Clearwater Mayo Blvd

Based on record review and interview, the manager failed to ensure that the emergency responder face sheet contained the name, address and telephone number of the resident's current pharmacy as required under Arizona Revised Statute (A.R.S.) 36-420.04. A.3. Findings include: 1. A record review of the facility's prefilled Emergency Medical Services (EMS) Face Sheet for 11 of 11 sampled residents revealed that the form was missing the section containing the name, address, and phone number of the resident's current pharmacy. 2. In an interview, E1 acknowledged that the manager failed to ensure that the EMS face sheet contained the name, address, and phone number of the resident's current pharmacy as required.

Based on record review, documentation review, and interview, the manager failed to ensure compliance with A.R.S. § 36-411 for two of eleven sampled employees. The deficient practice posed a risk if E5 or E8 were a danger to a vulnerable population. Findings include: 1. A review of E5 and E8's personnel records revealed, neither employee had a valid Department of Public Safety (DPS) Fingerprint Clearance card. 2. An online check by the Compliance Officer on July 25, 2025 of the Arizona Department of Public Safety (DPS) web portal at https://psp.azdps.gov/services/cardStatusRequest revealed that E5 applied for a Fingerprint card in March 2025. A search the application number returned no results. 3. E8 did not have a fingerprint card nor an application for review. 4. A documentation review of the facility's Policies and Procedures stated, "background and criminal records clearances as required by government regulations" for all employees. 5. In an interview, E1 acknowledged the manager did not ensure compliance with A.R.S. § 36-411 for E5 and E8.

Based on record review, documentation review, and interview, the manager failed to ensure that a manager, a caregiver, assistant caregiver, or a volunteer provide documentation of freedom from infectious Tuberculosis (TB) as specified in R9-10-113. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. A review of E3’s personnel record revealed no documentation indicating that the employee completed the two-step TB process was available for review. 2. A review of E4, E6, and E7's personnel records revealed a TB screening and risk assessment form was not available for review. 3. A documentation review of the facility's Policies and Procedure titled, "Tuberculosis (TB) Care Staff" stated, "1. All TB tests conducted will be 2-step TB tests. 2. The Employee TB Consent Screening and Documentation form may be used." 4. In an interview, E1 acknowledged documentation of freedom from infectious Tuberculosis (TB) was not provided for E3, E4, E6, and E7.

Based on record review and interview, the manager failed to ensure that before or at the time of acceptance of an individual, the individual submits documentation that is dated within 90 calendar days before the individual is accepted by an assisted living facility and: If an individual is requesting or is expected to receive supervisory care services, personal care services, or directed care services: includes whether the individual requires: continuous medical services, continuous or intermittent nursing services, or restraints; and is dated and signed by a: Physician, Registered nurse practitioner, Registered nurse, or Physician assistant. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R3's medical records revealed, based on the resident's admission dates, the initial or continuation medical authorization form was required. 2. A review of R3's medical records revealed "Physician's Report and Admission Orders-Arizona" form did not have the resident's name listed on it nor the resident's level of care. 3. In an interview, E1 acknowledged the initial physician statement did not document if R3 received supervisory care services, personal care services, or directed care services.

Based on record review, documentation review, and interview, the manager failed to ensure that a resident provided evidence of freedom from infectious Tuberculosis before or within seven calendars after the resident's date of occupancy as specified in R9-10-113. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. A review of R1, R2, R7, and R9’s medical records revealed, documentation of a TB screening and risk assessment form, was not available for review for four of eleven sampled residents. 2. A documentation review of the facility's Policies and Procedure titled, "Tuberculosis (TB) Residents" stated, "The Community will screen residents at the time of admission for information regarding exposure to or symptoms of TB." 3. In an interview, E1 acknowledged documentation of freedom from infectious Tuberculosis (TB) was not provided for R1, R2, R7, and R9.

Based on documentation review, record review, and interview, the manager failed to ensure, before providing assisted living services to a resident, a caregiver provided current documentation of first aid training and cardiopulmonary resuscitation (CPR) training certification specific to adults, for one of two sampled personnel members. The deficient practice posed a risk if the caregivers were unable to meet a resident's needs during an emergency. Findings include: 1. A review of facility documentation revealed a staff schedule for July-September 2024. The schedule revealed E3 worked at the facility on multiple shifts from July-September 2024 as a caregiver. 2. A review of E3's personnel record revealed documentation of first aid training and CPR training. However, the first aid and CPR documentation had expired on August 19, 2024. 3. In an interview, E1 acknowledged E3 had no current documentation of CPR and first aid training.