Desert Home of Arizona

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 risk for potential food borne illnesses. Findings include: 1. The Compliance Officer observed the facility ' s thermometer in the door of the refrigerator measured the temperature to be 18\'b0 F and the thermometer in the back of the refrigerator read 29\'b0 F. 2. Using the Department issued digital thermometer, the Compliance Officer observed the facility ' s refrigerator temperature to be 48.6\'b0 F. The refrigerator contained milk, eggs, and other foods that required refrigeration. 3. In an interview, E2 acknowledged foods requiring refrigeration were not maintained at 41\'b0 F or below.

Based on documentation review and interview, the manager failed to ensure policies and procedures were available to employees and volunteers of the assisted living facility. The deficient practice posed a risk as policies and procedures reinforce and clarify standards expected of employees and volunteers. Findings include: 1. A review of Department documentation revealed the perpetual license for AL12591 was effective May 5, 2023. 2. In an interview with E2, the Compliance Officer requested to review the facility's policies and procedures. However, the policies and procedures were not provided for review. E2 did not have access to the policies and procedures because they were "on the computer." 3. In an interview, E1 reported the policies and procedures were currently in the process of being digitized and were not available for review at the time of the survey. E1 reported the policies and procedures from E1's sister facility could be made available for review if E1 could drive to pick them up and return in 20 minutes; however, the policies were not written for AL12591. 4. In an interview, E2 acknowledged the policies and procedures for AL12591 were not available to employees and volunteers of the assisted living facility.

Based on record review, documentation 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 to include whether the individual required continuous medical services, continuous nursing services, intermittent nursing services or restraints; signed and dated by a physician, registered nurse practitioner, registered nurse or physician assistant, for two of two residents. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R1's (admitted 2023) medical record revealed no documentation dated within 90 calendar days before R1's date of admission, to include whether R1 required continuous medical services, continuous nursing services, intermittent nursing services or restraints; signed and dated by a physician, registered nurse practitioner, registered nurse, or physician assistant. 2. A review of R2's (admitted 2023) medical record revealed no documentation dated within 90 calendar days before R2's date of admission, to include whether R2 required continuous medical services, continuous nursing services, intermittent nursing services or restraints; signed and dated by a physician, registered nurse practitioner, registered nurse, or physician assistant. 3. A documentation review of the facility's policies and procedures revealed a policy titled, "Resident Acceptance, Rights, Termination (edited June 12, 2023)." The policy stated, " Before or at the time of acceptance of an individual expected to receive assisted living services, the individual submits documentation that is dated within 90 calendar days before the individual is accepted stating if the individual needs continuous medical services, continuous or intermittent nursing services, or restraints that is dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant." 4. In an interview, E1 acknowledged the required documentation was not available for review. E1 reported the document titled, "Initial Physician Recommendation Form," which included the information required by the Rule, was completed for R1 and R2. E1 reported the forms were "sent out" to be signed by R1 ' s and R2 ' s "house doctor" or primary care physician.

Based on record review and interview, the manager accepted and retained an individual when the primary condition for which the individual needed assisted living services was a behavioral health issue, for one of two residents. The deficient practice posed a risk as R1's primary condition was not within the facility's scope of services. Findings include: R9-10-101.32. "Behavioral health issue" means an individual's condition related to a mental disorder, a personality disorder, substance abuse, or a significant psychological or behavioral response to an identifiable stressor or stressors. 1. A review of R1's medical record revealed a document titled, "Individual Service Plan" for personal care services signed and dated in June 2023, by a medical practitioner. The document stated, "Primary Diagnosis... Altered mental status, ETOH [alcohol] withdrawal ...Secondary Diagnosis: GERD [gastroesophageal reflux disease], hypertension, BPH [benign prostatic hyperplasia], ARTHRITIS ...Chronic Conditions: BPN [brachial plexus neuropathy], HTN [hypertension], Osteoarthritis ...Staff to check on residents (sic) wellness daily and ensure identified needs are met ...Staff to offer limited assistance with dining by completing any small tasks to ensure successful eating." 2. A review of R1's medical record revealed a document (dated June 12, 2023). The document was titled, "Life Care Center of North Glendale ...Progress Notes *NEW*." The document stated R1 ' s diagnoses were: "Alcohol abuse with withdrawal delirium (F10.131), Unsteadiness on Feet (R26.81), Other chest pain (R07.89), Essential (Primary) hypertension (I10), Difficulty in walking, not elsewhere classified (R26.2), Benign prostatic hyperplasia without lower urinary tract symptoms (N40.0), anxiety disorder, unspecified (F41.9)..." The document was signed by a physician, O1. 3. In an interview, E1 reported being aware R4's primary diagnosis was a behavioral health issue. E1 reported R1's referral source reported the facility would be able to meet R1's future needs. The referral source identified R1's future needs as possible assistance with showering E1 agreed the facility was not authorized to provide detoxification services. E1 reported R1 displayed some visible signs of detoxification upon admission, such as uncontrollable shaking.

Based on record review and interview, the manager failed to ensure a caregiver documented the services provided in the resident's medical record, for three of three residents sampled. The deficient practice posed a risk as services could not be verified as provided against a service plan. Findings include: 1. A review of R1's medical record revealed a service plan dated June 22, 2023. The plan stated R1 was to receive the following services: -Staff to check on residents (sic) wellness daily and ensure identified needs are met ...Daily -Staff to offer limited assistance with dining by completing any small tasks to ensure successful eating ...daily. 2. A review of R1 ' s medical record revealed a care plan dated June 22, 2023. The plan stated R1 was to receive the following services: -Vital signs..[once] daily ...day shift -Diet Order: Regular ...Staff to assist with set up [twice] daily. 3. A review of R2's medical record revealed a service plan dated June 22, 2023. The plan stated R2 was to receive the following services: -Staff will clean the residents apartment daily ... -Staff to check on residents (sic) wellness daily ... -Staff will assist resident with incontinence to keep them clean and odor-free ...daily -Staff to offer moderate assistance with dining by completing any tasks to ensure successful eating ... -Staff will offer full assistance when the resident is getting dressed ... -Staff will provide limited assistance with AM/PM routine by providing cueing, reminders, and standby assists [for sleep]... -Staff to assist with a skin evaluation and be aware of weekly assessments with Care Specialist ... -Staff will give daily treatment of wound to keep it clean and avoid infection ... -Staff will wash, dry, fold, return, and put away residents (sic) laundry ...daily 4. The Compliance Officer requested to review the documentation of services provided to R1 and R2. However, documentation of services for June and July 2023 was not provided for review. 5. In an interview, E1 acknowledged documentation of services provided in June and July 2023, was not available for review. E1 reported the documentation was developed, but inaccessible at the time of the survey.

Based on observation and interview, the manager failed to ensure a refrigerator used by an assisted living facility to store food contained a thermometer that was accurate to plus or minus 3\'b0 F, placed at the warmest part of the refrigerator. The deficient practice posed a risk for potential food borne illnesses. Findings include: 1. The Compliance Officer observed the facility's thermometer in the door of the refrigerator measured the temperature to be 18\'b0 F and the thermometer in the back of the refrigerator read 29\'b0 F. 2. Using the Department issued digital thermometer, the Compliance Officer observed the facility's refrigerator temperature to be 48.6\'b0 F. The refrigerator contained milk, eggs, and other foods that required refrigeration. 3. In an interview, E2 acknowledged the refrigerator used to store food contained a thermometer that was not accurate to plus or minus 3\'b0 F, placed at the warmest part of the refrigerator.