Az Life Assisted Living Home II, LLC

Based on documentation review, observation, and interview, the licensee implemented a modification of the facility, without an approval or amended license issued by the Department. The deficient practice posed a risk as the Department was unable to assess and approve the modification, as the facility did not submit an updated floor plan, and documentation of compliance with local building and zoning codes. Findings include: 1. A review of Department documentation revealed a floor plan for AL10775. The document indicated AL10775 had six bedrooms. Department documentation revealed no documentation the licensee submitted a request for approval for a modification to the physical plant, including the addition of three bedrooms. 2. During the facility tour, the Compliance Officers observed the inside and outside of the facility were in a remodel. The garage was in the process of the remodel. The nook was already converted into a bedroom. 3. In an interview, E1 reported the garage was in the process of being remodeled into two bedrooms. E1 also reported in 2023 the nook was converted into a bedroom. E1 did not have the exact date of the conversion. 4. In an interview, E1 reported being unaware approval was required from the Department for a modification of the facility. E1 acknowledged modifications were made to the facility, and to the floor plan, without Department approval.

Based on observation, documentation review, and interview, the manager failed to ensure toxic materials stored by the facility were stored in a locked area and inaccessible to residents. The deficient practice posed a health and safety risk if a resident inappropriately used the toxic material. Findings include: 1. During the facility tour, the Compliance Officers observed a unlocked shed in the backyard. Within the shed the following chemicals were found: -A can of Raid for ants and roaches; -A can of Rust-Oleum gloss protective enamel; -A can of Rust-Oleum all surface paint and primer; -A can of Johnsen's Starting fluid; and -A gallon of Roundup. 2. During the facility tour, the Compliance Officers observed a bottle of Gorilla glue and Nail polish remover in the food pantry. 3. A review of the facility policies and procedure revealed a policy title, "Environmental and Physical Plant Safety" which stated, "15. Poisonous and toxic materials will be in labeled containers and stored in a locked area separate from food preparation and food storage areas, and medications and are inaccessible to residents." 4. In an interview, E1 acknowledged toxic materials in the shed and pantry were stored unlocked.

Based on record review and interview, the manager failed to ensure a resident had a written service plan signed and dated by the manager, for two of four residents sampled. The deficient practice posed a risk if the service plan was not developed to articulate decisions and agreements. Findings include: 1. A review of R1's medical record revealed a current written service plan dated in July 2023, for personal care services. However, the service plan was signed by E2 and not signed and dated by the manager. 2. A review of R3's medical record revealed a current written service plan dated in March 2023, for personal care services. However, the service plan was signed by E2 and not signed and dated by the manager. 3. In an interview, E2 acknowledged R1's and R3's service plans were not signed and dated by E1.

Based on record review and interview, the manager failed to ensure, before or at the time of an individual's acceptance by the assisted living facility, there was a documented residency agreement with the assisted living facility to include the manager's signature and date signed, for four of four residents sampled. Findings include: 1. A review of R1's (admitted in 2023) medical record revealed a documented residency agreement. However, the residency agreement was signed by E2 and not signed and dated by the manager. 2. A review of R2's (admitted in 2023) medical record revealed a documented residency agreement. However, the residency agreement was signed by E2 and not signed and dated by the manager. 3. A review of R3's (admitted in 2023) medical record revealed a documented residency agreement. However, the residency agreement was signed by E2 and not signed and dated by the manager. 4. A review of R4's (admitted in 2023) medical record revealed a documented residency agreement. However, the residency agreement was signed by E2 and not signed and dated by the manager. 5. In an interview, E2 acknowledged R1's, R2's, R3's, and R4's residency agreements did not include E1's signature and the date signed.