Circles of Life Residential Care

Based on observation, record review, and interview, the manager failed to ensure a qualified caregiver, who had been designated in writing, was present on the assisted living facility's premises and accountable for the assisted living facility when the manager was not present on the assisted living facility premises. The deficient practice posed a risk as no individual was designated to act on behalf of the governing authority in the onsite management of the assisted living facility. Findings include: 1. Upon arrival, the Compliance Officer observed E3 was the only personnel member present and working at the facility. The Compliance Officer asked E3 if E3 was the manager's designee. E3 stated, "No, I am just the caregiver." E3 called E1 to come to the facility to facilitate the inspection. The Compliance Officer requested the facility's policies and procedures or other documentation to review while waiting for E1 to arrive. E3 again called E1 and E1 directed E3 to give the Compliance Officer access to the tablet which contained electronic resident information. However, the Internet connection was not operating properly, and the Compliance Officer was unable to review information. 2. E3 asked the Compliance Officer to wait for E1 to facilitate the inspection. E1 arrived approximately one hour later and facilitated the inspection from that point. 3. In an interview, E1 acknowledged the manager failed to ensure a qualified caregiver, designated in writing, was present on the premises and accountable for the assisted living facility when the manager was not present.

Based on documentation review and interview, the manager failed to provide documentation required by this Article within two hours after a Department request. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the licensee did not provide the Department with the requested documentation required by this Article. Findings include: 1. The Compliance Officer arrived on-site at approximately 1:15 PM. E3 asked the Compliance Officer to wait for E1 to arrive to facilitate the inspection. 2. E1 arrived at approximately 2:30 PM and reported the facility stored all documentation electronically and E1 would email the Compliance Officer the requested documentation. The Compliance Officer requested the following documentation at 2:40 PM with a two hour deadline of 4:40 PM. -The facility's policies and procedures; -R1's, R2's, and R3's complete resident medical records including any incident reports; -All personnel records; -Staff schedules for the last 3 months; and -Manager designee documentation. 3. The Compliance Officer received the following electronic documention within the 2 hour time frame: -The facility's policies and procedures; -R1's, R2's, and R3's partial medical records; and -E3's and E4's personnel records. 4. In an interview, E1 acknowledged the requested documentation was not provided within the required time frame.

Based on record review and interview, the manager failed to ensure a caregiver provided a resident with the assisted living services in the resident's service plan and documented the services provided in the resident's medical record, for three of three residents sampled. The deficient practice posed a risk as the Department was unable to determine substantial compliance as the licensee did not provide the Department with the requested documentation required by this Article. Findings include: 1. A review of R1's medical record revealed a document titled, "Service Plan," dated July 28, 2023, which listed the following services R1 was to be provided: -Eating: Independent; Three times daily and as needed with snacks; -Oral Care: Independent; Twice daily and as needed; -Nail Care: Independent; Nails checked daily and trimmed as needed; -Hair Care: Independent; Daily and as needed; -Dressing: Requires assistance; Twice daily and as needed; -Bathing: Requires assistance; Twice weekly and as needed; -Toileting: Requires assistance; Daily as needed; -Transferring: Requires assistance; Daily and as needed; and -Transportation to Appointments: Requires assistance; As needed. 2. A review of R2's medical record revealed a document titled, "Service Plan," dated December 13, 2023, which listed the following services R2 was to be provided: -Eating: Independent; Three times daily and as needed with snacks; -Oral Care: Requires supervision; Twice daily and as needed; -Nail Care: Requires supervision; Nails checked daily and trimmed as needed; -Hair Care: Requires supervision; Daily and as needed; -Dressing: Requires assistance; Twice daily and as needed; -Bathing: Requires assistance; Twice weekly and as needed; -Toileting: Requires total care; Daily as needed -Transferring: Requires assistance; Daily and as needed; and -Transportation to Appointments: Requires total care; As needed 3. A review of R3's medical record revealed a document titled, "Service Plan," dated March 11, 2024, which listed the following services R3 was to be provided: -Eating: Independent; Three times daily and as needed with snacks; -Oral Care: Requires supervision; Twice daily and as needed; -Nail Care: Requires supervision; Nails checked daily and trimmed as needed; -Hair Care: Requires supervision; Daily and as needed; -Dressing: Requires supervision; Twice daily and as needed; -Bathing: Requires assistance; Twice weekly and as needed; -Toileting: Requires total care; Daily as needed; -Transferring: Independent; Daily and as needed; and -Transportation to Appointments: Requires assistance; As needed. 4. A review of R1's, R2's, and R3's medical records revealed no documentation to reflect R1, R2, and R3 were provided with the assisted living services in R1's, R2's, and R3's service plans. 5. In an interview, E1 acknowledged the Compliance Officer did not receive documentation that R1, R2, and R3 were provided with the assisted living services in R1's, R2's, and R3's service plans. E1 repo

