Ativo Senior Living of Yuma

Based on record review and interview, the manager failed to ensure a written notice of termination of residency included the policy for refunding fees, charges, or deposits, or the deposition of a resident’s fees, charges, and deposits. Findings include: 1. A review of R5’s medical record revealed a letter dated January 30, 2026, regarding R5’s “14 Day Notice for Behaviors Outside of Our Scope of Service.” The letter included the reason for the termination of R5’s residency and contact information for the State Long-Term Care Ombudsman. However, the letter did not include the policy for refunding fees, charges, or deposits, or the deposition of a resident’s fees, charges, and deposits, as required. 2. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on documentation review and interview, the manager failed to ensure a caregiver or an assistant caregiver documented an event in which a resident had an accident, emergency, or injury and needed medical services, as required per R9-10-819.D.2. Findings include: 1. A review of facility documentation revealed an incident report, dated January 1, 2026, documenting an accident in which R4 required medical services. The report documented the event, including the description of the emergency, names of individuals who observed the incident, actions taken by the caregiver, and documentation of notification of the resident’s primary care provider. However, the report did not include documentation of notification of the resident’s emergency contact or any actions taken to prevent the emergency in the future. 2. A review of facility documentation revealed an incident report, dated January 7, 2026, which documented an emergency in which R7 required medical services. The report did not include documentation of immediate notification of R7’s primary care provider, nor did it include documentation of any notification of R7’s emergency contact. 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

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 or behavioral health services for one of six certified caregivers sampled. Findings include: 1. A review of facility staff documentation revealed E4 was hired in September 2025 and worked numerous shifts in January 2026. 2. A review of E4’s personnel record revealed evidence of documentation indicating E4’s skills and knowledge were verified before providing physical or behavioral health services was unavailable for review. 3. In an interview, the findings were reviewed with E1, and no additional information was provided.

Based on documentation review and interview, the health care institution failed to ensure a training program for all staff regarding fall prevention and fall recovery, which included initial training and continued competency, was developed. Findings include: 1. A request was made to review the facility’s fall prevention and fall recovery training, which included initial training and continued competency training in fall prevention and fall recovery. However, evidence of documentation of such a program was unavailable for review. 2. A review of facility personnel records revealed evidence of documentation of fall training. However, evidence of documentation of what the fall training included was unavailable for review. 3. In an interview, E1 advised they were aware the facility was required to have a fall prevention and fall recovery training program. E1 indicated they were unable to locate and were not aware of a specific training program for the facility on fall prevention and fall recovery. 4. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review, document review, and interview, for one of eight caregivers sampled, the manager failed to ensure a caregiver provided current documentation of cardiopulmonary resuscitation (CPR) or first aid training before providing assisted living services to a resident. 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 E8’s personnel record revealed E8 was hired on June 1, 2023, as a certified caregiver. Further review revealed E8's last day of employment was January 26, 2026. The personnel record contained a copy of an adult CPR certification and first aid training that expired in December 2025. However, evidence of documentation indicating E8 had completed CPR training specific to adults, or first aid training since December 2025, was unavailable for review. 2. A review of facility payroll records revealed documentation indicating E8 worked numerous shifts in January 2026. 3. In an interview, E1 advised E1 had been appointed manager of the facility on January 24, 2026, and did not realize E8 was working without a valid CPR certification or first aid training. 4. In an exit interview, findings were reviewed with E1, and no additional information was provided.

Based on record review and interview, the manager failed to ensure a caregiver documented the services provided in the resident's medical record for one of seven residents sampled. Findings include: 1. A review of R2's medical record revealed a current service plan describing the services provided by the facility staff. The plan included the service “Bathing,” which indicated R2 required full assistance with bathing twice per week. 2. A review of R2’s medical record revealed a document used for tracking the services provided to R2 in January 2026. The document indicated R2 received bathing assistance on January 4, 2026 and January 21, 2026, but did not receive bathing assistance on January 7, 11, 14, 18, or 25, 2026. Further review revealed documentation indicating R2 did not receive bathing services because R2 was on the “wrong schedule.” 3. In an interview, E1 expressed E1 did not know if R2 did or did not receive bathing services as outlined in R2’s service plan for January 2026. 4. In an exit interview, the findings were reviewed with E1, and no additional information was provided.