Brookdale Flagstaff

Based on record review and interview, the assisted living center failed to maintain a standardized form for each resident that included the information prescribed in A.R.S. § 36-420.04.A.1-9 for four out of six residents sampled. The deficient practice posed a risk if the facility was not prepared in case of an emergency. Findings include: 1. A review of R1's medical record revealed a standardized form to be used if an emergency responder was contacted, however, the form was missing the following information: 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. 2. A review of R2's medical record revealed a standardized form to be used if an emergency responder was contacted, however, the form was missing the following information: 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. A review of R3's medical record revealed a standardized form to be used if an emergency responder was contacted, however, the form was missing the following information: 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. 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. 4. A review of R4's medical record revealed a standardized form to be used if an emergency responder was contacted, however, the form was missing the following information: 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. 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. 5. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on documentation review, and interview, the health care institution failed to ensure that the health care institution established, documented, and implemented tuberculosis (TB) infection control activities that included annually assessing the health care institution's risk of exposure to infectious TB. The deficient practice posed a TB exposure risk to residents. Findings include: 1. A review of the facility's documentation revealed no documentation of annually assessing the health care institution's risk of exposure to infectious tuberculosis. 2. In an exit interview, the findings were reviewed with E1 and no additional information was provided. 3. Technical assistance was provided on this Rule during the inspection conducted on April 24, 2025.

Based on documentation review, record review, and interview, the manager failed to ensure that a resident provided evidence of freedom from infectious tuberculosis (TB) within seven calendar days after the resident's date of occupancy, as stated in R9-10-113 for four of six residents sampled. The deficient practice posed a TB exposure risk to residents. Findings include: 1. R9-10-113.A states "If a health care institution is subject to the requirements of this Section, as specified in an Article in this Chapter, the health care institution's chief administrative officer shall ensure that the health care institution establishes, documents, and implements tuberculosis infection control activities that...2. Include: a. For each individual who is employed by the health care institution, provides volunteer services for the health care institution, or is admitted to the health care institution and who is subject to the requirements of this Section, screening, on or before the date specified in the applicable Article of this Chapter, that consists of: i. Assessing risks of prior exposure to infectious tuberculosis, ii. Determining if the individual has signs or symptoms of tuberculosis, and iii. Obtaining documentation of the individual's freedom from infectious tuberculosis according to subsection (B)(1)..." 2. A review of R2, R4, R5, and R6's medical records revealed no documentation of assessing risks of prior exposure to infectious TB and a determination of whether these residents had signs or symptoms of TB. Based on these residents' date of occupancy, this documentation was required. 3. In an exit interview, the findings were reviewed with E1 and no additional information was provided. 4. Technical assistance was provided on this Rule during the inspection conducted on April 24, 2025.

Based on record review and interview, the manager failed to ensure a resident accepted by the assisted living facility submitted documentation signed by a medical practitioner or a registered nurse that stated whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, for two of six 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 medical record revealed no documentation that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints. Based on R1’s acceptance date, this documentation was required. 2. A review of R4's medical record revealed no documentation that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints. Based on R4’s acceptance date, this documentation was required. 3. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on record review and interview, the manager failed to ensure a resident received orientation to the exits from the assisted living facility and the route to be used when evacuating the assisted living facility within 24 hours of acceptance, for three of six residents sampled. The deficient practice posed a health and safety risk if the resident needed to exit the facility in an emergency. Findings Include: 1. A review of R1's, R3's, and R4's medical records revealed no documentation of orientation to the exits from the assisted living facility and the route to be used when evacuating the assisted living facility within 24 hours of acceptance. Based on their date of acceptance, this documentation was required. 2. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on record review and interview, the manager failed to ensure the caregiver documented the services provided in the resident's medical record for one of six residents reviewed. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. A review of R2's medical record revealed a service plan dated August 7, 2025, and an activities of daily living (ADL) sheet dated September 2025. The ADL sheet indicated the services: 2-hour checks, and brief change every 2 hours or as needed were not provided on September 13, 2025, as stated in the service plan. 2. In an interview, E2 reported that E3, who was scheduled for the night shift on September 13, 2025, confirmed that R2 did not have the services provided. 3. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on documentation review and interview, the manager failed to ensure that residents were treated with dignity, respect, and consideration. The deficient practice posed a risk of a resident rights violation. Findings include: 1. A documentation review revealed documentation of an internal investigation stating that a second caregiver found E3 fell asleep in the chair in R5's room, left the window open in R5's room, and did not change R5's brief when it was wet. 2. In an interview, E2 confirmed that the incident happened. 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review, documentation review, and interview, the manager failed to ensure that a resident was provided a diet that met the resident’s nutritional needs as specified in the resident’s service plan. The deficient practice posed a risk as R5's nutritional needs were not met. Findings include: 1. A review of R5's medical record revealed an activities of daily living sheet that indicated R5 did not receive breakfast on September 3 and September 7, 2025. 2. A documentation review revealed an incident investigation dated September 7, 2025. The investigation confirmed that R5 did not receive breakfast on September 3 and September 7, 2025. 3. In an interview, E2 confirmed that R5 did not receive breakfast on September 3 and September 7, 2025. 4. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on the documentation review and interview, the manager failed to ensure that the temperature of a resident's room was maintained between 70° F and 84° F. The deficient practice posed a risk to the physical health and safety of a resident. Findings Include: 1. A documentation review revealed documentation of an internal investigation that stated a caregiver observed the temperature of R2's room at 50° F while the resident was lying in bed. 2. In an interview, E2 reported that it was confirmed that R2's room was not at the required temperature. 3. In an exit interview, the findings were reviewed with E2, and no additional information was provided.

