Assisted Living at Bloomfield Manor, INC

Based on documentation review, observation, and interview, the governing authority failed to notify the Department according to Arizona Revised Statutes (A.R.S.) \'a7 36-425(I) when there was a change in the manager and identify the name and qualifications of the new manager. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the documentation was not available during the inspection, and the documentation was not provided within two hours after a Department request. Findings include: 1. A review of Department documentation revealed notification from E1 on May 9, 2023 reporting E1 was no longer the assisted living manager of the facility, effective May 1, 2023. However, documentation of the name and qualifications of the new manager was not available for review. 2. During the environmental inspection of the facility, the Compliance Officer observed E2's manager's license posted on a wall, with an issue date of April 19, 2023. 3. In an interview, E1 reported E2 was the facility's manager effective May 1, 2023. E1 acknowledged the notification provided to the Department did not identify the name and qualifications of the new manager.

Based on documentation review, record review, and interview, the administrator failed to ensure documentation required by this Article was provided to the Department within two hours after a Department request. The deficient practice posed a risk as the Department was unable to determine substantial compliance. Findings include: 1. A review of Department documentation revealed the governing authority failed to notify the Department when there was a change in the manager and identify the name and qualifications of the new manager. 2. A review of R1's medical record revealed a document titled "Determination for ALF admission/retention." The document stated "My patient does not need continuous medical services, continuous nursing services, or restraints." The document was signed and dated by a physician. However, the document was dated after R1's acceptance. 3. A review of R3's medical record revealed a service plan dated February 28, 2023. The service plan stated "Resident receives: Medication ADMINISTRATION under the direction of resident's Primary Physician. Resident receives what assistance with self-administration of meds and with whom ON/OFF premises? Supervisory Care-self medicates receives NO ASSISTANCE with Meds locked in room and has MD order on file." However, the aforementioned sections were left blank, and the service plan did not include the amount, type, and frequency of assisted living services being provided to the resident, including medication administration or assistance in the self-administration of medication. 4. A review of R1's medical record revealed an updated service plan dated March 20, 2023 for directed care services. R1's service plan stated "Medical diagnosis: Dementia; alcohol abuse; HTN; Malignant Neoplasm, kidney, liver cirrhosis, DM-II; depression; vit b & D deficiency; covid unit; osteoarthritis; incontinence." The service plan had a signature line which stated "Resident/Representative" and contained R1's signature. However, evidence R1 had a representative designated was not available for review. 5. A review of R3's medical record revealed a service plan dated February 28, 2023 for personal care services. The service plan stated "Regular diet...appetite good...Family MD will be notified when appetite decreases more than 50%..." However, the service plan did not indicate the nutritional needs as indicated in the aforementioned medication order. 6. In an interview, E1 acknowledged the aforementioned documentation was not provided within two hours after a Department request

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 the assisted living facility to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse or physician assistant, for one of three residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs, the Department was unable to determine substantial compliance as the documentation was not in the medical record during the inspection, and the documentation was not provided within two hours after a Department request. Findings include: 1. A review of R1's medical record revealed a document titled "Determination for ALF admission/retention." The document stated "My patient does not need continuous medical services, continuous nursing services, or restraints." The document was signed and dated by a physician. However, the document was dated after R1's acceptance. 2. In an interview, E1 acknowledged the documentation was not submitted before or at the time of R1's acceptance.

Based on record review and interview, the manager failed to ensure a resident's written service plan included the amount, type, and frequency of assisted living services being provided to the resident, including medication administration or assistance in the self-administration of medication, for one of three residents sampled. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the documentation was not in the medical record during the inspection, and the documentation was not provided within two hours after a Department request. Findings include: 1. A review of R3's medical record revealed a service plan dated February 28, 2023. The service plan stated "Resident receives: Medication ADMINISTRATION under the direction of resident's Primary Physician. Resident receives what assistance with self-administration of meds and with whom ON/OFF premises? Supervisory Care-self medicates receives NO ASSISTANCE with Meds locked in room and has MD order on file." However, the aforementioned sections were left blank, and the service plan did not include the amount, type, and frequency of assisted living services being provided to the resident, including medication administration or assistance in the self-administration of medication. 2. In an interview, E1 reported R3 received medication administration. E1 acknowledged R3's service plan did not include amount, type, and frequency of assisted living services being provided to the resident, including medication administration.

Based on record review and interview, the manager failed to ensure a resident's representative was designated for a resident who was unable to direct self-care, for one resident sampled who received directed care services. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the documentation was not in the medical record during the inspection, and the documentation was not provided within two hours after a Department request. Findings: 1. Arizona Revised Statutes (A.R.S.) \'a7 36-401(A)(16) states "Directed care services means programs and services, including supervisory and personal care services, that are provided to persons who are incapable of recognizing danger, summoning assistance, expressing need or making basic care decisions." 2. A review of R1's medical record revealed an update service plan dated March 20, 2023 for directed care services. R1's service plan stated "Medical diagnosis: Dementia; alcohol abuse; HTN; Malignant Neoplasm, kidney, liver cirrhosis, DM-II; depression; vit b & D deficiency; covid unit; osteoarthritis; incontinence." The service plan had a signature line which stated "Resident/Representative" and contained R1's signature. However, evidence to indicate R1 had a designated representative was not available for review. 3. In an interview, E1 reported R1 did not have a representative. E1 reported the facility was looking into obtaining a representative for R1. E1 acknowledged the manager failed to ensure a resident's representative was designated for a resident who was unable to direct self-care.