Blue Sky at Vista

Based on documentation review, interview, and record review, the assisted living home failed to maintain a standardized form for each resident that included the information prescribed in Arizona Revised Statutes (A.R.S.) § 36-420.04(A)(1) through (9) for one of two sampled residents. The deficient practice posed a risk if the emergency responder was not aware of critical health information for a resident. Findings include: 1. A.R.S. 36-420.04.A states, "A. An assisted living center or assisted living home that contacts an emergency responder on behalf of a resident shall provide to the emergency responder a written document that includes all of the following: 1. The reason or reasons the emergency responder was requested on behalf of the resident. 2. Whether the resident receives medication services and, if the resident has provided this information to the assisted living center or assisted living home, a list of all the resident's prescription and over-the-counter medications, their dosages and how frequently they are administered. 3. The name, address and telephone number of the resident's current pharmacy. 4. A list of any known allergies to any medications, additives, preservatives or materials like latex or adhesive. 5. The name and contact information for the resident's primary care physician and power of attorney or authorized representative. 6. Basic information about the resident's physical and mental conditions 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, if known. 7. The point-of-contact information for the assisted living center or assisted living home, including the telephone number, if available, cell phone number and email address. A point of contact must be available to respond to questions regarding the information provided twenty-four hours a day, seven days a week. 8. 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. This paragraph does not preclude a resident from revoking the resident's health insurance portability and accountability act release authorization. 9. A copy of the resident's advance directives, if any, on file at the assisted living center or assisted living home. This paragraph does not preclude a resident from revoking or modifying the resident's advance directives." 2. A review of R1's medical record revealed a standardized form that did not include a copy of the resident's health insurance portability and accountability act (HIPAA) release as required. 3. In an exit interview, the findings were reviewed with E3 and E4, and no additional information was provided.

Based on documentation review, observation, and interview, the manager failed to ensure the means of exiting the facility for a resident who does 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 to the outside area allowing the resident to be at least 30 feet away from the facility. The deficient practice posed a risk if staff were 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. During the environmental inspection of the facility, the Compliance Officer observed a door leading to the back yard had an alert. However, the alert was turned off at the time of observation. 3. In an interview, the findings were reviewed with E3 and E4 and no additional information was provided.

Based on observation and interview, the manager failed to ensure medications stored by the facility were stored in a separate locked room, closed, or self-contained unit. 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 Officer observed a basket of medications stored in an unlocked cabinet in the facility's unlocked laundry room. 2. In an interview, E3 and E4 acknowledged medications were stored in an unlocked manner. 3. In an exit interview, the findings were reviewed with E3 and E4 and no additional information was provided.

Based on observation 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 risk to the physical health and safety of a resident if toxic materials were accessible. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed two open containers of Lysol Laundry Sanitizers and Arm and Hammer Laundry Booster Super Washing Soda in an unlocked laundry room. 2. In an interview, E3 and E4 acknowledged the poisonous and toxic materials were not stored in a locked area and were not inaccessible to residents. 3. In an exit interview, the findings were reviewed with E3 and E4 and no additional information was provided.

Based on documentation review, record review, and interview, for one of one residents reviewed, the manager failed to ensure a resident's medical record contained documentation of a significant change in a resident's behavior, physical, cognitive, or functional condition and the action taken by a manager or caregiver to address the resident's changing needs. Findings include: 1. A review of a facility self-reported complaint revealed R1 passed away at the facility on March 1, 2024. 2. A review of R1's medical record revealed R1 had documented falls on the following dates: -November 8, 2023; -November 19, 2023; -December 2, 2023; -February 19, 2024; -February 24, 2024; and -February 27, 2024. 3. A review of R1's medical record revealed an incident report dated February 25, 2024. The incident report documented R1's fall. However, the section for documenting follow up and corrective action was blank. 4. Further review of R1's medical record revealed an incident report dated February 27, 2024 for a fall. The incident report documented R1's fall. However, the section for documenting follow up and correction action was blank. 5. In an interview, the Compliance Officer asked what the facility was doing to address R1's changing needs, as R1 seemed to be having falls more lately. E2 revealed the facility had implemented more frequent safety checks for R1, and also placed a mattress on the floor next to R1's bed to avoid R1 falling directly on the floor. E2 acknowledged the changes implemented by the facility were not documented in R1's medical record. 6. In an interview, E2 acknowledged R1's medical record did not include documentation of action taken to address R1's changing needs.