Based on the record review, documentation review, and interview, the manager failed to ensure that there was a means of exiting the facility that 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 general or specific whereabouts of a resident. Findings include: 1. A review of Department documentation revealed the facility was authorized to provide directed care services. 2. A review of R1's medical record revealed that R1 received directed care services. 3. A record review revealed an incident report dated May 25, 2025. The incident report revealed that R1 eloped from the facility through the memory care exit door. At the time of the elopement, the memory care door was not controlled or alerted. 4. In an interview, E1 reported that a church service was taking place in the memory care. When the church members were breaking down their equipment and leaving, R1 followed the church members out of the unit and went outside in front of the facility. A facility staff member noticed that R1 was missing and found R1 sitting on a rock. E1 acknowledged there were means of exiting the facility to an outside area, which did not control or alert employees of the egress of a resident from the facility. 5. During the investigation, the Compliance Officer observed all doors were controlled or alerted.

Based on record review and interview, the manager failed to ensure that an employee provided documentation of freedom from infectious tuberculosis (TB) on or before the date the individual began providing services at or on behalf of the assisted living facility, as specified in R9-10-113, for two of four employees sampled. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. R9-10-113.A states "If a health care institution is subject to the requirements of this Section, as specified in an Article in this Chapter, the health care institution's chief administrative officer shall ensure that the health care institution establishes, documents, and implements tuberculosis infection control activities that...2. Include: a. For each individual who is employed by the health care institution, provides volunteer services for the health care institution, or is admitted to the health care institution and who is subject to the requirements of this Section, screening, on or before the date specified in the applicable Article of this Chapter, that consists of: i. Assessing risks of prior exposure to infectious tuberculosis, ii. Determining if the individual has signs or symptoms of tuberculosis, and iii. Obtaining documentation of the individual's freedom from infectious tuberculosis according to subsection (B)(1)..." 2. A review of E4's and E6's personnel records revealed completion of two-step TST testing. However, no documentation of assessing risks of prior exposure to infectious TB and determining if the E4 and E6 had signs or symptoms of TB was available for review. Based on E4's and E6's hire dates, this documentation was required. 3. In an interview, E1 acknowledged E4 and E6 did not provide documentation of freedom from infectious TB as specified in R9-10-113. This is a repeat deficiency from the inspection conducted on December 27, 2023.

Based on record review and interview, the manager failed to ensure a written service plan included the level of service the resident was expected to receive, for one of two residents sampled. The deficient practice posed a risk as the service plan did not reinforce and clarify the services to be provided to a resident. Findings include: 1. A review of R1's medical record revealed a written service plan dated March 15, 2025. The service plan did not include the level of service R1 received. 2. In an interview, E1 and E2 acknowledged R1's service plan did not include the level of service the resident received.

