Canyon Assisted Living LLC

Based on observation, documentation review, and interview, the manager failed to ensure documentation was maintained of the caregivers and assistant caregivers working each day, including the hours worked by each. The deficient practice posed a risk as there was no documentation to identify the staff that was present each day to ensure the health and safety of residents. Findings include: 1. When the Compliance Officer arrived, E4 was the only person working at the facility. 2. Review of the posted personnel schedule dated July 2024 revealed E1 and E3 were scheduled to work the 6 am-6 am shift July 10th. E1 and E3 were not present when the Compliance Officer arrived, and E4 was not listed on the schedule. 3. In an interview, E1 acknowledged documentation was not maintained of the caregivers and assistant caregivers working each day, including the hours worked. Technical assistance was provided on this rule during the compliance and complaint inspection conducted on December 19, 2022.

Based on record review and interview, the manager failed to ensure 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 one of three employees reviewed. 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. Review of the Centers for Disease Control and Prevention website revealed a web page titled "TB Screening and Testing of Health Care Personnel." The web page stated, "If the Mantoux tuberculin skin test (TST) is used to test health care personnel upon hire (preplacement), two-step testing should be used." 3. Review of E3's personnel record revealed a negative TB skin test that was less than 12 months old, however no additional documentation of freedom from infectious TB was available for review. Based on E3's hire date, this documentation was required. 4. In an interview, E1 acknowledged E3 did not provide documentation of freedom from infectious TB as specified in R9-10-113 on or before the date the individual began providing services at or on behalf of the assisted living facility. Technical assistance was provided on this rule during the compliance and complaint inspection conducted on December 19, 2022.

Based on observation, record review, documentation review, and interview, the manager failed to ensure a trained caregiver was present on the assisted living facility's premises when the manager was not present. The deficient practice posed a risk as no qualified employee was present to meet a resident's needs. Findings include: 1. When the Compliance Officer arrived, the manager was not present. E4 was the only employee at the facility with three residents. 2. There was no personnel record for E4, and no documentation that E4 had completed a caregiver training program approved by the Department or the Board of Examiners for Nursing Care Institution Administrators and Assisted Living Facility Managers provided. Therefor, E4 was no qualified to be left alone with the residents based on the lack of caregiver training. 3. A review of the azcg.tmutest.com website revealed no documentation of a caregiver training certificate for E4. 4. In an interview, E1 reported that E4 was not a caregiver, and that E1 left the residents alone with E4 so that E1 could pick up E1's child. E1 acknowledged neither a manager or caregiver was present at the facility when the Compliance Officer arrived.

Based on record review and interview, the manager failed to ensure a personnel record for each employee included the individual's starting date of employment, for one of three employee records reviewed. Findings include: 1. A review of E1's personnel record revealed the record did not include the starting date of employment. 2. In an interview, E1 acknowledged E1's personnel record did not include the starting date of employment. Technical assistance was provided on this rule during the compliance and complaint inspection conducted on December 19, 2022.

Based on observation, record review, and interview, the manager failed to ensure a personnel record was available for one of two employees reviewed. The deficient practice posed a risk as required information could not be verified for E4. Findings include: 1. When the Compliance Officer arrived, E4 was the only employee present at the facility. 2. Review of the personnel records revealed no record for E4. 3. During an interview, E1 acknowledged a personnel record was not available for E4. This is a repeat deficiency from the on-site compliance and complaint inspection conducted on December 19, 2022.

Based on record review, observation, and interview, the manager failed to ensure the caregiver documented the services provided in the resident's medical record, for one of two residents reviewed. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. Review of R1's medical record revealed a current written service plan for directed care services dated April 6, 2024. This service plan stated the following service was needed: "Clean fingernails, Trimmed, clip, filed." 2. Review R1's medical record revealed documents titled "Vitals and Activities of Daily Living" for May, June, and July 2024. However, the service titled "Finger Nail Care" contained no signature or initial from a caregiver indicating the service had been provided on all three documents. 3. The Compliance Officer observed that R1's fingernails appeared as if the nail care was provided. 4. During an interview, E1 acknowledged R1's medical record did not include documentation of nail care. This is a repeat deficiency from the on-site compliance and complaint inspection conducted on December 19, 2022.

