Blooming Meadows

Based on documentation review, record review, and interview, the governing authority failed to administer a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk if a staff member was not properly trained to assist a resident who had fallen and was unable to recover independently. Findings include: 1. A review of facility documentation revealed a policy and procedure titled "FALL PREVENTION and RECOVERY POLICY AND PROCEDURE" which stated, "All employees will have a class on fall prevention upon date hired and a continuous training on a yearly basis by a school approved and regulated by NCIA board regarding fall prevention and recovery." 2. A review of E2's personnel record revealed E2 was hired as the manager. However, the review revealed no training regarding fall prevention and fall recovery. 3. In an interview, E1 stated, “[E2] doesn’t have it.” This is a repeat citation from the compliance inspection conducted on September 25, 2023.

Based on documentation review, interview, and record review, the manager of an assisted living home who contacted an emergency responder on behalf of a resident failed to provide a written document with all required information to the emergency responder. The deficient practice posed a risk if the emergency responder was not aware of critical health information for the resident. Findings include: 1. A review of facility documentation revealed a policy and procedure (P&P) titled “POLICY AND PROCEDURE IN SITUATIONS REQUIRING EMERGENCY RESPONDERS.” The P&P stated: “During emergency situations in the facility when emergency responders are called to assist, it is imperative that correct and updated information regarding the resident needing emergency services are provided to the responders. A written document with all the resident’s necessary information shall be furnished for the responders and the hospital, if needed, to properly and efficiently treat the resident.” The P&P continued by listing most of the items listed in this statute. 2. In an interview, E1 reported R2 had an accident, emergency, or injury on March 9, 2025, that resulted in facility personnel contacting an emergency responder on behalf of R2. E1 reported facility personnel provided the emergency responders with a copy of R2’s current medication administration record (MAR), current documentation of assisted living services provided to R2, and a form provided by R2’s hospice provider. 3. A review of R2’s medical record revealed the aforementioned MAR and hospice form. However, the document was not a facility-wide standardized form as required by Arizona Revised Statutes A.R.S. § 36-420.04(C) that included the information prescribed in this statute. The review further revealed facility personnel did not provide emergency responders with the following documentation: - The reason or reasons the emergency responder was requested on behalf of R2; - The name, address and telephone number of R2's current pharmacy; - Basic medical history, such as having diabetes or a pacemaker or experiencing frequent falls or cardiovascular and cerebrovascular events, as well as dates of recent episodes, as applicable; - The point-of-contact information for the assisted living home, including the email address; and - A copy of R2's health insurance portability and accountability act release authorizing a receiving hospital to communicate with the assisted living home to plan for R2's discharge. 4. In an interview, E1 acknowledged the written documents provided to emergency responders on March 9, 2025, did not include all required information.

Based on interview and documentation review, the manager of an assisted living home failed to maintain a standardized form for each resident that included the information prescribed in Arizona Revised Statute (A.R.S.) § 36-420.04(A)(1-9). The deficient practice posed a risk if the emergency responder was not aware of critical health information for a resident. Findings include: 1. In an interview, E1 reported each resident had a face sheet facility personnel could give to emergency responders when facility personnel contacted emergency responders on behalf of a resident. 2. A review of facility documentation revealed face sheets for R1, R2, R3, and R4. However, the face sheets did not include the following: - A place to document the reason or reasons the emergency responder was requested on behalf of the resident (for R1, R2, R3, and R4); - The name (for R3 and R4), address (for R1, R2, R3, and R4), and telephone number (for R2, R3, and R4) of the resident's current pharmacy; - A list of any known allergies to any medications, additives, preservatives or materials like latex or adhesive (for R1, R2, R3, and R4); - The name and contact information for the resident's primary care physician (for R2 and R4); - Basic information about the resident's physical and mental conditions (for R2, R3, and R4) and basic medical history, such as having diabetes or a pacemaker or experiencing frequent falls or cardiovascular and cerebrovascular events, as well as dates of recent episodes, as applicable (for R1, R2, R3, and R4); - The point-of-contact information for the assisted living home, including the telephone number, if available, cell phone number and email address (for R1, R2, R3, and R4); and - A copy of the resident's health insurance portability and accountability act release authorizing a receiving hospital to communicate with the assisted living center or assisted living home to plan for the resident's discharge (for R1, R2, R3, and R4). 3. In an interview, E1 acknowledged the facility did not maintain a standardized form that included all information prescribed in this statute.