Based on interview and record review, the manager failed to ensure a service plan included how the medication was stored and controlled, for one of one resident sampled, who stored medication in the resident's residential unit. The deficient practice posed a health and safety risk. Findings include: 1. In an interview, E2 reported that R2 received personal care services and self-administered medication. 2. A review of R2's medical record revealed a written service plan dated February 12, 2025. This service plan did not include how the medication would be stored and controlled in R2's room. 3. In an interview, E1 and E2 acknowledged that the service plan did not indicate how the medications would be stored and controlled. This is a repeat deficiency from the inspection conducted on January 4, 2023.

Based on documentation review, record review, and interview, the manager failed to ensure that policies and procedures were implemented to protect the health and safety of a resident that covered how a caregiver will respond to a resident's sudden, intense, or out-of-control behavior to prevent harm to the resident or another individual. Findings include: 1. A review of the facility’s policy and procedure revealed a policy titled “Analysis of Behavior Expression in Residents with Dementia” which reflected “ 2. …The interventions identified to address the behavioral expression of the resident should be record on the resident service plan along with a corresponding resident log notation…”. 2. A review of a facility’s documentation revealed a document titled “Incident Investigation” dated March 31, 2025, which revealed a resident-to-resident physical altercation between R1 and R2, and the residents were separated. 3. A review of a facility’s documentation revealed a document titled “Incident Investigation” dated March 31, 2025, which revealed a resident-to-resident physical altercation between R3 and R4. Intervention identified “Immediately separated R3 and R4, and started a 1:1 sitter for R3 at all times until advised otherwise. Removed R3’s cane from the room. R3 ambulates around the community without assistive devices. Notified PCP of R3 behaviors and requested for the Psych provider to review R3’s medication list. Urine sample collected and sent to rule out UTI for R3.” 4. A review of R3’s medical record revealed a service plan dated March 14, 2025, which did not reflect the interventions implemented for R3’s behavior. 5. A review of R1’s medical record revealed a service plan dated March 21, 2025, which reflected “Behavior management: Resident will be able to manage their behaviors with assistance. Resident engages in the following behaviors (demonstrates anxious/disruptive/aggressive behavior requiring additional attention, including throwing objects). However, R1’s service plan did not include interventions implemented for R1’s behavior. 6. In an interview, E1 reviewed R1’s and R3’s service plans and the facility’s procedure and acknowledged that the facility’s policy and procedures were not implemented.

Based on observation and interview, the manager failed to ensure food stored by the facility was free from spoilage and was safe for human consumption. The deficient practice posed a risk for potential food borne illnesses. Findings include: 1. The Compliance Officer observed the following food stored in the activity room refrigerator: -A block of cheese had greenish/blackish mold spots on the sides and in the middle with an expiration date of November 30, 2024; -A jar of pickles had cloudy liquid with an expiration date of September 25, 2009; -A Greek yogurt was watery with an expiration date of January 11, 2025; -A container of sour cream was watery and had a foul odor with an expiration date of January 6, 2025; and -American Cheese slices with dried white spots on the sides with an expiration date of November 30, 2024. 2. In an interview, E1 acknowledged that food stored by the facility was not free from spoilage.

Based on observation and interview, the manager failed to ensure that premises and equipment were cleaned and disinfected. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed in R4's bathroom, the extended toilet seat had a thick layer of dried fecal matter on the back and sides. 2. During an environmental inspection of the facility, the Compliance Officer observed the carpets in the hallways and R3's and R4's room had large dark stains on the carpet. 3. During an environmental inspection of the facility, the Compliance Officer observed a strong pungent odor of urine in the East Wing on the first floor and in R2's room. 4. In an interview, E1 acknowledged the premises were not cleaned or disinfected.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials were maintained in a locked area and were inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During the compliance inspection, the Compliance Officer observed the following toxins that were not stored in a locked area: In the Activity room: -A container of "Tide" Detergent; -A spray bottle of "Peroxide" Multi-surface cleaner and disinfectant; -A spray bottle of "Oasis 7 Orange Force" multi-surface cleaner; and -A container of "Cerma Bryte" stove cleaner. In R5's bathroom: -A container of "Clorox" wipes; -A half-gallon bottle of bleach; -A bottle of "Clorox" cleaner spray; and -A container of "Lysol' disinfectant. 2. In an interview, E1 acknowledged the materials in the resident bedrooms and activity room were unlocked and were accessible to residents. This is a repeat deficiency from an inspection conducted on January 31, 2024.