At Dana's Loving Care Assisted Living LLC

Based on documentation review, record review, and interview, the health care institution failed to develop and administer a training program including initial training and continued competency training in fall prevention and fall recovery for three of four staff sampled. Findings Include: 1. A review of facility documentation revealed policies and procedures (approved February 2023) for fall prevention and recovery. The policy titled "Fall Prevention and Fall Recovery Training Program" stated "Upon being hired ...staff will complete the Facility ' s Fall Prevention and Fall Recovery Training Program ... .will be maintained in the staff member ' s records. Once a year all staff ...re-complete the Facility ' s Fall Prevention and Fall Recovery Training Program ...". 2. A review of E1 ' s personnel record (date of hire 2021) revealed initial and continued competency training for fall prevention. However, the record did not contain current documentation of a training program for fall recovery. 3. A review of E2 ' s personnel record (date of hire 2021) revealed initial and continued competency training for fall prevention. However, the record did not contain current documentation of a training program for fall recovery. 4. A review of E4 ' s personnel record (date of hire not provided) revealed E4 did not contain current documentation of a training program for fall prevention and fall recovery. 5. In an interview E1 acknowledged the health care institution failed to develop and administer a training program including initial training and continued competency training in fall prevention and fall recovery for E1, E2, and E4.

Based on record review, observation, and interview, the manager failed to ensure an individual residing in an assisted living home, who is not a resident, a manager, a caregiver, or an assistant caregiver either complied with the fingerprinting requirements in A.R.S. \'a7 36-411, or interacted with residents only under the supervision of an individual who has a valid fingerprint clearance card. Findings Include: 1. A review of E4 ' s personnel record revealed no documentation to comply with the fingerprinting requirements in A.R.S. \'a7 36-411. 2. During the environmental inspection, the compliance officer observed E4 (date of hire not provided) sleeping in a bedroom in the facility. 3. In an interview E1 reported E4 is a housekeeper and cleans around the facility. E1 reported E4 did not have documentation to comply with the fingerprinting requirements in A.R.S. \'a7 36-411, or interacted with residents only under the supervision of an individual who has a valid fingerprint clearance card.

Based on record review and interview, the manager failed to ensure a personnel record for each employee included the requisite components, for one of four personnel records sampled. The deficient practice posed a risk as required information could not be verified for E4. Findings Include: 1. A review of E4 ' s personnel record (date of hire unknown) revealed evidence of freedom from infectious tuberculosis, if required for the individual according to subsection (A)(8). However the personnel record did not contain evidence of the following documentation according to (A)(1): - The individual's name, date of birth, and contact telephone number - The individual's starting date of employment or volunteer service and, if applicable, the ending date - The individual's qualifications, including skills and knowledge applicable to the individual's job duties - The individual's education and experience applicable to the individual's job duties - The individual's completed orientation and in-service education required by policies and procedures - The individual's license or certification, if the individual is required to be licensed or certified in this Article or in policies and procedures - If the individual is a behavioral health technician, clinical oversight required in R9-10-115 - Cardiopulmonary resuscitation training, if required for the individual in this Article or policies and procedures - First aid training, if required for the individual in this Article or policies and procedures - Documentation of compliance with the requirements in A.R.S. \'a7 36-411(A) and (C) 2. In an interview E1 confirmed E4 ' s personnel record did contain evidence of freedom from infectious tuberculosis, but did not contain evidence of documentation mentioned above.

Based on record review and interview, the manager failed to ensure documentation stating a manager may terminate residency of a resident with a 14-calendar-day written notice of termination of residency under any of the conditions in subsection (C) for two of two residents sampled. Findings Include: 1. A review of R1 ' s medical record revealed a residency agreement with a section titled "Terminations". The section stated "Review of subsection \'a9 reads" 1. The individual requires continuous: a. Medical services; b. Nursing services ...or c. Behavioral Health services; 2. The assisted living facility services needed by the individual are not within the assisted living facility ' s scope of services. 3. The assisted living facility does not have the ability to provide the assisted living services needed by the Individual; or 4. The individual requires restraints, including use of bedrails". However, the residency agreement does not include R9-10-807.C.2-3 to terminate residency of a resident with a 14-calendar-day written notice of termination of residency. 2. A review of R2 ' s medical record revealed a residency agreement with a section titled "Terminations". The section stated "Review of subsection \'a9 reads" 1. The individual requires continuous: a. Medical services; b. Nursing services ...or c. Behavioral Health services; 2. The assisted living facility services needed by the individual are not within the assisted living facility ' s scope of services. 3. The assisted living facility does not have the ability to provide the assisted living services needed by the Individual; or 4. The individual requires restraints, including use of bedrails". However, the residency agreement does not include R9-10-807.C.2-3 to terminate residency of a resident with a 14-calendar-day written notice of termination of residency. 3. In an interview E1 acknowledged R1 and R2 did not have documentation stating a manager may terminate residency of a resident with a 14-calendar-day written notice of termination of residency under any of the conditions in subsection (C).

Based on record review and interview, the manager failed to ensure a written service plan that was reviewed and updated based on changes in the requirements in subsections (A)(3)(a) through (f) as follows: at least once every three months for a resident receiving directed care services. Findings Include: 1. A review of R1 ' s medical record revealed a service plan that confirmed R1 (accepted 2021) was receiving directed care services at the facility. R1 ' s service plan documented the last update for the service plan as February 23, 2023. 2. In an interview E1 reported R1 did not have an updated service plan. E1 reported R1 ' s representative has not met with E1 to update the service plan within the last three months. This is a repeat citation from the annual compliance inspection conducted on February 24, 2022.

