Avista Senior Living, Historic Downtown Mesa

Based on documentation review and interview, the manager failed to ensure a dog or cat allowed in the facility was vaccinated against rabies. The deficient posed a risk if a dog allowed into the facility did not meet the vaccination requirements. Findings Include: 1. A review of facility records revealed documentation of rabies vaccination for a dog, O1, who was living at the facility with R9. However, the rabies vaccination had expired on September 15, 2025. No evidence of current vaccination against rabies was available for review. 2. A review of facility records revealed documentation of rabies vaccination for a dog, O2, who was living at the facility with R10. However, the rabies vaccination had expired on August 19, 2023. No evidence of current vaccination against rabies was available for review. 3. In an interview, E1 acknowledged that O1 and O2 did not have current evidence of vaccination against rabies.

Based on documentation review, record review, and interview, the manager failed to ensure that personnel records for four of the eight sampled personnel included documentation of freedom from infectious tuberculosis (TB), as specified in R9-10-113. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. R9-10-113.A states "If a health care institution is subject to the requirements of this Section, as specified in an Article in this Chapter, the health care institution's chief administrative officer shall ensure that the health care institution establishes, documents, and implements tuberculosis infection control activities that...2. Include: a. For each individual who is employed by the health care institution, provides volunteer services for the health care institution, or is admitted to the health care institution and who is subject to the requirements of this Section, screening, on or before the date specified in the applicable Article of this Chapter, that consists of: i. Assessing risks of prior exposure to infectious tuberculosis, ii. Determining if the individual has signs or symptoms of tuberculosis, and iii. Obtaining documentation of the individual's freedom from infectious tuberculosis according to subsection (B)(1)..." 2. A review of E3’s, E4’s, E5's, and E6’s personnel records revealed no documentation of a risk assessment of prior exposure to infectious TB, or a determination of whether E5 had signs or symptoms of TB. Based on the hire dates of E2, E4, E5, and E6, this documentation was required. 3. In an interview, E1 acknowledged that E3, E4, E5, and E6's personnel records did not contain complete documentation of TB requirements at the time of the inspection. 4. Technical assistance was provided on this Rule during the inspections conducted on August 6, 2024.

Based on interview and observation, the manager failed to ensure a resident was treated with dignity, respect, and consideration. The deficient practice posed a risk as resident rights were violated. Findings include: 1. In an interview, R1 reported that E2 did not treat residents with respect, but would not elaborate further. 2. In an interview, R2 reported that E2 accused R2 of bringing bedbugs into the facility and that E2 accused R2 of undermining E2's authority when R2 went to E1 for assistance with responding to the bedbugs. 3. In an interview, E1 acknowledged that residents reported that E2 did not treat residents with dignity, respect, and consideration.

Based on documentation review, record review, and interview, the manager failed to ensure that a caregiver's skills and knowledge were verified and documented before the caregiver provided health services and according to policies and procedures. The deficient practice posed a risk if a personnel member was unable to meet a resident's needs. Findings include; 1. A review of the facility's policies and procedures revealed a policy titled, "Caregiver Employment Requirements." The policy stated, "Needed skills and knowledge will be verified and documented prior to the caregiver providing services .." 2. A review of E3's personnel record revealed no documentation of verification of E3's skills and knowledge prior to providing health services. 3. In an interview, E1 reported E3 was a current employee of the facility. E1 acknowledged verification of skills and knowledge was not documented in E3's personnel record before E3 provided health services, and according to the facility's policies and procedures.

Based on record review, observation, and interview, the manager failed to ensure the caregiver documented the services provided in the resident's medical record, for one of ten residents reviewed. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. A review of R6's medical record revealed a service plan that indicated, R6 would receive minimal assistance with bathing, two times a week. 2. A review of R6's activities of daily living (ADL) documentation revealed R6 received minimal assistance with bathing as needed (PRN). The ADL for July 2024 indicated R6 did not receive assistance with bathing for the month of July. The only entry for the month of July was documentation of service non applicable on July 6, 2024. 3. In an interview, E1 reported R6 received assistance with bathing within the month of July. E1 acknowledged a caregiver failed to document the services provided in R6's medical record. Technical assistance was provided regarding this rule during the compliance inspection conducted on February 7, 2023.

Based on observation and interview, the manager failed to ensure that foods requiring refrigeration were maintained at 41\'b0 F or below. The deficient practice posed a risk for potential food borne illnesses. Findings include: 1. During an environmental tour of the facility, the Compliance Officers observed an open bottle of Bulls-Eye Honey Smoke Barbecue Sauce stored on an unrefrigerated shelf in the kitchen. The sauce label stated, "refrigerate after opening." 2. In an interview, E1 acknowledged foods requiring refrigeration were not maintained at 41\'b0 F or below.

Based on observation and interview, the manager failed to ensure that food was stored to protect from potential contamination. Findings include: 1. During an environmental tour of the facility, the Compliance Officers observed an unlocked refrigerator located in an unlocked activity room accessible to residents. The refrigerator contained a used napkin, dried, unidentifiable, food residue, various uncleaned food storage containers, and condiments. 2. In an interview, E1 acknowledged food stored by the facility was not protected from potential contamination.

Based on observation and interview, the manager failed to ensure that poisonous materials stored by the assisted living facility were maintained in labeled containers in a locked area inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental tour of the facility, the Compliance Officers observed the following toxic materials placed on the counter of an unlocked activity room, accessible to residents: - Windex Glass Cleaner; - McKesson Disposable Germicidal Surface Wipes; - Dawn Dish Soap; and - Essenza Hand Soap. 2. The Compliance Officers observed bottles of the following toxic materials in an unlocked cabinet below the sink in an unlocked activity room, accessible to residents: - Miracle Gro All Purpose Plant Food; - Febreze Allergen Reducer; - 20 Mule Team Borax; - Bright Solutions DNA Cleaner; and - An unlabeled spray bottle containing an unidentifiable green liquid, labeled by hand as "Miracle Gro Mixture" with a hand-drawn skull and crossbones. 3. In an interview, E1 acknowledged toxic materials stored by the facility were maintained in labeled containers in a locked area inaccessible to residents.