Cactus Villa LLC

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 assisted living facility and, if the individual was requesting or was expected to receive supervisory care services, personal care services, or directed care services, was dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant, for two of two residents sampled. Findings include: 1. A review of R1's medical record revealed an undated, untitled document which listed R1's name and stated the following: "Dear primary care provider: Our facility would like to be in compliance with Arizona state laws, therefore please complete the following in order that we might be able to serve you and your patient better." Below this, the document indicated R1 was appropriate to receive supervisory, personal, or directed care services. The document also indicated R1 did not require continuous medical services, continuous nursing services, or restraints. However, the document was not signed or dated by a physician, registered nurse practitioner, registered nurse, or physician assistant. 2. A review of R2's medical record revealed an undated, untitled document which listed R2's name and stated the following: "Dear primary care provider: Our facility would like to be in compliance with Arizona state laws, therefore please complete the following in order that we might be able to serve you and your patient better." Below this, the document indicated R2 was appropriate to receive supervisory, personal, or directed care services. The document also indicated R2 did not require continuous medical services, continuous nursing services, or restraints. However, the document was not signed or dated by a physician, registered nurse practitioner, registered nurse, or physician assistant. 3. In an interview, E1 acknowledged R1 and R2 did not submit documentation dated within 90 calendar days before the individual was accepted by an assisted living facility which was dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant.

Based on record review and interview, the manager failed to ensure a written service plan was reviewed and updated at least once every three months, for one of one resident sampled who received directed care services. Findings include: 1. A review of R2's medical record revealed a written service plan for directed care services, dated February 3, 2023. However, a more recently reviewed and updated service plan was not available for review. 2. In an interview, E1 acknowledged R2's service plan was not reviewed and updated at least once every three months.

Based on record review, observation, and interview, the manager failed to ensure medication was administered in compliance with a medication order, for one of two residents sampled. Findings include: 1. A review of R2's medical record revealed a directed care service plan dated February 3, 2023, which indicated R2 received medication administration. Further review of R2's medical record revealed a signed medication order dated June 19, 2023 for "Metoprolol succinate ER 50 MG (milligrams) tablet, extended release 24 hr, Take 0.5 tablets 3 times a day by oral route." 2. Further review of R2's medical record revealed medication administration records (MARs) for June and July, 2023. R2's June 2023 MAR indicated a half tablet of "Metoprolol ER 50 MG" was administered to R2 at 8:00 AM and 8:00 PM June 1-30, 2023. R2's July 2023 MAR indicated a half tablet of "Metoprolol ER 50 MG" was administered to R2 at 8:00 AM from July 1-17, 2023; and at 8:00 PM from July 1-16, 2023. However, documentation which indicated R2 received Metoprolol three times per day as ordered in June and July of 2023 was not available for review. 3. The Compliance Officer observed a medication bottle for "Metoprolol ER Succinate 50 MG tablets" in a basket of R2's medication. The label on the bottle read, "Take 1/2 tablet by mouth three times daily." 4. In an interview, E1 reported the frequency at which R2 was to receive a half tablet of "Metoprolol succinate ER 50 MG tablet" was changed from three times per day to two times per day when R2 was at the hospital "a few months ago." E1 reported a medication change order for the decreased frequency was not available for review and acknowledged the medication was not administered in compliance with the most recent available medication order.