Based on record review and interview, the manager failed to ensure a caregiver or an assistant caregiver documented the services provided in the resident's medical record for one of the two residents sampled. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings Include: 1. A review of R1 ' s medical record revealed R1 ' s service plan and indicated services for washing hair daily or as needed (PRN). 2. A review of R1 ' s medical record revealed R1 ' s Activities of Daily Living (ADL) documentation for May 2023 and June 2023. R1 ' s ADL documentation for May 2023 indicated on the line titled "SHAMPOO" R1 ' s hair was washed on May 1, 2023, May 5, 2023, May 14, 2023, May 18, 2023, May 28, 2023. R1 ' s ADL documentation for June 2023 indicated on the line titled "SHAMPOO" R1 ' s hair was washed on June 1, 2023. 3. In an interview E1 confirmed R1 received the services mentioned above but the services were not documented in R1 ' s medical record.

Based on record review and interview, the manager failed to ensure a resident's medical record contained medication order from a medical practitioner for each medication that is administered to the resident or for which the resident receives assistance in the self-administration of the medication for one of two residents sampled. The deficient practice posed a risk as medication administered could not be verified against a medication order. Findings Include: 1. A review of R1 ' s medical record revealed a medication administration record for May 2023 and June 2023 with the following medications: Quetiapine 50mg Trazodone 50mg 2. A review of R1 ' s medical record revealed the record did not contain current documentation of a medication order from a medical practitioner for the medication mentioned above. 3. In an interview E1 acknowledged R1 ' s medical record did not contain the medication order from a medical practitioner for the medication mentioned above. E1 reported E1 received the medication order via fax from the medical practitioner at 11:59 AM.

Based on the record review and interview, the manager of an assisted living facility authorized to provide directed care services failed to not accept or retain a resident who, except provided in R9-10-814.B.2, is confined to a bed or chair because of an inability to ambulate even with assistance. Findings Include: 1. A review of R1 ' s medical record revealed a service plan that confirmed R1 (accepted 2021) was receiving directed care services at the facility. R1 ' s service plan documented the last update for the service plan as February 23, 2023. R1 ' s service plan documented R1 is non-ambulatory, uses a wheelchair, and requires maximum assistance with ambulation. 2. In an interview E1 reported the documentation for authorization to retain R1 titled "Request to Remain" in R1's medical record was not signed by a medical practitioner at least once every six months throughout the duration of the resident ' s condition.

Based on record review, observation, and interview, the manager failed to ensure if a verbal order for a resident's medication is received from a medical practitioner by the assisted living facility the verbal order is documented in the resident's medical record for one of two residents sampled. Findings Include: 1. A review of R2 ' s medical record revealed the medication administration record (MAR) for May 2023. The MAR indicated the medication Topicalcy 5% cream was administered three times weekly and documented on May 2, 2023, May 4, 2023, May 7, 2023, May 9, 2023, May 11th, 2023, May 13, 2023, May 16, 2023, May 18, 2023, May 20, 2023, May 22, 2023, May 24, 2023, May 27, 2023, May 29, 2023, and May 31, 2023. 2. A review of R2 ' s medical record revealed the MAR for June 2023. The MAR indicated R2 was not administered the medication mentioned above in June 2023. 3. During the environmental inspection, the Compliance Officers observed the medication container for R2 and located the medication mentioned above. The Compliance Officers observed the bottle of the medication titled "Imiquimod 5% cream packet". 4. In an interview E1 reported the facility received a verbal order for the medication mentioned above for June 2023 from a medical practitioner. E1 reported the verbal order instructed to discontinue the medication. E1 reported the verbal order was not documented upon receipt. 5. In an interview E1 confirmed the bottle of medication titled "Imiquimod 5% cream packet" is the medication on the May 2023 and June 2023 MAR for R2. E1 reported the medication was not administered after May 31, 2023.

Based on documentation review, observation, and interview, the manager failed to ensure the hot water temperatures were maintained between 95\'ba F and 120\'ba F in areas of an assisted living facility used by residents. Findings Include: 1. A review of facility documentation revealed policies and procedures (approved February 2023) for hot water temperatures. The policy on page 23 stated "F. Hot water temperatures are maintained between 95\'b0 F and 120\'b0 F in areas of an assisted living Facility used by Residents". 2. During the environmental inspection, the Compliance Officers observed the water temperature reach 143\'b0F in the common bathroom used by residents at the facility. 3. In an interview E1 acknowledged the hot water temperatures were maintained between 95\'ba F and 120\'ba F in areas of an assisted living facility used by residents.

Based on documentation review, observation, and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were maintained in labeled containers in a locked area separate from food preparation and storage, and dining areas. The deficient practice posed a risk to the physical health and safety of a resident. Findings Include: 1. A review of facility documentation revealed policies and procedures (approved February 2023) for toxic materials. In the policy on page 23 stated "K. "Poisonous or toxic materials stored by the assisted living Facility are maintained in labeled containers in a locked area separate from food, preparation and storage, dining areas..". 2. During the environmental inspection, the compliance officer observed "Windex" and "Lysol" spray bottles in the cabinet under the kitchen sink at the facility. The compliance officer observed the cabinet was unlocked and the toxic materials were accessible to the residents. 3. In an interview E1 acknowledged the toxic materials stored by the assisted living facility were not maintained in labeled containers in a locked area separate from food preparation and storage, and dining areas.