Az Joyful Living

Based on observation and interview, the manager failed to ensure that the premises were free from a condition or situation that may cause a resident or other individual to suffer physical injury. The deficient practice posed potential physical health risks to the residents. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed roaches on the sink counter in a bathroom. 2. In an exit interview, the findings were reviewed with E2 and no additional information was provided. 3. Technical assistance was provided on this rule during the inspection conducted on March 7, 2024.

Based on record review and interview, the manager retained a resident without meeting the requirements in R9-10-814.B.2, at least once every six months throughout the duration of the resident's condition, for a resident confined to a bed or chair because of an inability to ambulate even with assistance, for one of two residents sampled. The deficient practice posed a risk if the facility was unable to meet R1's needs. Findings include: 1. A review of R1's (admitted in 2020) medical record revealed a current service plan, dated in August 2022, for directed care services. The service plan indicated R1 was non-ambulatory. Further review revealed a document titled, "Confinement Determination," dated January 12, 2023, which indicated R1 was "confined on bed," but "[R1's] needs can be met" by the facility. In addition, the medical record contained a document titled, "Authorization for Continued Residency," indicated R1 was "bed bound/ chair bound/ unable to walk," and examined by a medical provider and authorized to remain in the facility. The document was signed on September 8, 2023, however it did not include a date of examination. Evidence of another examination in June 2023 or January 2024 was unavailable for review. 2. In an interview, E1 advised R1 was bed bound and was last examined in September 2023. E1 acknowledged R1's medical record did not contain evidence of compliance with R9-10-814.B.2.b.i, at least once every six months.

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. Findings include: 1. During a tour of the facility, the Compliance Officers observed a hall closet with a door knob which could be locked with a key. However, the door was unlocked and E1 opened the door with little apparent effort. On the floor inside the closet, the Compliance Officers observed portable baskets containing various hygiene items. One basket also contained two medications, "Mucinex DM, Dextromethorphan HBR 30 mg, Guaifenesin 600 mg," and "Melatonin 12 mg." 2. In an interview, E1 advised the medications belonged to a caregiver. E1 acknowledged that medications were not stored in in a self-contained unit used only for medication.

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 emergency and needed medical services, as required per R9-10-818.D.2. Findings include: 1. A review of facility Quality Management reports from April 2023 through March 2024 revealed three incidents involving emergencies where 911 was contacted. The Quality Management reports indicated the first incident occurred in May 2023, the second incident occurred in July 2023, and the third incident occurred on February 2024. 2. A request was made to review the incident reports for the May and July 2023 incidents as well as the February 2024 incident. However, evidence of documentation of an incident report for any of the three identified incidents in which a resident was involved in an emergency was unavailable for review. 3. In an interview, E1 advised the May 2023 incident involved R3 and the February 2024 incident involved R4, however E1 did not identify which resident was involved in the July 2023 incident. E1 a agreed all three incidents were not documented in incident reports as required.

Based on documentation review and interview, the manager failed to implement an ongoing quality management program which, at a minimum, included a method to identify, document, and evaluate incidents. The deficient practice posed a risk as a quality management program documents the necessary information required to effectively manage services provided. Findings include: 1. A review of the facility's policies and procedures, last reviewed March 7, 2022, revealed a policy titled "Quality Management Program." This policy stated "The Manager shall ensure that: 1. A documented incident report is submitted...that include: a. An identification/documentation or date collections /evaluation of each incident (911, falls, ...) using the facility incident report form;" 2. A review of facility Quality Management reports from April 2023 through March 2024 revealed three incidents involving emergencies where 911 was contacted. The Quality Management reports indicated the first incident occurred in May 2023, the second incident occurred in July 2023, and the third incident occurred on February 2024. 3. A request was made to review the incident reports for the three incidents identified. However, evidence of documentation of the May and July 2023 incident reports, or the February 2024 incident report was unavailable for review. 4. In an interview, E1 advised the May 2023 incident involved R3 and the February 2024 incident involved R4, however E1 did not identify which resident was involved in the July 2023 incident. E1 a agreed all three incidents were not documented in incident reports as required.