Based on interview and documentation review, the manager of an assisted living home failed to maintain a copy of the document provided to the emergency responder which included the items listed in Arizona Revised Statutes (A.R.S.) § 36-420.04(A)(1-9). Findings include: 1. In an interview, E1 reported R2 had an accident, emergency, or injury on March 9, 2025, that resulted in facility personnel contacting an emergency responder on behalf of R2. E1 reported facility personnel provided the emergency responders with a copy of R2’s current medication administration record (MAR), current documentation of assisted living services provided to R2, and a form provided by R2’s hospice provider. However, when the Compliance Officer asked if the facility personnel maintained a copy of the documents provided to the emergency responder, E1 stated, “No.” 2. A review of facility documentation revealed no copies of the documents provided to the emergency responders on March 9, 2025.

Based on documentation review, record review, and interview, the chief administrative officer failed to implement tuberculosis (TB) infection control activities including baseline screening, for four of four sampled residents and one of three sampled personnel members; annually providing training and education related to recognizing the signs and symptoms of tuberculosis, for three of three sampled personnel members; and annually assessing the health care institution’s risk of exposure to infectious tuberculosis. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. A review of Department documentation revealed this rule went into effect on May 4, 2022. 2. A review of facility documentation revealed a policy and procedure (P&P) titled “TUBERCULOSIS (TB) TESTING.” The P&P stated: “1. For each individual required to be screened for infectious tuberculosis, the manager or manager's designee shall obtain from the individual: a. On or before the date the individual begins providing services at the facility (employee), or is admitted to the facility (resident), one of the following as evidence of freedom from infectious tuberculosis: v. Should undergo risk assessment and symptom evaluation…Appendix 3.” The review revealed a copy of “Appendix 3. Integrated Tuberculosis (TB) Screening and Risk Assessment Form…” 3. A review of R1's, R2’s, R3’s, and R4’s medical records revealed all four residents were accepted by the facility after May 4, 2022, and more than seven days before the date of the inspection. However, the review revealed no baseline screening including assessing risks of prior exposure to infectious TB and determining if the four residents had signs or symptoms of TB. 4. In an interview, E1 reported not knowing about the requirement for baseline screening for residents. 5. A review of facility documentation revealed a copy of “Appendix 6. Educational Supplement on Tuberculosis (TB) Infection.” The document stated, “The 2019 MMWR CDC/NTCA Recommendations include annual education [italics in original] be provided to all health care personnel (HCP).” The document continued with a list of topics, including “Active TB signs and symptoms.” 6. A review of E2's personnel record revealed E2 was hired as the manager in October 2024. However, the review revealed no baseline screening including assessing risks of prior exposure to infectious TB and determining if E2 residents had signs or symptoms of TB. The review further revealed no training and education related to recognizing the signs and symptoms of TB. 7. A review of E1’s and E3’s personnel records revealed E1 worked as a caregiver since 2020 and E3 worked as a caregiver since 2019. However, the review revealed no initial or annual training and education related to recognizing the signs and symptoms of TB. 8. In an interview, when the Compliance Officer asked if E1 provided E2’s full personnel record, E1 stated, “Yeah.” When the Compliance Officer asked if E2 h