Based on documentation review, record review, and interview, the manager failed to ensure a resident medical record contained documentation of notification of the resident of the availability of vaccination for influenza (flu) and pneumonia, according to A.R.S. \'a7 36-406(1)(d), to one of one resident reviewed. The deficient practice posed a potential illness risk to residents. Findings include: 1. A.R.S. \'a7 36-406(1)(d) states "The department shall: 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. Review of R2's medical record revealed no documentation showing the flu vaccination was offered or received. Based on R2's date of admission, this documentation was required. 3. In an interview, E1 acknowledged R2's medical record did not include documentation showing the flu vaccination was offered or received.

Based on record review and interview, the manager failed to ensure a service plan included documentation of the resident's weight or documentation from a medical practitioner stating weighing the resident was contraindicated, for one of one resident reviewed receiving directed care services. The deficient practice posed a health and safety risk to the residents. Findings include: 1. Review of R1's medical record revealed a current written service plan for directed care services dated April 6, 2024. This service plan revealed no documentation of R1's weight. In addition, R1's medical record revealed no documentation of R1's weight or documentation from a medical practitioner stating weighing R1 was contraindicated. 2. In an interview, E1 acknowledged R1's service plan did not include documentation of R1's weight and documentation was not available in R1's medical record from a medical practitioner stating weighing R1 was contraindicated.

Based on observation and interview, the manager failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. 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 the following medications in an unlocked box in the kitchen refrigerator: -Morphine Sulfate Oral Solution -Lorazepam 2. During an environmental inspection of the facility, the Compliance Officer observed the following medications in an unlocked drawer in the kitchen: -"Novothyral" -"Dafalgan" -"dapagliflozinum/metforminum" -"Bisoprolol" In an interview, E1 reported that these medication belonged to E4. 3. In an interview, E1 acknowledged the medications were not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. This is a repeat deficiency from the on-site compliance and complaint inspection conducted on December 19, 2022.

Based on observation and interview, the manager failed to ensure foods requiring refrigeration were maintained at 41\'b0 F or below. The deficient practice posed a health risk to the residents. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed an open container of grape jelly and ketchup in a kitchen cabinet. Both of these containers stated "Refrigerate after opening." 2. During an interview, E1 acknowledged the foods were stored at room temperature and required refrigeration.

Based on documentation review and interview, the manager failed to ensure the facility's 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 policies and procedures revealed a document titled "Disaster Plan". However, there was no documentation showing that the disaster plan had been reviewed. 2. During an interview, E1 acknowledged the facility's disaster plan was not reviewed within the last 12 months. Technical assistance was provided on this rule during the compliance and complaint inspection conducted on December 19, 2022.

Based on observation and interview, the manager failed to ensure hot water temperatures were maintained between 95\'b0 F and 120\'b0 F in the areas of a facility used by residents, which posed a health and safety risk to the residents. Findings include: 1. During an environmental inspection of the facility with E1, the Compliance Officer observed the hot water temperature at 127.2\'b0 F in the hall bathroom near resident bedrooms. 2. In an interview, E1 acknowledged the hot water temperature was not maintained between 95\'b0 F and 120\'b0 F in the areas of a facility used by residents. This is a repeat deficiency from the on-site compliance and complaint inspection conducted on December 19, 2022.

Based on observation and interview, the manager failed to ensure poisonous or toxic material stored by the assisted living facility was maintained in a locked area inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed, in an unlocked kitchen cabinet, a bottle of "Lemon Scent Cleaning Bleach" which stated "Keep out of reach of Children DANGER". 2. In an interview, E1 acknowledged poisonous or toxic material stored by the assisted living facility was not maintained in a locked area inaccessible to residents. Technical assistance was provided on this rule during the compliance and complaint inspection conducted on December 19, 2022.