Cami Assisted Living Home LLC

Based on documentation review, record review, and interview, the manager failed to ensure that when the assisted living home contacted an emergency responder on behalf of a resident, provided the emergency responder a written document that included 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 two of two residents sampled. 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 and R2’s emergency medical services documentation revealed no documentation of R1’s and R2’s health insurance portability and accountability act release documents. 3. In an exit interview, the findings were discussed with E1 and no additional information was provided.

Based on documentation review and interview, the health care institution’s chief administrative officer failed to implement tuberculosis infection control activities that annually assessed the health care institution’s risk of exposure to infectious tuberculosis. Findings include: 1. A review of the facility’s TB risk assessment documentation revealed a completed TB risk assessment. However, the document lacked a date. 2. A review of the facility’s policies and procedures revealed a policy titled "Tuberculosis (TB) Control - Tuberculosis Screening”. The policy stated, “The facility will be assessed on an annual basis to determine TB risk. This assessment will be completed on the facility form called “Facility Tuberculosis Risk Assessment” at least once every 12 months.” 3. In an exit interview, the findings were discussed with E1 and no additional information was provided.

Based on record review, documentation review, and interview, the manager failed to ensure that before providing assisted living services to a resident, a manager provided current documentation of first aid training and cardiopulmonary resuscitation (CPR) training specific to adults, for one of two personnel records sampled. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency. Findings include: 1. A review of E2’s personnel record revealed a CPR certification from American Health Care Academy, with an issuance date of March 13, 2024. However, upon further review it was revealed that the CPR certification did not include a skills demonstration as it was a curriculum only course. After further review, it was revealed that documentation of a valid CPR certification that demonstrated skills was not available. 2. A review of E2’s personnel record revealed E2 was a licensed registered nurse. 3. A review of R1’s medical records revealed E2 performed R1’s Tuberculosis (TB) skin test in 2025. 4. A review of the American Health Care Academy website revealed that all CPR courses were conducted online. 5. A review of the facility’s policies and procedures revealed a policy titled "First Aid and CPR Training”. The policy stated, “In order to keep First Aid and CPR training and skills up to date it is required that each employee and volunteer provide the following: Documentation that verifies that the employee or volunteer has received CPR training……….Method and content of CPR training which includes the ability to perform and demonstrate cardiopulmonary resuscitation.” 6. A review of Department documentation revealed the E2 was the manager. 7. In an exit interview, the findings were discussed with E1 and no additional information was provided.

Based on documentation review, record review, and interview, the manager failed to ensure that a resident provided evidence of freedom from infectious tuberculosis (TB) as specified in R9-10-113, for one of two residents sampled. The deficient practice posed a potential illness 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 the facility’s policies and procedures revealed a policy titled "Tuberculosis (TB) Control - Tuberculosis Screening”. The policy stated, “Before admission or on the day of admission all residents will be required to complete TB screening and a risk assessment on a facility form called “Tuberculosis (TB) Screening and Risk Assessment”. 3. A review of R1’s medical record revealed no documentation that assessed R1's risks of prior exposure and signs and symptoms of TB 4. In an exit interview, the findings were discussed with E1 and no additional information was provided.

Based on documentation review, observation, and interview, the manager failed to ensure that there was a means of exiting the facility that monitored or alerted employees of the egress of a resident from the facility. This 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 licensed to provide directed care services. 2. During an environmental tour, the Compliance Officers observed that the exit door to the backyard was equipped with a way to alert employees of the egress of a resident from the facility. However, the alert did not make a sound. The Compliance Officers also did not observe E1 or E3 monitoring the door. 3. In an interview, E3 reported to E1 that a piece of the alarm fell off, but had not been reattached. 4. In an exit interview, the findings were discussed with E1 and no additional information was provided.

Based on documentation review and interview, the manager failed to ensure the disaster plan was reviewed at least once every 12 months. The deficient practice posed a risk as a disaster plan reinforces and clarifies standards expected of employees. Findings include: 1. A review of the facility’s disaster plan documentation revealed a review conducted on June 3, 2024. However, documentation of an additional review was not available. 2. In an exit interview, the findings were discussed with E1 and no additional information was provided.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials were maintained in a locked area and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. The Compliance Officer observed that the following substances were unsecured and accessible to residents: - Windex - Weiman Glass Cook Top Cleaner & Polish - Las Totally Awesome Cleaner With Bleach 2. In an interview, E1 confirmed that which was established through observation.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials were maintained in a locked area and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. The Compliance Officer observed that the following substances were unsecured and accessible to residents: - Windex - Weiman Glass Cook Top Cleaner & Polish - Las Totally Awesome Cleaner With Bleach 2. In an interview, E1 confirmed that which was established through observation.

Based on observation and interview, the manager failed to ensure medications stored by the facility were stored in a separate locked room, closet, cabinet, or self-contained unit. The deficient practice posed a risk to residents who could access the medication. Findings include: 1. The Compliance Officer observed, upon arrival to the facility, the medication cabinet in the kitchen was unlocked. The Compliance Officer observed the unlocked cabinet contained seven residents' medications. The cabinet had a locking device, however the locking device was broken. 2. The Compliance Officer observed E3 to be the only personnel member at the facility when the Compliance Officer arrived, E3 was not accessing the medications at the time of arrival, and E3 left the immediate area multiple times, leaving the cabinet unlocked. 3. In an interview, E2 acknowledged medications were stored unlocked.