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with Arizona Revised Statutes (A.R.S.) § 36-411(C)(1-2), for two of four sampled personnel members. 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)(1-2) states: "C. 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. Verify the current status of a person's fingerprint clearance card." 2. A review of facility documentation revealed a policy and procedure (P&P) titled “FINGERPRINTING REQUIREMENTS.” The P&P stated: “4. Facility owners shall make documented, good faith efforts to: a. Contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in an assisted living facility [and] b. Verify the current status of a person's fingerprint clearance card of its validity through DPW website.” 3. A review of E2’s personnel record revealed a photocopy of a picture of E2’s current fingerprint clearance card (FCC). However, the review revealed no documentation of compliance with A.R.S. § 36-411(C)(1-2). 4. A review of Department documentation revealed E2 had previous employment at A Place of Joy Assisted Living as well as at Gateway Assisted Living LLC. However, no documentation was available showing that E2's previous employers had been contacted. 5. A review of the Department of Public Safety (DPS) website revealed E2's FCC was valid. 6. In an interview, when the Compliance Officer asked if a representative of the assisted living facility contacted E2’s previous employers, E1 stated, “No.” When the Compliance Officer asked if a representative of the assisted living facility verified E2’s FCC, E1 stated, “No.” 7. A review of E3’s personnel record revealed a previous employment and a photocopy of E3’s current FCC. However, the review revealed no documentation of compliance with A.R.S. § 36-411(C)(1-2). 8. A review of the DPS website revealed E3's FCC was valid. 9. In an interview, when the Compliance Officer asked if a representative of the assisted living facility contacted E3’s previous employers, E1 stated, “No.” When the Compliance Officer asked if a representative of the assisted living facility verified E3’s FCC, E1 stated, “No.” Technical assistance was provided on this rule during the compliance inspection conducted on July 6, 2022.

Based on documentation review, record review, and interview, the manager failed to ensure documentation was maintained for at least 12 months after the last date on the documentation of the caregivers and assistant caregivers working each day, including the hours worked by each. The deficient practice posed a risk as the Department was provided false or misleading information. Findings include: 1. A review of facility documentation revealed a policy and procedure (P&P) titled “STAFFING POLICY.” The P&P stated: “Employees are required to accurately record all time worked, including the time they begin and end each shift. Staff should also record the beginning and ending time of any split shift or departure from work for personal reasons. Employees are responsible for completing their own name records on a daily basis. Altering, falsifying, tampering with time records, and/or recording time on another employee's time record will result in disciplinary action, up to and including termination.” The review further revealed personnel schedules dated between March 2024 and March 2025. The schedules revealed the following: - No documentation of who worked on May 31, 2024; July 31, 2024; August 31, 2024; October 31, 2024; December 31, 2024; and January 31, 2025; - Personnel worked on February 29-30, 2025, even though February 2025 only had 28 days; - E3 worked from 12:00 PM to 9:00 PM on August 1, 3, 5-6, 8, 10, 12-13, 15, 17, 19-20, 22, 24, 26-27, and 29, 2024; - E3 worked from 12:00 PM to 9:00 PM on October 1, 3, 5-6, 8, 10, 12-13, 15, 17, 19-20, 22, 24, 26-27, and 29, 2024; - E3 worked from 12:00 PM to 9:00 PM on November 1, 3, 5-6, 8, 10, 12-13, 15, 17, 19-20, 22, 24, 26-27, and 29, 2024; - E3 worked from 12:00 PM to 9:00 PM on December 1, 3, 5-6, 8, 10, 12-13, 15, 17, 19-20, 22, 24, 26-27, and 29, 2024; - E3 worked from 12:00 PM to 9:00 PM on January 1, 3, 5-6, 8, 10, 12-13, 15, 17, 19-20, 22, 24, 26-27, and 29, 2025; and - E3 worked from 12:00 PM to 9:00 PM on February 1, 3, 5-6, 8, 10, 12-13, 15, 17, 19-20, 22, 24, and 26-27, 2025. 2. A review of R1’s medical record revealed a series of medication administration records (MARs) dated August 2024 and October 2024 through February 2025. The MARs revealed E3 administered medication to R1 at times and on dates E3 was not documented as working in each of the aforementioned months. 3. In an interview, E1 reported the personnel schedule was inaccurate. E1 reported E3 often worked at times and on dates E3 was not documented as working. Technical assistance was provided on this rule during the compliance inspection conducted on July 6, 2022.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance of an individual, the individual submitted documentation dated within 90 calendar days before the individual was accepted by the facility to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, for three of four sampled residents. The deficient practice posed a risk if the facility was unable to meet the needs of a resident. Findings include: 1. A review of R1's, R2’s, and R3’s medical records revealed documents titled "Authorization for Continued Residency." All authorizations indicated whether the resident in question required continuous medical services, continuous or intermittent nursing services, or restraints. However the documents revealed the following: - R1’s document was signed and dated two days after R1 was accepted by the facility, - R2’s first document was signed and dated more than one week after R2 was accepted by the facility and R2’s second document was signed and dated more than one month after R2 was accepted by the facility, and - R3’s document was signed and dated nearly two weeks after R3 was accepted by the facility. 2. In an interview, E1 acknowledged R1, R2, and R3 did not submit the aforementioned authorizations within 90 calendar days before or at the time of acceptance. This is a repeat citation from the compliance inspections conducted on September 25, 2023; July 11, 2022; and July 28, 2021.

