Azure Care Home, LLC

Based on record review and interview, the manager failed to ensure documentation required by this Article was provided to the Department within two hours after a Department request. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the licensee did not provide the Department with the requested documentation required by this Article. Findings include: 1. On January 16, 2024 the Compliance Officer requested the following documents during the on-site inspection: - documentation of E1 and E2's cardiopulmonary resuscitation (CPR) and first aid training (received E1's CPR, first aid after the two hours); - documentation for R1, and R2 dated within 90 calendar days before the individual is accepted by an assisted living facility; - documentation of R1, and R2's influenza and pneumonia vaccinations. 2. In an interview, E1, acknowledged this information was not provided to the Compliance Officer within two hours after a Department request.

Based on record review, and interview, the manager failed to ensure before providing assisted living services to a resident, a manager or caregiver provided current documentation of first aid training and cardiopulmonary resuscitation (CPR) training certification specific to adults for one of three caregivers sampled. The deficient practice posed a risk if E2 was unable to meet a resident's needs during an emergency. Findings include: 1. A review of E2's personnel record revealed E2 worked as a medication tech/caregiver and had a hire date of June 2016. No documentation was available for review to show E2 had current first aid training and cardiopulmonary resuscitation (CPR) training certification specific to adults. No other documentation was provided while the Compliance Officer was on-site. 2. In an interview, E1 reported being unable to locate E2's current first aid training and cardiopulmonary resuscitation (CPR) training certification specific to adults.

Based on record review and interview, the manager failed to ensure an individual submitted documentation dated within 90 calendar days before the individual was accepted by the facility, and if an individual was requesting or was expected to receive supervisory care services, personal care services, or directed care services, to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant, for two of three residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R1, and R2's, medical records revealed no documentation dated within 90 calendar days before the residents were accepted by the facility, and if an individual was requesting or was expected to receive supervisory care services, personal care services, or directed care services, to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant. No documentation was provided during the on-site compliance inspection. 2. In an interview, E1, reported being unable to locate R1's and R2's documentation dated within 90 calendar days before the individual was accepted by the facility.

Based on record review, documentation review, observation, and interview, the manager failed to ensure a resident's medical record contained documentation of notification of the resident of the availability of vaccination for for influenza and pneumonia, according to A.R.S. \'a7 36-406(1)(d) for two of three residents sampled. This deficient practice posed a potential illness risk to residents. Findings include: A.R.S. \'a7 36-406(1)(d) states, " 1. The department shall... (d) Require as a condition of licensure that nursing care institutions and assisted living facilities make vaccinations for influenza and pneumonia available to residents on site on a yearly basis. The department shall prescribe the manner by which the institutions and facilities shall document compliance with this subdivision, including documenting residents who refuse to be immunized." 1. A review of R1's medical record revealed R1 has been residing in the assisted living facility for four months. However, there was no documentation of evidence to indicate the facility offered the influenza and pneumonia vaccination on a yearly basis or documentation of R1's refusal of the pneumonia vaccination. 2. A review of R2's medical record revealed R2 has been residing in the assisted living facility for more than twelve months. The Compliance Officer observed documentation on the influenza vaccination. However, there was no documentation of evidence to indicate the facility offered the pneumonia vaccination on a yearly basis or documentation of R2's refusal of the pneumonia vaccination on a yearly basis. 3. In an interview, E1 acknowledged being unable to locate the vaccinations for influenza and pneumonia for R1 and R2. This is a repeat citation from the compliance inspection conducted on January 23, 2023.

Based on record review, observation, and interview, the manager failed to ensure a medication administered to a resident was administered in compliance with a medication order, and was accurately documented in the resident's medical record, for one of three residents records sampled. Findings include: 1. A review of R1's medical record revealed an order for "Lantanoprost Solution 0.005%, instill 1 drop in left eye @ bedtime for Glaucoma", dated November 28, 2023. 2. A review of R1's medication administration record (MAR) dated January 2024 revealed no documentation of the administration of Lantanoprost Solution 0.005%. 3. A review of R1's medication organizer revealed Lantanoprost Solution 0.005% box had been opened and the vile was half gone. 4. A review of documentation revealed no evidence that R1's medical practitioner discontinued the Lantanoprost Solution 0.005%. 5. In an interview, E1 acknowledged medication was not administered in compliance with a medication order, and was not accurately documented in the resident's medical record.