Desert Palace Assisted Living

Based on record review and interview, the manager failed to ensure that a resident had a service plan that was established, documented, and implemented and when initially developed, was signed and dated by the resident or resident’s representative, for two of two residents sampled. Findings include: 1. A review of R1's medical record revealed a service plan, dated June 12, 2025. However, the resident or resident's representative did not sign and date the service plan. 2. A review of R2's medical record revealed a service plan, dated August 3, 2025. However, the resident's representative did not sign and date the service plan. 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on documentation review and interview, the health care institution failed to develop a training program for all staff regarding fall prevention and fall recovery that included initial and continued competency training. Findings include: 1. A review of the facility's policies and procedures revealed a policy titled "Fall Prevention and Recovery." The policy did not include the facility's development of a training program for all staff regarding fall prevention and fall recovery. 2. In an exit interview, the findings were reviewed with E1, and no additional information was provided. This is a repeated deficiency from the compliance and complaint inspection conducted on May 23, 2024. Technical assistance was provided regarding this rule during the compliance inspection conducted on May 19, 2023.

Based on documentation review, record review, and interview, the manager failed to ensure that a resident provided evidence of freedom from infectious tuberculosis (TB) before or within seven calendar days after the resident's date of occupancy and as specified in R9-10-113, for two of two residents sampled. The deficient practice posed a 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. A review of R1's medical record revealed documentation of a chest x-ray indicating R1 was free from infectious TB, which was more than 12 months old. However, documentation of a positive TB skin test, to warrant the use of a chest x-ray was not available. Based on R1's date of acceptance, this documentation was required. 3. A review of R2's medical record did not include documentation of R2's freedom from infectious TB per R9-10-113. Based on R2's date of acceptance, this documentation was required. 4. In an exit interview, the findings were reviewed with E1 and no additional information was provided. This is a repeated deficiency from the compliance and complaint inspection conducted on May 23, 2024.