Based on record review and interview, the manager failed to ensure there was a documented residency agreement with the assisted living facility that included the policy and procedure for a resident to terminate residency because services were not provided to the resident according to the resident's service plan, for four of four sampled residents. Findings include: 1. A review of R1's, R2's, R3's, and R4's medical records revealed residency agreements for each of the four residents. However, the review revealed the residency agreements did not include the policy and procedure for a resident to terminate residency because services were not provided to the resident according to the resident's service plan. 2. In an interview, E1 stated, “No” when the Compliance Officer asked if the aforementioned residency agreements included the policy and procedure required by this rule. This is a repeat citation from the compliance inspection conducted on September 25, 2023.

Based on documentation review, interview, and record review, the manager failed to ensure a written notice of termination of residency included all items required by this rule, for one of one applicable sampled resident. Findings include: 1. A review of facility documentation revealed a policy and procedure (P&P) titled “TERMINATION OF RESIDENCY (BY THE FACILITY).” The P&P stated: The manager or manager’s designee shall ensure that a written notice of termination of residency includes: a. The date of notice; b. The reason for termination; c. The policy for refunding fees, charges or deposits; d. The deposition of a resident’s fees, charges and deposits; and e. Contact information for the State Long-Term Care Ombudsman; f. Service plan; [and] g. Latest TB test.” 2. In an interview, E1 reported R2 went to the hospital in the early morning on March 9, 2025, because R2 was having a seizure due to lack of medication. E1 reported R2 was not to return to the facility, stating, “[R2] hasn’t paid in months.” E1 stated R2 had not paid “since January.” E1 reported R2’s card had been declined. E1 reported E1 terminated R2’s residency for nonpayment of fees. 3. A review of R2’s medical record revealed no written notice of termination of residency. 4. In an interview, E1 stated, “I should have written a termination.”

