Arrowhead Symphony Assisted Living Home, LLC

Based on record review and interview, the manager failed to ensure before or at the time of acceptance of an individual, the individual submitted documentation dated within 90 calendar days before the individual was accepted by an assisted living facility to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, for one of two residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R2's medical record revealed physician-signed document dated January 25, 2023 that had check boxes if R2 required continuous medical services, continuous or intermittent nursing services, or restraints. However, the information was left blank and did not indicate if R2 required continuous medical services, continuous or intermittent nursing services, or restraints. 2. In an interview, E1 acknowledged R2 did not provide documentation signed by a medical practitioner or a registered nurse that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints.

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), according to A.R.S. \'a7 36-406(1)(d), to one of two residents 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 R1's medical record revealed R1 received the flu vaccination December 7, 2022. However, current documentation was not available showing the flu vaccination was offered or received. Based on R1's acceptance date, this documentation was required. 3. In an interview, E1 acknowledged R1's medical record did not include current documentation showing the flu vaccination was offered or received.

Based on record review and interview, the manager failed to ensure a resident's orientation to the assisted living facility's evacuation plan and the route to be used was documented, for one of two residents reviewed. The deficient practice posed a health and safety risk if the resident needed to exit the facility in an emergency. Findings include: 1. A review of R2's medical record revealed no documentation of orientation to the exits from the facility and the route to be used when evacuating the facility. Based on R2's date of acceptance this documentation was required. 2. In an interview, E1 acknowledged documentation of the orientation was not available for review.

Based on observation and interview, the manager failed to ensure poisonous or 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 the residents. Findings include: 1. The Compliance Officer observed ambulatory residents in the facility. 2. The Compliance Officer observed the following chemicals in an unlocked kitchen drawer. - Loctite glue. - Super glue gel .12 oz 3. In an interview, E1 acknowledged poisonous or toxic materials were stored by the assisted living facility in unlocked areas.