Based on record review and interview, the manager failed to ensure the caregiver documented the services provided in the resident's medical record, for two 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. A review of R1's medical record revealed a service plan, dated June 12, 2025, that indicated R1 would receive the following services: Shower, twice a week; Partial bath, on days when shower is not given; Shampoo, twice a week; Oral care, twice a day (bid); Nail care, daily (qd) and as needed (PRN); Comb hair, qd and PRN; Partial assistance with dressing; Maintenance of room; Laundry services; Partial assistance with toileting; Medication administration; Transfer assistance with one caregiver; Ambulation assistance with one caregiver; Encouragement of fluid intake; and Encouragement to eat meals and snacks. 2. A review of R1's activities of daily living (ADL) documentation did not include documentation of all aforementioned services provided to R1 October 15, 2025 - present. 3. A review of R2's medical record revealed a service plan, dated August 3, 2025, that indicated R2 would receive the following services: Shower, three times a week; Partial bath, on days when shower is not given; Shampoo, three times a week; Oral care, bid; Nail care, daily qd and PRN; Comb hair, qd and PRN; Partial assistance with dressing; Maintenance of room; Laundry services; Brief changes, PRN; Medication administration; Transfer assistance with one caregiver; Ambulation assistance with one caregiver; Encouragement of fluid intake; and Encouragement to eat meals and snacks. 4. A review of R2's ADL documentation did not include documentation of all aforementioned services provided to R2 October 15, 2025 - present. 5. In an interview, E2 reported all aforementioned services were provided to R1 and R2 October 15, 2025 - present. 6. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on observation and interview, the manager failed to ensure that a resident's medical record was protected from loss, damage, or unauthorized use. The deficient practice posed a risk of protected, sensitive resident health information being disclosed without the resident's consent or knowledge. Findings include: 1. During an environmental tour of the facility, the Compliance Officers observed the residents’ medical records stored in an unlocked cabinet, accessible through the facility’s kitchen. 2. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that a resident’s medical record contained the document signed by the resident consenting for the resident’s representative to act on the resident’s behalf or a copy of the health care power of attorney, for two of two residents sampled. Findings include: 1. A review of R1’s medical record revealed R1 had a power of attorney designated. However, R1’s medical record did not include a copy of the health care power of attorney documentation. 2. A review of R2’s medical record revealed R2 had a power of attorney designated. However, R2’s medical record did not include a copy of the health care power of attorney documentation. 3. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on documentation review, record review and interview, the manager failed to ensure that a resident's medical record contained documentation of the resident's notification of the availability of vaccination for influenza (flu) and pneumonia, according to A.R.S. § 36-406(1)(d), for two of two residents sampled. The deficient practice posed a potential illness risk to residents. Findings include: 1. A.R.S. § 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 license for not making a vaccination available if there is a shortage of that vaccination in this state as determined by the director." 2. A review of R1's medical record did not include documentation of R1's notification of the availability of vaccinations for flu and pneumonia. Based on R1's date of admission, this documentation was required. 3. A review of R2's medical record did not include documentation of R2's notification of the availability of vaccinations for flu and pneumonia. Based on R2's date of admission, this documentation was required. 4. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that a service plan for a resident receiving directed care services included cognitive stimulation and activities to maximize functioning and coordination of communications with the resident’s representative or family members, for one of two residents sampled. The deficient practice posed a risk if the resident's representative and other individuals identified were unable to participate in decisions concerning the assisted living services the resident was to receive. Findings include: 1. A review of R2's medical record revealed a service plan, dated August 8, 2025, which indicated R2 received directed care services. However, the service plan did not include cognitive stimulation and activities to maximize functioning and coordination of communications with the resident’s representative or family members. 2. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on documentation review, observation, and interview, the manager failed to ensure that there was a means of exiting the facility that monitored or alerted employees of the egress of a resident from the facility. The deficient practice posed a risk if the facility was unaware of the general or specific whereabouts of a resident. Findings include: 1. A review of Department documentation revealed the facility was licensed to provide directed care services. 2. During an environmental tour of the facility, the Compliance Officers observed the back door to be equipped with an alarm to alert employees of egress; however, the alarm was not functioning at the time of inspection. 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that a medication administered to a resident was administered in compliance with a medication order, for one of two residents 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 an order, dated August 13, 2024, for Stool Softener 100 milligrams (mg), 2 tablets by mouth (po) daily (qd). 2. A review of R1's medication administration record (MAR) for October 2025 revealed R1 was to be administered Stool Softener 100 mg, 2 tablets po as needed (PRN), and indicated it was administered to R1 on the following dates: October 1, 2025; October 3, 2025; October 5, 2025; October 7, 2025; October 10, 2025 - October 11, 2025; and October 13, 2025. 3. In an interview, E1 reported R1 was administered Stool Softener 100 mg PRN. 4. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that medication administered to a resident was accurately documented in the resident's medical record, for two of two residents sampled. 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 signed medication list, dated August 13, 2024, which included the following medications: Aspirin 81 milligrams (mg) 1 tablet by mouth (po) daily (qd); Atorvastatin 40 mg, 1 tablet po qd; Clopidogrel 75 mg, 1 tablet po qd; Levothyroxine 112 micrograms (mcg), 1 tablet po qd; Metoprolol 25 mg, 1 tablet po qd; Oxybutynin 5 mg, 1 tablet po qd; Gabapentin 100 mg, 2 capsules po at bedtime (qhs); Mirtazapine 30 mg, 1 tablet po qhs; Benadryl 25 mg, 1 tablet po qd; Losartan 50 mg, 1 tablet po qd; Lantus 100 units/milliliter (U/mL), 14 U subcutaneously twice a day (bid); Humalog 100 U/mL, 15 U before meals; Famotidine 20 mg, 1 tablet po bid; and Stool Softener 100 mg, 2 tablets po qd. 2. A review of R1's medication administration record (MAR) for October 2025, did not include documentation of all aforementioned medications administered to R1 from October 15, 2025 - present. 3. A review of R2's medical record revealed a signed medication list, dated May 8, 2025, which included the following medications: Trazodone 50 mg, 1 tablet po qhs; Senna 8.6 mg, 2 tablets po qd; Acetaminophen 500 mg, 2 tablets po three times a day (tid); and Haldol 2 mg/mL, 2 mL po tid. 4. A review of R2's MAR for October 2025, did not include documentation of all aforementioned medications administered to R2 from October 15, 2025 - present. 5. In an interview, E2 reported all medications were administered to R1 and R2 October 15, 2025 - present as ordered. 6. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on observation and interview, the manager failed to ensure the premises of the assisted living facility were free from a condition or situation that may cause a resident or other individual to suffer physical injury. The deficient practice poses a health and safety risk to residents. Findings include: 1. While on-site for the compliance inspection, the Compliance Officers observed a bucket filled with a hammer, nails, and other construction materials stored in the facility's family room. 2. The Compliance Officers also observed ambulatory residents walking throughout the facility. 3. In an interview, the findings were reviewed with E1, and no additional information was provided.