Based on documentation review, interview, and record review, the manager failed to ensure a caregiver or an assistant caregiver provided a resident with the assisted living services in the resident's service plan, for two of four sampled residents. The deficient practice posed a risk as services were not provided per a resident's service plan. Findings include: 1. A review of facility documentation revealed a policy and procedure titled “SERVICE PLAN” which stated, “A manager shall ensure that: 1. A caregiver or an assistance caregiver: a. Provides a resident with the assisted living services in the resident’s service plan.” 2. In an interview, E1 reported facility personnel assisted R1 with bathing two times per week and medication administration daily. When the Compliance Officer asked if facility personnel provided R1 with any other activities of daily living, E1 stated, “No.” 3. A review of R1's medical record revealed a service plan dated December 19, 2024. The service plan revealed R1 was to receive a variety of services, including oral care twice daily, nail care daily, shaving daily, ambulation, and foot elevation when sitting or in bed. The review revealed documentation of assisted living services provided to R1 (ADLs) in March 2025. The ADLs revealed the following: - R1 received assistance with oral care twice daily on March 1 -10, 2025; - R1 did not receive assistance with nail care in March 2025; - R1 received assistance with shaving on March 5 and 10, 2025; - No documentation demonstrating R1 received assistance with ambulation in March 2025; and - No documentation demonstrating R1 received assistance with foot elevation in March 2025. 4. In an interview, when the Compliance Officer asked who performed R1’s oral care and shaving, E1 stated, “[R1] does it.” 5. A review of R2's medical record revealed a service plan dated August 29, 2024, and updated on December 29, 2024. The service plan revealed R2 was to receive assistance with nail care daily. The review revealed ADLs dated September 2024 through February 2025 which indicated R2 did not receive daily assistance with nail care. 6. In an interview, E1 acknowledged a caregiver or an assistant caregiver did not provide R1 and R2 with the assisted living services in R1's and R2’s service plans.

Based on interview and documentation review, the manager failed to ensure when a resident had an accident, emergency, or injury that resulted in the resident needing medical services, a caregiver or an assistant caregiver documented all items required by this rule. The deficient practice posed a potential risk of re-injury. Findings include: 1. In an interview, E1 reported R2 had an accident, emergency, or injury that resulted in R2 needing medical services on March 9, 2025. 2. A review of facility documentation revealed no incident report in compliance with this rule. 3. In an interview, when the Compliance Officer asked if facility personnel created an incident report in compliance with this rule, E1 stated, “No, I haven’t done it.”

Based on documentation review, interview, and record review, the manager failed to ensure a caregiver or an assistant caregiver documented the services provided to a resident in the resident's medical record, for two of four sampled residents. The deficient practice posed a risk as services could not be verified as provided against a service plan and the Department was provided false or misleading information Findings include: 1. A review of facility documentation revealed a policy and procedure titled “SERVICE PLAN” which stated, “A manager shall ensure that: 1. A caregiver or an assistance caregiver: a. Documents the services provided in the resident’s medical record.” 2. In an interview, E1 reported facility personnel assisted R1 with bathing two times per week and medication administration daily. When the Compliance Officer asked if facility personnel provided R1 with any other activities of daily living, E1 stated, “No.” 3. A review of R1's medical record revealed a service plan dated December 19, 2024. The service plan revealed R1 was to receive a variety of services, including oral care twice daily, nail care daily, and shaving daily. The review revealed documentation of assisted living services provided to R1 (ADLs) in February 2025 and March 2025. The February ADLs revealed documentation demonstrating R1 received assistance with oral care twice daily on February 1-28, 2025; assistance with nail care on February 1-6, 13, 18, and 21-27, 2025; and assistance with shaving on February 2, 4, 9, 15, 19, 21-23, and 25, 2025. The March ADLs revealed documentation demonstrating R1 received assistance with oral care twice daily on March 1 -10, 2025, and assistance with shaving on March 5 and 10, 2025. 4. In an interview, when the Compliance Officer asked who performed R1’s oral care, nail care, and shaving, E1 stated, “[R1] does it.” E1 acknowledged a caregiver or an assistant caregiver erroneously documented services not provided to R1 by a caregiver or an assistant caregiver. 5. A review of R2's medical record revealed a service plan dated August 29, 2024, and updated on December 29, 2024. The service plan revealed R2 was to receive a variety of services including combing hair twice daily, selecting clothing, incontinence checks and brief changes, ambulation, transfers, and elevating feet when in bed. The review revealed ADLs dated September 2024 through February 2025. However, the ADLs revealed no documentation of combing hair twice daily, selecting clothing, incontinence checks and brief changes, ambulation, transfers, and elevating feet when in bed. 6. In an interview, E1 acknowledged a caregiver or an assistant caregiver failed to document the services provided to R2.

