Christina's Assisted Living

Based on record review and interview, the manager failed to ensure the assisted living home maintained a standardized form for each resident that included the information prescribed in subsection A of this section for three of three residents reviewed. Findings include: 1. Review of R1's, R2's, and R3's medical record revealed a resident information document. This document contained spaces designated for the information required in subsection A of ARS 36-420.04, however the following information was not included: - The name, address and telephone number of the resident's current pharmacy; - 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; and - 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. 2. A review of the facility's emergency documentation revealed a form titled "Assisted Living Resident Transfer Checklist." However, the form was blank at the time of review and was not completed for each individual resident. 3. In an interview, E1 reported that the resident information document with a medication list was the documentation provided to first responders when entering the home. E1 acknowledged that the assisted living home did not maintain a standardized form for each resident.

Violation cited

Based on documentation review and interview, the manager failed to ensure that a resident was treated with dignity, respect, and consideration. Findings include: 1. A review of E5's personnel record revealed a document titled 'Disciplinary Action Form" reporting "Employment Termination" due to "unauthorized restraint of a resident." 2. A review of facility documentation revealed a document titled "Abuse/Or Neglect Allegation Investigation Notes" which reported E5 admitted to restraining R2. The document reported R2 reported E5 used a "sheet" to restrain R2. Per the document the hospice chaplain witnessed the restraint and the hospice RN conducted an eval or review of R2's condition. The document reported facility management was made aware and removed the caregiver for the remainder of the shift. 3. A review of facility documention revealed a self report to Adult Protective Services of the events. 4. In an interview R2 was not able to provide information on the incident. 5. In an interview, E1 reported hospice evaluated R2 and E5's employment was terminated. E1 acknowledged R2 was not treated with dignity, respect, and consideration.

Based on documentation review, record review, and interview, the manager failed to ensure a resident was not subjected to restraint. The deficient practice posed a potential for physical injury and psychological distress. Findings include: 1. Arizona Administrative Code (A.A.C.) R9-10-101(201) states: "Restraint" means "any physical or chemical method of restricting a patient's freedom of movement, physical activity, or access to the patient's own body." 2. A review of E5's personnel record revealed a document titled 'Disciplinary Action Form" reporting "Employment Termination" due to "unauthorized restraint of a resident." 3. A review of facility documentation revealed a document titled "Abuse/Or Neglect Allegation Investigation Notes" which reported E5 admitted to restraining R2. The document reported R2 reported E5 used a "sheet" to restrain R2. Per the document the hospice chaplain witnessed the restraint and the hospice RN conducted an eval or review of R2's condition. The document reported facility management was made aware and removed the caregiver for the remainder of the shift. 4. A review of facility documention from revealed a self report to Adult Protective Services of the events. 5. In an interview R2 was not able to provide information on the incident. 6. In an interview, E1 reported hospice evaluated R2 and E5's employment was terminated. E1 acknowledged R2 was subjected to restraint.

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 Officers observed the following on a shelf in the closet of an unlocked resident room: - Thirty syringes of "Lorazepam 2 milligram(MG)/Milliliter(ML) Intenso - 15ML syringes"; and - One bottle of "Quetiapine Fumarate 25 MG - Quantity: 60." 2. In an interview, E3 reported the medications had been delivered at 8:00 PM on February 10, 2025. E1 acknowledged the medication was not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage.

Based on observation and interview, the manager failed to ensure medication was stored according to the instructions on the medication container. Findings include: 1. During an environmental tour of the facility, the compliance officer observed a clear plastic bag of medications on a table in the living room of the facility. Further observation revealed the following medication: - Lorazepam 2 milligram(MG)/Milliliter(ML) Intenso - Give 0.5ML (1MG) by mouth every 4 hours as needed - thirty 15ML syringes. The bag was labled with white and blue stickers stating "REFRIGERATE" and a red sticker stating "DO NOT FREEZE Keep Medication in a Refrigerator." However, the medication was not in the refrigerator and the medication was wrapped with cold packs that at the time of survey were warm to the touch. 2. In an interview, E3 reported the medications had been delivered at 8:00 PM on February 10, 2025 and was not refrigerated. E1 acknowledged the Lorazepam was not stored according to the instructions on the medication container.

