an interview, E1 reported E2 and E3 had current documentation of evidence of freedom from infectious TB. However, the documentation was not provided for review during the inspection or during the exit interview.

Based on record review and interview, the manager failed to ensure a resident provided evidence of freedom from infectious tuberculosis (TB) before or within seven calendar days after the resident's date of occupancy, for one of two residents sampled. The deficient practice posed a TB exposure risk to residents. Findings include: R9-10-113(B) A health care institution's chief administrative officer shall: 1. For an individual for whom baseline screening and documentation of freedom from infectious tuberculosis is required by an Article in this Chapter, as specified in subsection (A)(2)(a), obtain one of the following as evidence of freedom from infectious tuberculosis: a. Documentation of a negative Mantoux skin test or other tuberculosis screening test that: i. Is recommended by the U.S. Centers for Disease Control and Prevention (CDC), ii. Was administered within 12 months before the date the individual begins providing services at or on behalf of the health care institution or is admitted to the health care institution, and iii. Includes the date and the type of tuberculosis screening test; b. If the individual had a history of tuberculosis or documentation of latent tuberculosis infection, as defined in A.A.C. R9-6-1201, compliance with subsection (A)(2)(b); or c. If the individual had a positive Mantoux skin test or other tuberculosis screening test according to subsection (B)(1)(a) and does not have history of tuberculosis or documentation of latent tuberculosis infection, as defined in A.A.C. R9-6-1201, a written statement: i. That the individual is free from infectious tuberculosis, signed by a medical practitioner or local health agency, as defined in A.A.C. R9-6-101; and ii. Dated within 12 months before the date the individual begins providing services at or on behalf of the health care institution or is admitted to the health care institution; and 2. As part of the annual assessment of the health care institution's risk of exposure to infectious tuberculosis according to subsection (A)(2)(d), ensure that documentation is obtained for each individual required to be screened for infectious tuberculosis that: a. Indicates the individual's freedom from symptoms of infectious tuberculosis; and b. Is signed by a medical practitioner, occupation health provider, as defined in A.A.C. R9-6-801, or local health agency, as defined in A.A.C. R9-6-101. 1. A review of R1's (admitted in 2023) medical record revealed a document signed and dated by a physician. The document stated "Date of last chest x-ray Nov 22...Result neg." However, the medical record revealed no evidence R1 had a history of a positive skin test or other TB screening test recommended by the Centers for Disease Control and Prevention (CDC); and the chest x-ray was not an infectious TB screening test. 2. In an interview, E1 acknowledged R1 did not provide current documentation of freedom from infectious TB.