Based on observation, interview, and record review, the manager failed to ensure a resident's medical record was protected from loss, damage, or unauthorized use. The deficient practice posed a risk as protected and sensitive resident health information was lost. Findings include: 1. The Compliance Officer observed resident medical records on a shelf and on a desk in an unlocked and unsecured area of the facility near the dining room. 2. In an interview, E1 reported E1 normally kept resident records where the Compliance Officer found them. 3. In a separate interview, E1 reported emergency responders took R2 to the hospital a few days before the inspection. 4. A review of R2’s medical record revealed no documentation of assisted living services provided to R2 (ADLs) in March 2025. 5. In an interview, E1 reported E1 had given the emergency responders R2’s original ADLs for March 2025, and did not make a copy. E1 reported not having the ADLs. E1 acknowledged facility personnel failed to ensure a resident's medical record was protected from loss, damage, or unauthorized use.

Based on documentation review, record review, and interview, the manager failed to ensure a resident's medical record contained documentation of medication administered to the resident that included the date and time of administration or assistance, for two of four sampled residents. The deficient practice posed a risk as the Department was provided false or misleading information. Findings include: 1. A review of facility documentation revealed a policy and procedure (P&P) titled “MEDICATION ADMINISTRATION." The P&P stated: “Each time a medication is administered, it must be documented. Your documentation of medication administration must be done at the time that you give medication.” 2. A review of R1's medical record conducted at approximately 11:45 AM on March 11, 2025, revealed a medication administration record (MAR) dated March 2025. The MAR revealed documentation demonstrating E1 administered atorvastatin to R1 at 3:00 PM on March 11, 2025, several hours in the future. 3. In an interview, E1 reported the documentation for 3:00 PM was a mistake. 4. A review of R3's medical record conducted at approximately 12:15 PM on March 11, 2025, revealed a MAR dated March 2025. The MAR revealed documentation demonstrating E1 administered metformin to R3 at 8:00 PM on March 11, 2025, several hours in the future. 5. In an interview, E1 stated, “I just made a mistake.”

Based on documentation review, observation, and interview, the manager failed to ensure 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 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 egress of a resident from the facility. Findings include: 1. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. The Compliance Officer observed a door-sized window leading from a resident room to the backyard. The Compliance Officer observed the base of the window was mere inches from the floor and the window had no screen blocking egress. The Compliance Officer observed the window did not have a control or an alert installed. 3. In an interview, E1 stated the window “Need[ed] a door chime.”

Based on documentation review, record review, interview, and observation, the manager failed to ensure medication administered to a resident was administered in compliance with a medication order, for two of four sampled residents. The deficient practice posed a risk if a resident experienced a change in condition due to improper administration of medication. Findings include: 1. A review of facility documentation revealed a policy and procedure (P&P) titled “MEDICATION ADMINISTRATION.” The P&P stated: “The manager or manager’s designee shall ensure that a medication administered to a resident is administered in compliance with a medication order…Some medications must be administered only at very specific times of the day…It is very important for medication to be given at the time of day that is written on the medication order.” 2. A review of R1’s medical record revealed a service plan which indicated R1 was to receive medication administration. The review revealed a medication order, dated August 21, 2024, for “ARIPRAZOLE [sic] 5mg PO / DAILY 3:00 pm” and “ATORVASTATIN 40mg PO / DAILY 3:00 pm,” as well as an order for a vitamin at 3:00 PM, totaling three tablets to be administered at 3:00 PM. The review further revealed a medication administration record (MAR) dated March 2025. The MAR indicated R1 received atorvastatin 40 mg and the vitamin daily at 3:00 PM and aripiprazole daily at 8:00 AM. 3. In an interview, E1 reported E1 put R1’s 8:00 AM and 3:00 PM medication in two separate cups and gave both cups to R1 in R1’s room at 8:00 AM. E1 reported E1 then left R1’s room without administering any medication to R1. E1 reported R1 took the medication R1’s self. 4. The Compliance Officer observed the 3:00 PM cup of medication in R1’s room next to R1. Inside the cup, the Compliance Officer observed one vitamin and one tablet of aripiprazole 5 mg. The Compliance Officer observed no atorvastatin. 5. In an interview, E1 reported E1 already administered R1’s aripiprazole at 8:00 AM instead of at 3:00 PM as ordered. E1 reported E1 normally administered R1’s aripiprazole at 8:00 AM. E1 acknowledged E1 did not administer R1’s aripiprazole as ordered. E1 reported E1 usually gave R1 only two tablets in the 3:00 PM cup. Upon observing the cup containing the vitamin and aripiprazole and not atorvastatin, E1 stated, “How come that looks different?” The Compliance Officer observed E1 remove the cup from R1’s room to correct the error. 6. A review of R2’s medical record revealed a service plan which indicated R2 was to receive medication administration. The review revealed a medication order, dated October 10, 2024, for the following medications: - “laxative (senna) docusate po 7 pm,” - “tamsolosin [sic] 0.4 m po 8 PM,” - “levetiracetam 500 m po 8AM / 8PM,” - “Levothyroxine 175 mcg Po 7 AM,” and - “trazadone [sic] 50 po 8 PM.” The review further revealed a MAR dated March 2025 which revealed the following: - R1 did not receive senna on March 7-8, 2025; - R1 did n