Based on documentation review, observation, and interview, the manager failed to ensure poisonous or toxic materials stored by the assisted living facility were maintained in a locked area, labeled and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. A review of Department records revealed the facility was licensed to provide directed care services. 2. During an environmental inspection, Compliance Officer observed ambulatory residents in the home. 3. During the environmental tour, the Compliance Officer observed the following poisonous or toxic material in the unlocked cabinet of a common area bathroom accessible to residents: - One bottle of "Fabuloso Multi-Purpose Cleaner"; - One spray bottle of "Fabuloso Multi-Purpose Cleaner"; - One spray bottle of "Lysol All Purpose Cleaner"; - One can of "Black Flag Spider and Scorpion Killer"; and - One can of "Hot Shot Spider and Scorpion Killer." 4. During the environmental tour, the Compliance Officers observed the following poisonous or toxic material in the unlocked kitchen cabinet: - One container of "Comet with Bleach"; and - One bottle of "Great Value Glass Cleaner." 5. In an interview, E1 acknowledged poisonous or toxic materials stored by the assisted living facility were not maintained in a locked area, labeled and inaccessible to residents.

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; signed and dated by a physician, registered nurse practitioner, registered nurse or physician assistant, for two of three residents sampled. The deficient practice posed a risk if a resident was not assessed and determined to be within the scope of an assisted living facility prior to receiving services. Findings include: 1. A review of R1's medical record revealed a document titled, "Pre-Admission Determination" dated May 3, 2023, signed by a physician, and documenting R1's level of care and needs. However, the document was not dated within 90 calendar days before R1's date of admission. 2. A review of R2's medical record revealed a document titled, "Pre-Admission Determination" dated May 8, 2023, signed by a medical practitioner and documenting R2's level of care and needs. However, the document was not dated within 90 calendar days before R2's date of admission. 3. In an interview, E1 acknowledged R1's and R2's medical records did not contain documentation that was dated within 90 days before the individual was accepted by the assisted living facility and was signed and dated by a physician, registered nurse practitioner, registered nurse or physician assistant.

Based on record review and interview, the manager failed to ensure that there was a documented residency agreement with the assisted living facility, for two of three residents sampled. Findings include: 1. A review of R1's medical record revealed a document titled, "Marigold Assisted Living Residency Agreement." The document stated, "The parties to this contract are: a. Marigold Assisted Living, hereafter, 'The Home or Facility' b. [R1], hereafter, 'The Resident/s' c. [O1], hereafter, 'The Responsible Party/Representative'" The residency agreement was not between Christina's Assisted Living and R1. 2. A review of R3's medical record revealed a document titled, "Marigold Assisted Living Residency Agreement." The document stated, "The parties to this contract are: a. Marigold Assisted Living, hereafter, 'The Home or Facility' b. [R3], hereafter, 'The Resident/s' c. [O2], hereafter, 'The Responsible Party/Representative'" The residency agreement was not between Christina's Assisted Living and R3. 3. In an interview, E1 acknowledged the residency agreements were not between the assisted living facility and the resident.

Based on record review and interview, the manager failed to ensure a medication administered to a resident was administered in compliance with a medication order, for one of three residents sampled. Findings include: 1. A review of R1's medical record revealed a service plan dated May 6, 2023. The service plan revealed R1 received medication administration. 2. A review of R1's medical record revealed a signed medication order dated June 1, 2023 for Sertraline 50 milligrams (mg), take 1/2 tablet daily at bedtime for one week, then one tablet daily at bedtime for one week, and finally two tablets daily at bedtime. 3. A review of R1's medication administration record (MAR) for the months of June 2023, July 2023, and August 2023 revealed the Sertraline 50 mg was listed on each MAR with the following administration instructions: -June 2023: Sertraline 50 mg, amount = 1/2 was listed on the MAR. However, there was no documentation to indicate R1 received the medication as directed in June as the MAR was blank; -July 2023: Sertraline 50 mg, 2 tablets at bedtime; the MAR indicated R1 received the medication every day in July 2023. -August 2023: Sertraline 50 mg, 1/2 tablet at bedtime. The MAR indicated R1 received the medication on August 1, 2023. 4. A review of R1's medications revealed Sertraline 50 mg was available for use. The bottle stated, "Take 2 tablets by mouth at bedtime for depression." 5. A review of R1's medication organizer revealed only one Sertraline 50 mg pill in the bedtime slot for the remaining days available in the organizer. 6. In an interview, E1 acknowledged the Sertraline 50 mg was not administered in compliance with the medication order. E1 reported E1 would get clarification on the order from the hospice agency and make necessary adjustments.

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. Findings include: 1. During the on-site inspection, the Compliance Officer observed E2 and E3 going in and out of a closet that contained the residents' medications. The caregivers shared a set of keys and the closet was kept locked. 2. At some point during the inspection, the keys to the medication closet were left hanging in the lock and remained there until E1 brought it to the attention of E2 and E3. The keys were then removed. 3. In an interview, E1 acknowledged E1 failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage.