Arroyo Gardens Independent and Assisted Living

Based on documentation review, record review and interview, the manager failed to ensure, for seven of seven sampled residents, a documented residency agreement included the current policy and procedure for the assisted living facility to terminate residency. R9-10-807(G) states: "A manager may terminate residency of a resident as follows: 1. Without notice, if the resident exhibits behavior that is an immediate threat to the health and safety of the resident or other individuals in an assisted living facility; 2. With a 14-calendar-day written notice of termination of residency: a. For nonpayment of fees, charges, or deposit; or b. Under any of the conditions in subsection [R9-10-807](C); or 3. With a 30-calendar-day written notice of termination of residency, for any other reason." R9-10-807(C) states: "A manager shall not accept or retain an individual if: 1. The individual requires continuous: a. Medical services; b. Nursing services, unless the assisted living facility complies with A.R.S. § 36-401(C); or c. Behavioral health services; 2. The primary condition for which the individual needs assisted living services is a behavioral health issue; 3. The 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; 4. The assisted living facility does not have the ability to provide the assisted living services needed by the individual; or 5. The individual requires restraints, including the use of bedrails." Findings include: 1. A documentation review of the facility's policies and procedures revealed a policy and procedure manual, last reviewed and approved by the manager on April 12, 2024. The policy manual included a policy titled, "Termination of Residency", effective April 2024, which stated, "Community Initiated Termination of Residency. 1. The manager may terminate residency of a resident without notice, if the resident exhibits behavior that is an immediate threat to the health and safety of the resident or other individuals in the community. 2. The manager may terminate residency of a resident after providing 14 days written notice to the resident or the representative for one of the following reasons: a. Nonpayment of fees, charges, or deposit; or b. The individual requires continuous medical services, nursing services, or behavioral health services; c. The services needed by the individual are not within the community's scope of services d. The community does not have the ability to provide the assisted living services needed by the individual; or e. The individual requires restraints, including the use of bedrails. 3. With a 30 day notice, the manager may terminate the residency of a resident for any other reason." 2. A review of R1's, R2's, R3's, R4's, R5's, R6's and R7's medical records revealed similar residency agreements were included in each resident's record. However, in the termination sectio

Based on record review and interview, the manager failed to ensure a service plan, for two of four sampled residents receiving directed care services, included coordination of communications with the resident's representative, family members, or other individuals identified in the resident's service plan. Findings include: 1. A review of R1's medical record revealed a service plan, updated March 23, 2025, for directed care services. However, R1's service plan did not include coordination of communication with R1's representative, family members, or other individuals identified in R1's service plan. 2. A review of R4's medical record revealed a service plan, updated February 11, 2025, for directed care services. However, R4's service plan did not include coordination of communication with R4's representative, family members, or other individuals identified in R4's service plan. 3. In an interview, E1 acknowledged the service plans provided for R1 and R4 had not included coordination of communications.

Based on record review and interview, the manager failed to ensure a medication administered to a resident was administered in compliance with a medication order, for two of seven residents sampled who received medication administration. Findings include: 1. A review of R3's medical record revealed a service plan, updated December 17, 2024, for personal care services including medication administration. 2. A review of R3’s medical record revealed a list of medication orders, dated February 26, 2025, which included an order for: - “Carvedilol Oral Tablet 12.5 MG. Give 1 tablet by mouth two times a day for a-fib. Hold for SPB 150 + HR < 55." 6. A review of R5's medical record revealed a MAR, dated April 2025. For Metoprolol administration, the MAR documented the following: - On April 11, at "0800," R5’s blood pressure and pulse were documented as, “Blood Pressure: 169/54, Pulse: 54”; - On April 12, at "0800," R5’s blood pressure and pulse were documented as, “Blood Pressure: 152/62, Pulse: 55”; - On April 13, at "0800," R5’s blood pressure and pulse were documented as, “Blood Pressure: 162/63, Pulse: 58”; - On April 15, at "0800," R5’s blood pressure and pulse were documented as, “Blood Pressure: 155/76, Pulse: 58”; - On April 16, at "0800," R5’s blood pressure and pulse were documented as, “Blood Pressure: 157/80, Pulse: 60”; - On April 17, at "0800," R5’s blood pressure and pulse were documented as, “Blood Pressure: 138/64, Pulse: 53”; - On April 20, at "0800," R5’s blood pressure and pulse were documented as, “Blood Pressure: 154/64 Pulse: 62”; - On April 22, at "0800," R5’s blood pressure and pulse were documented as, “Blood Pressure: 157/58, Pulse: 54”; - On April 23, at "2000," R5’s blood pressure and pulse were documented as, “Blood Pressure: 162/73, Pulse: 75”; - On April 27, at "2000," R5’s blood pressure and pulse were documented as, “Blood Pressure: 154/69, Pulse: 61”; and - On April 29, at "2000," R5’s blood pressure and pulse were documented as, “Blood Pressure: 152/60, Pulse: 66.” 7. During the on-site inspection conducted on May 13, 2025, the Compliance Officer requested to review documentation of notification of R5's nurse practitioner of R5's blood pressure and pulse as ordered, however, documentation was not available for review. 8. In an interview, E1 acknowledged the provided documentation for R3 and R5 indicated medications had not been administered in compliance with a medication order.

Based on observation, documentation review, and interview, the manager failed to ensure that foods requiring refrigeration were maintained at 41° F or below. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed a facility refrigerator used for resident food storage in a memory care unit to have a temperature reading of 50° F displayed on a thermometer mounted on a shelf on the door of the refrigerator. 2. In an interview, E1 acknowledged that foods requiring refrigeration were not maintained at 41° F or below.

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 inaccessible to residents. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed a storage closet in the assisted living section of the facility. The closet door was locked, however, the door had not been closed completely, and the Compliance Officer was able to enter the storage room without a key. Inside the storage closet, the Compliance Officer observed containers of, "CLR," "Ecolab 20 Neutral Disinfectant Cleaner," "Folex Instant carpet spot remover," "Medline Micro-Kill," and "OdoBan 3-in-1 Carpet cleaner concentrate." 2. In an interview, E1 acknowledged the storage closet was not inaccessible to residents at the time of the environmental tour.

Based on record review, documentation review, and interview, the manager failed to ensure, before providing assisted living services to a resident, a manager or caregiver provided current documentation of cardiopulmonary resuscitation (CPR) training certification specific to adults for one of four caregivers sampled. The deficient practice posed a risk if the employees were unable to meet a resident's needs during an emergency. Findings include: 1. A review of E6's personnel record revealed E6 was hired as a caregiver in January 2023. 2. A review of E6's personnel record revealed a copy of a National Health & Safety Association card for CPR and First Aid. This course was taken on September 3, 2022. 3. An online search of the National Health & Safety Association revealed this is an online course. 4. A review of a policy's and procedures revealed a policy titled "CPR and First Aid Training" with an update of February 23, 2023. The policy stated "Before providing personal or direct care to the resident, a manager or caregiver shall provide documentation of current first aid training and cardiopulmonary resuscitation training certificate specific to adults. Documentation of first aid training and CPR certification, including copies of current certification cards, shall be maintained in the employee's personnel file. .... Note: Online CPR certification/recertification is NOT accepted for compliance with this requirement". 5. A review of staff schedules revealed E6 was scheduled to work a 2:00 PM until 10:15 PM shift on June 3, 4, 6, 7, 8, 11, 12, 13, 15, 18, 19, 20, 21, and 22, 2023. 6. In an interview, E1, and E2, acknowledged E6's personnel record did not include documentation of cardiopulmonary resuscitation (CPR) training certification specific to adults.