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 one resident sampled. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. A review of R1's medical record revealed a medication administration record (MAR) dated March 2024. The MAR indicated R1 received several medications, including the following: -Diazepam 5 milligrams (mg), one tablet at 7:00 AM and 7:00 PM; -Docusate 100 mg, one tablet at 7:00 PM; -Trazodone 100 mg, one tablet at 7:00 PM; and -Valproic acid 250 mg/5ml orally at 7:00 AM, 2:00 PM, and 7:00 PM. 2. A review of R1's medical record revealed no signed medication orders for the aforementioned medications. 3. In an interview, E1 acknowledged the aforementioned medications were not administered in compliance with a medication order as no signed orders were provided for review.

Based on record review, observation, and interview, the manager failed to ensure medication administered to a resident was documented in the resident's medical record, for one of one resident sampled receiving medication administration. The deficient practice posed a risk as medication could not be verified as administered against a medication order. Findings include: 1. A review of R1's medical record revealed a medication administration record (MAR), dated March 2024. The MAR included the following scheduled medications: -Diazepam 5 milligrams (mg), one tablet at 7:00 AM and 7:00 PM; -Docusate 100 mg, one tablet at 7:00 PM; -Levothyroxine .075 mg, one tablet at 6:00 AM; -Olanzapine 5 mg, mg, one tablet at 7:00 AM and 7:00 PM; -Trazodone 100 mg, one tablet at 7:00 PM; and -Valproic acid 250 mg/5ml orally at 7:00 AM, 2:00 PM, and 7:00 PM. 2. Further review of R1's MAR revealed the aforementioned medications were not documented as administered on the following days at the required times: -March 11, 2024-March 14, 2024. 3. In an interview, E1 acknowledged the aforementioned medications were not documented in R1's medical record as administered. However, E1 reported E1 believed R1 received the medications as prescribed.

Based on documentation review, record review, and interview, the manager failed to ensure when a resident had an accident, emergency, or injury that resulted in the resident needing medical services, a caregiver or assistant caregiver documented the date and time of the accident, emergency, or injury; a description of the accident, emergency, or injury; the names of individuals who observed the accident, emergency, or injury; the actions taken by the caregiver or assistant caregiver; the individuals notified by the caregiver or assistant caregiver; and any action taken to prevent the accident, emergency, or injury from occurring in the future. The deficient practice posed a risk as critical information needed in an investigation regarding a resident's urgent medical needs were not obtained as required. Findings include: 1. A review of Department documentation revealed R1 was transported via emergency medical services to Chandler Regional Medical Center on September 29, 2023. 2. In an on-site complaint investigation, the Compliance Officer requested R1's medical record for review, including any incident reports. 3. A review of R1's electronically submitted medical record revealed no incident reports were received as requested. 4. In an interview, E1 acknowledged the facility called 911 for R1 on September 29, 2023. E1 reported the facility did create an incident report documenting the emergency room visit. However, E1 reported not remembering the Compliance Officer requested incident reports and therefore, they were not provided.

Based on observation and interview, the manager failed to ensure the current phone number for the unit in the Department responsible for licensing and monitoring the assisted living facility was conspicuously posted. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed there were no current phone numbers posted. 2. During an interview, E1 acknowledged the manager failed to ensure the current phone number for the unit in the Department responsible for licensing and monitoring the assisted living facility was conspicuously posted.

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 were not prescribed the accessible medication. Findings include: 1. The Compliance Officer observed three ambulatory residents on the premises. 2. During the environmental inspection of the facility, the Compliance Officer observed the kitchen refrigerator contained a box with "Lorazepam Intensol oral concentrate 2 mg (milligrams) per ml (milliliter)" medication. Neither the refrigerator nor the box were locked. 3. In an interview, E2 reported the "Lorazepam Intensol" belonged to E3. 4. In an interview, E1 acknowledged medications were 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 a refrigerator used by the assisted living facility to store food contained a thermometer placed at the warmest part of the refrigerator. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed there was no thermometer in the kitchen refrigerator. 2. In a joint interview, E1 and E2 acknowledged the kitchen refrigerator did not contain a thermometer.