Az Assisted Living, LLC

Based on observation and interview, the manager failed to ensure a refrigerator used by an assisted living facility to store food or medication contained a thermometer accurate to plus or minus 3° F, placed at the warmest part of the refrigerator. The deficient practice posed a health and safety risk if the refrigerator was not maintained at a proper temperature. Findings include: During an environmental inspection of the facility with E1, the Compliance Officers observed the outside refrigerator used by the assisted living facility to store food or medication did not contain a thermometer.  In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with A.R.S. § 36-411(C), for one of two personnel sampled. The deficient practice posed a risk if the employees were a danger to a vulnerable population. Findings include: 1. A.R.S. § 36-411(C)(1) states, "Each residential care institution, nursing care institution and home health agency shall make documented, good faith efforts to: 1. Contact previous employers to obtain information or recommendations that may be relevant to a person’s fitness to work in a residential care institution, nursing care institution or home health agency." 2. A review of E1's personnel record revealed documentation of professional references; however, documentation of the facility's good faith efforts to contact E1's previous employers was not available for review. 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on documentation review, record review, and interview, the manager failed to ensure that a caregiver provided evidence of freedom from infectious tuberculosis (TB) as specified in R9-10-113 before the individual began providing services, for two of two personnel sampled. The deficient practice posed a potential illness 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 the Centers for Disease Control and Prevention website revealed a web page titled "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005." The web page stated, "If TST (Mantoux Skin Test) is used for baseline testing, two-step testing is recommended for HCWs (Health Care Workers) whose initial TST results are negative. If the first-step TST result is negative, the second-step TST should be administered 1-3 weeks after the first TST result was read." 3. A review of E1's personnel record revealed two negative TB skin tests. However, the tests were read after E1 began providing services. 4. A review of E2's personnel record revealed two negative TB skin tests. However, the tests were read after E2 began providing services. 5. In an interview, E2 reported E2 was unaware of the testing requirements prior to providing health services. 6. 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, for one of two sampled residents, a resident's service plan was signed and dated by the manager. Findings include: 1. A review of R1’s medical record revealed a service plan, dated October 1, 2025. However, the service plan was not signed and dated by the facility’s manager. 2. In an exit interview, the findings were reviewed with E1, and no additional information was provided. This is a repeat citation from the compliance and complaint inspection conducted on April 4th, 2024.

Based on record review and interview, the manager failed to ensure that a service plan for a resident receiving directed care services included encouragement to eat and coordination of communications with the resident’s representative or family members, for two of two residents sampled. The deficient practice posed a risk if the resident's representative and other individuals identified were unable to participate in decisions concerning the assisted living services the resident was to receive. Findings include: 1. A review of R1's medical record revealed a service plan, dated September 8, 2025. However, the service plan did not include encouragement to eat and coordination of communications with the resident’s representative or family members. 2. A review of R2's medical record revealed a service plan, dated October 1, 2025. However, the service plan did not include encouragement to eat and coordination of communications with the resident’s representative or family members. 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on observation and interview, the manager failed to ensure that medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed a risk to residents who were not prescribed the accessible medication. Findings include: During an environmental inspection of the facility with E1, the Compliance Officers observed an unlocked refrigerator in the kitchen that contained the medication Insulin Glargine 100 units/milliliter. In an exit interview, the findings were reviewed with E1, and no additional information was provided. This is a repeat citation from the compliance and complaint inspection conducted on April 4th, 2024.

Based on observation and interview, the manager failed to ensure that the premises and equipment used at the facility were free from a condition or situation that may cause a resident or other individual to suffer physical injury. The deficient practice posed potential egress dangers to residents. Findings include: During an environmental inspection of the facility with E1, the Compliance Officers observed multiple pieces of equipment, bird cages, roofing materials, tools, and buckets openly stored behind the bird enclosure. While on site, E1 immediately had a fence installed behind the bird enclosure so that the pieces of equipment, bird cages, roofing materials, tools, and buckets were no longer openly accessible to residents. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on document review, observation, record review and interview, the governing authority failed to notify the Department according to A.R.S. \'a7 36-425(I), which required immediate notification to the Department in writing, identifying the name and qualifications of the new manager when there was a change in the manager. Findings include: 1. Review of Department records revealed E8 listed as the manager. 2. In an interview, E3 reported E8's date of termination was August 31, 2023. 3. During an environmental inspection of the facility, the Compliance Officers observed E1's manager's certificate posted near the front door of the facility. 4. Review of E1's personnel record revealed a hire date of March 28, 2024. 5. Review of E2's personnel record revealed E2 was the manager starting November 3, 2023. E2's termination date was not provided to the Compliance Officer. 6. Review of E4's personnel record revealed a valid manager's certificate. 7. In an interview, E3 reported E4 served as manager between E8 and E2, and between E2 and E1. 8. In an interview, E1 and E3 reported E1 was the current manager and acknowledged the Department was not notified in writing of the changes in managers.

Based on record review and interview, the manager failed to ensure a written service plan was updated at least once every three months, for two of two residents reviewed who were receiving directed care services, which posed a health and safety risk to the residents if the employees did not know what services the residents needed. Findings include: 1. Review of R1's medical record revealed a current written service plan for directed care services dated November 6, 2023. However, a service plan after November 6, 2023 was not available for review. 2. Review of R2's medical record revealed a current written service plan for directed care services dated December 3, 2023. However, a service plan after December 3, 2023 was not available for review. 3. During an interview, E1 acknowledged R1 and R2 received directed care services and the service plans were not updated at least once every three months.

Based on record review and interview, the manager failed to ensure a written service plan included the signature and date from the manager, for two of three residents reviewed. The deficient practice posed a risk if the service plans were not developed to articulate decisions and agreements. Findings include: 1. Review of R1's medical record revealed a current written service plan for directed care services dated November 6, 2023. However, this service plan did not include a signature and date from the manager. 2. Review of R2's medical record revealed a current written service plan for directed care services dated December 4, 2023. However, this service plan did not include a signature and date from the manager. 3. In an interview, E1 acknowledged R1's and R2's service plans did not contain a signature and date from the manager.

Based on observation and interview, the manager failed to ensure a calendar of planned activities was prepared at least one week in advance of the date the activity was provided. Findings include: 1. During an environmental inspection of the facility with E1, the Compliance Officers observed the posted activity calendar. The activity calendar was dated September 1, 2023 - September 30, 2023. 2. In an interview, E1 acknowledged a calendar of planned activities was not prepared at least one week in advance.

Based on record review, observation, and interview, the manager failed to ensure a resident medical record contained a medication order from a medical practitioner for each medication that was administered, for one of three residents reviewed. The deficient practice posed a health and safety risk. Findings include: 1. Review of R2's medical record revealed a current written service plan dated December 4, 2023. This service plan indicated R2 received medication administration. 2. Review of R2's medical record revealed no documentation of a signed medication order or a verbal medication order for Lorazepam. 3. Review of R2's medical record revealed an April 2024 medication administration record (MAR). This MAR stated "Lorazepam 1 mg Tablet by mouth once daily at bedtime" and indicated one tab was administered at 7PM April 1st - April 3rd. 4. During an observation of R2's medications, Lorazepam 0.5mg tab was observed. 5. In an interview, E1 reported R2 received the medication as recorded on the MAR. 6. In an interview, E3 reported the medication order was faxed to the facility, but not added to the medical record. The medication order was not available for review. 7. In an interview, E1 acknowledged R2's medical record did not contain a medication order from a medical practitioner for a medication that was administered.

Based on record review, observation, and interview, the manager failed to ensure a resident's medical record contained documentation of a medication administered to the resident that included the correct strength, for one of three residents reviewed. Findings include: 1. A review of R1's medical record revealed a medication order (dated February 9, 2023) which stated "Trazadone HCL Oral Tablet 100 MG". 2. A review of R1's medication revealed a container of Trazadone 100MG Tablets. 3. A review of R1's Medication Administration Record (MAR) showed "Trazadone 50mg tablet" recorded as administered every day from April 1, 2024 - April 3 2024. 4. In an interview, E1 acknowledged the resident's medical record did not contain documentation of medication administered to the resident that included the correct strength.

Based on documentation review, record review, observation, and interview, the manager failed to ensure an individual authorized by policies and procedures to administer an opioid, documented in the resident's medical record the identification of the resident's need for the opioid and the effect of the opioid administered, for one of three residents reviewed. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. Review of the facility's policies and procedures revealed a policy titled "Medications Including Opioids and Narcotics" reviewed and signed by E1 March 30, 2024. This policy and procedure stated "[...] 3. Facility personnel will provide opioid medication based on doctor's orders for regular administration (on a regular basis) and will identify and document the level of pain and/or the resident's need for the opioid medication. [...] 4. The facility personnel authorized to provide assistance to medication administration or medication administration are to use common sense and verbal and nonverbal communication techniques to identify the residents need for the opioid by assessing the level of pain the resident may be experiencing. [...] This identification of the resident's need for the opioid must be documented in the NAR. [...] 7. Documentation of the assessment and monitoring is documented on the Narcotic Administration Form or PRN Chart (for medications which are not controlled substances) by the caregiver that administered or assisted the resident with self-administration." 2. Review of R3's medical record revealed a March 2024 medication administration record (MAR). This MAR revealed Morphine concentrate 100/5ml was administered on an "as needed" basis on the follow days: -March 4; -March 10; -March 27 Documentation was not available showing the identification of R3's need for the opioid and the effect of the opioid administered. 3. During an observation of R3's medications, morphine was available. 4. Review of R3's medical record revealed no documentation stating R3 had an end-of-life condition or an active malignancy. 5. During an interview, E1 acknowledged the caregiver did not document in R3's medical record the identification of the need for the opioid and the effect of the opioid administered.