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 residents with access to the poisonous or toxic materials. Findings include: 1. The Compliance Officer observed an unlocked laundry room. In the laundry room, the Compliance Officer observed two sets of cabinets with locks labeled “1” and “2.” On the wall next to the cabinets, the Compliance Officer observed keys labeled “1” and “2.” The Compliance Officer used the keys to open the locks. Inside the cabinets, the Compliance Officer observed a variety of poisonous or toxic materials, including air freshener, bleach, disinfectant spray, insecticide, laundry detergent, multi-surface cleaner, and wood floor cleaner. 2. In an interview, E1 acknowledged the aforementioned poisonous or toxic materials were accessible to residents. Technical assistance was provided on this rule during the compliance inspection conducted on July 6, 2022.

Based on documentation review, observation, 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 residents with access to the combustible or flammable liquids. Findings include: 1. A review of facility documentation revealed a policy and procedure titled “SAFETY OF THE FACILITY AND GROUNDS” which stated, “Combustible, flammable and other hazardous materials will be stored in safety approved containers outside the facility in a locked secure area that is inaccessible to residents.” 2. The Compliance Officer observed an unlocked laundry room. In the laundry room, the Compliance Officer observed two sets of cabinets with locks labeled “1” and “2.” On the wall next to the cabinets, the Compliance Officer observed keys labeled “1” and “2.” The Compliance Officer used the keys to open the locks. Inside the cabinets, the Compliance Officer observed a spray can of “WD-40” and a bottle of “Restore-A-Finish” wood finish. Both items displayed warnings regarding the contents being flammable. 3. In an interview, E1 acknowledged the aforementioned combustible or flammable liquids were accessible to residents. Technical assistance was provided on this rule during the compliance inspection conducted on July 6, 2022.

Based on documentation review, observation, and interview, the manager failed to ensure a swimming pool was enclosed by a wall or fence. Findings include: 1. A review of Department documentation revealed the facility became licensed in 2020. 2. The Compliance Officer observed the facility had a pool in the backyard. The Compliance Officer observed the pool was enclosed by a fence on all sides other than the south side where the pool fence was attached directly to the house itself. The Compliance Officer observed a window leading from a living room to the pool and no fence between the window and the pool. 3. In an interview, E1 acknowledged the pool was not entirely enclosed by a wall or fence that met this rule.

Based on documentation review, record review, and interview, the administrator failed to ensure the health care institution developed and administered a training program for all staff regarding fall prevention and fall recovery. The deficient practice posed a risk if a staff member was unable to meet a resident's needs during an emergency. Findings include: 1. A review of facility documentation revealed no evidence of a fall prevention and fall recovery training program. 2. A review of the personnel records for E1, E2, and E3 revealed no documented evidence to indicate E1, E2, and E3 completed fall prevention and fall recovery training. 3. In an interview, E1 and E2 acknowledged the facility had not developed and administered a training program for all staff regarding fall prevention and fall recovery.

Based on documentation review and interview, the manager failed to ensure policies and procedures were reviewed at least once every three years and updated as needed. Findings include: 1. A review of facility documentation revealed a policy and procedure manual labeled "Blooming Meadows Policy and Procedure Manual." The documentation indicated the most recent review date was February 28, 2019. 2. In an interview, E1 acknowledged the manager failed to ensure policies and procedures were reviewed at least once every three years and updated as needed.

Based on documentation, record review and interview, the manager failed to ensure a caregiver's or assistant caregiver's skills and knowledge were verified and documented according to policies and procedures, for three of three caregivers sampled. The deficient practice posed a risk if a personnel member did not have the skills and knowledge to meet a resident's needs. Findings include: 1. A review of facility policies and procedures revealed a section labeled "Verifying caregiver's skills and knowledge." The policy stated: "1.The manager will interview and assess the caregiver and test on caregiver skills using and assessment sheet...3. The manager will put the assessment sheet and information from previous employers in the employee's file." 2. A review of E1's, E2's, and E3's personnel records revealed no documentation to indicate E1's, E2's, or E3's skills and knowledge were verified. 3. In an interview, E1 and E2 acknowledged E1's, E2's, and E3's personnel records did not contain documented verification of E1's, E2's, and E3's skills and knowledge.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance of an individual, the individual submitted documentation dated within 90 calendar days before the individual was accepted, 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 two 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's and R2's medical records revealed no documentation dated within 90 calendar days before R1 and R2 were accepted by the assisted living facility to include whether R1 or R2 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. 2. In an interview, E1 and E2 acknowledged there was no documentation dated within 90 calendar days before R1 and R2 were accepted, to include whether R1 or R2 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. This is a repeat citation from the previous compliance inspection conducted on July 11, 2022.

Based on record review and interview, the manager failed to ensure a resident's documented residency agreement included the policy and procedure for a resident to terminate residency, including terminating residency because services were not provided to the resident according to the resident's service plan. Findings include: 1. A review of R1's and R2's medical records revealed the residency agreements for R1 and R2 did not include the policy and procedure for a resident to terminate residency, including terminating residency because services were not provided to the resident according to the resident's service plan. 2. In an interview, E1 and E2 reviewed and acknowledged the residency agreements for R1 and R2 did not include the policy and procedure for a resident to terminate residency, including terminating residency because services were not provided to the resident according to the resident's service plan.

Based on documentation review, record review, 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 influenza and pneumonia, according to Arizona Revised Statutes (A.R.S.) \'a7 36-406(1)(d), for two of two residents sampled. The deficient practice posed a potential illness risk to residents. Findings include: 1. 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. The department shall not impose a violation on a licensee for not making a vaccination available if there is a shortage of that vaccination in this state as determined by the director." 2. A review of R1's medical record revealed documentation of the notification of R1 of the availability of vaccination for influenza and pneumonia, dated November 12, 2021. However, there was no current documentation of the notification of R1 of the availability of vaccination for influenza and pneumonia. 3. A review of R2's medical record revealed documentation of the notification of R2 of the availability of vaccination for influenza and pneumonia, dated July 24, 2022. However, there was no current documentation of the notification of R2 of the availability of vaccination for influenza and pneumonia. 4. In an interview, E1 acknowledged R1's and R2's medical records did not include current documentation showing the influenza and pneumonia vaccination was offered or received.

Based on documentation review and interview, the manager failed to ensure a disaster drill for employees 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 a disaster plan. Findings include: 1. A review of facility documentation revealed no disaster drills were available to review. 2. In an interview, E1 acknowledged the manager failed to ensure a disaster drill for employees was conducted on each shift at least once every three months and documented.