Based on documentation review, observation, and interview, the manager failed to ensure there was a means of exiting the facility for a resident who did not have a key, special knowledge for egress, or the ability to expend increased physical effort, that provided access to an outside area, and controlled or alerted employees of the egress of a resident from the facility. The deficient practice posed a risk if the facility was unaware of the general or specific whereabouts of a resident. Findings include: 1. The facility was licensed at the directed care level. 2. During an environmental inspection of the facility with E1, the Compliance Officers observed two doors leading to a backyard. The outside area, in the backyard, allowed residents to be at least 30 feet away from the facility. The doors did not have a device that alerted employees of the egress of a resident from the facility and were unlocked. 3. In an interview, E1 and E6 reported one door did not have an alarm and the other door alarm was not working. 4. In an interview, E1 acknowledged there was not a means of exiting the facility that controlled or alerted employee of the egress of the resident.

Based on observation and interview, the manager failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed a risk to residents who could access the medication. Findings include: 1. During an environmental inspection of the facility, the Compliance Officers observed the following on a dresser in an unlocked room: -Dayquil Severe -Nyquil Severe -Family Care Nasal Relief spray -Walgreen's Acetaminophen tablets 2. In an interview, E1 and E5 reported access to that area of the home was usually locked. However, the door was unlocked at time of inspection. 3. In an interview, E1 acknowledged the medication was not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage.

Based on documentation review and interview, the manager failed to ensure an employee disaster drill was conducted on each shift at least once every three months and documented. The deficient practice posed a risk if employees were unable to implement the disaster plan. Findings include: 1. Review of the March 31, 2024 - April 6, 2024 personnel schedule revealed two shifts; 7AM-7PM (day shift) and 7PM-7AM (night shift). 2. Review of the facility's employee disaster drills revealed the most current disaster drill conducted June 12, 2023 on the day and night shift. No other employee disaster drill was available after June 12, 2023. 3. During an interview, E1 acknowledged the employee disaster drills were not conducted on each shift at least once every three months.

Based on documentation review and interview, the manager failed to ensure an evacuation drill for employees and residents was conducted at least once every six months. The deficient practice posed a risk if employees were unable to implement the evacuation plan. Findings include: 1. Review of the facility's employee and resident evacuation drills revealed the most current drill conducted June 12, 2023. No other employee and resident evacuation drills were available after June 12, 2023. 2. During an interview, E1 acknowledged the employee and resident evacuation drills were not conducted at least once every six months.

Based on observation and interview, the manager failed to ensure hot water temperatures were maintained between 95\'b0 F and 120\'b0 F in the areas of a facility used by residents. The deficient practice posed a health and safety risk to the residents. Findings include: 1. During an environmental inspection of the facility with E1, the Compliance Officers observed the hot water temperature at 125\'b0 F in the hall bathroom near resident bedrooms. 2. In an interview, E1 acknowledged the hot water temperatures were not maintained between 95\'b0 F and 120\'b0 F in the areas of a facility used by residents.

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. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental inspection of the facility, the Compliance Officers observed ambulatory residents. 2. During an environmental inspection of the facility with E1, the Compliance Officers observed the following: -Clorox wipes and Wipes.com Disinfectant Wipes in an unlocked pantry room; -Great Value Glass Cleaner, Clorox Wipes, and Weiman Stainless Steel Cleaner in an cabinet under the kitchen sink. The cabinet had a child safety latch, however, it was not locked; -Three bottles of Great Value Low-Splash Bleach in an unlocked garage, accessible to residents from the yard; -Clorox spray and Pledge spray in an unlocked cabinet in a common area bathroom. 3. In an interview, E1 acknowledged poisonous or toxic materials stored by the assisted living facility were not maintained in a locked area inaccessible to residents.

Based on observation, documentation review, and interview, the manager failed to ensure combustible or flammable liquids and hazardous materials stored by the assisted living facility were stored 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 inspection of the facility, the Compliance Officers observed ambulatory residents. 2. During an environmental inspection of the facility with E1, the Compliance Officers observed the following: -Cyclo Heavy Duty Break Away spray, which states "flammable aerosol", in the back yard; -Klean Strip Acetone, which states "Danger! Extremely flammable", in an unlocked garage. 3. In an interview, E1 acknowledged combustible or flammable materials stored by the assisted living facility were not maintained in a locked area inaccessible to residents.