Based on documentation review, record review, and interview, the health care institution failed to administer a training program for staff regarding fall prevention and fall recovery that included continued competency training, for two of two personnel reviewed. The deficient practice posed a risk as organized instruction and information related to resident care and safety was not implemented. Findings include: 1. A review of facility documentation revealed a fall prevention and fall recovery training program was available. 2. A review of E1's personnel records revealed continued competency training in fall prevention and fall recovery for February 2022 and February 2023. However, no documentation of continued competency training in fall prevention and fall recovery was available after February 2023. 3. A review of E2's personnel records revealed continued competency training in fall prevention and fall recovery for February 2022. However, no documentation of continued competency training in fall prevention and fall recovery was available after February 2022. 4. In an interview, E1 acknowledged the facility was not in compliance with A.R.S. \'a7 36-420.01 Technical Assistance was provided on this Rule during the compliance inspection conducted May 19, 2023.

Based on documentation review, record review, and interview, the manager failed to ensure a personnel record for each employee or volunteer included documentation of the individual's completed in-service education required by policies and procedures, for one of two personnel sampled. Findings include: 1. R9-10-101.116. "In-service education" means organized instruction or information that is related to physical health services or behavioral health services and that is provided to a medical staff member, personnel member, employee, or volunteer. 2. A review of facility documentation revealed a policy and procedure titled "Orientation, In-Service Training." The policy reported that 12 hours of In-Service training will be completed biennial. 3. A review of E2's (hired in 2021) personnel record revealed E2 was hired as a caregiver. However, documentation of in-service education for 2023 and 2024 was not available for review. 4. In an interview, E1 acknowledged in-service education for E2 was not available for review for 2023 and 2024.

Based on record review and interview, the manager failed to ensure a resident provided evidence of freedom from infectious tuberculosis (TB) as specified in R9-10-113, for one of four residents sampled. The deficient practice posed a TB exposure risk to residents and the Department was unable to determine substantial compliance as the documentation was not provided during the inspection. 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 R3's medical record revealed no documentation of freedom from infectious TB or a baseline symptom screening signed by a registered nurse, medical practitioner or local health department. Based on R3's acceptance date, this documentation was required. 3. In an interview, E1 acknowledged R3's medical record did not include documentation of freedom from infectious tuberculosis or a baseline symptom screening signed by a registered nurse, medical practitioner or local health department as required.

Based on record review, and interview, the health care institution's chief administrative officer failed to ensure the health care institution implemented tuberculosis infection control activities to include annual training and education related to recognizing the signs and symptoms of tuberculosis (TB) to individuals employed by the health care institution, for two of two personnel sampled. Findings include: 1. A review of E1's and E2's personnel records revealed documentation of initial training and education related to recognizing the signs and symptoms of TB. However, documentation of annual training and education related to recognizing the signs and symptoms of TB at least once every 12 months was not available for review for 2023 and 2024. 2. In an interview, E1 acknowledged E1's and E2's documentation of annual training and education related to recognizing the signs and symptoms of TB at least once every 12 months was not available for review for 2023 and 2024.

Based on observation, record review, and interview, the manager failed to designate, in writing, a caregiver who 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 a designated caregiver was not present on the premises and accountable when E1 was not present on the premises, the Department was unable to determine substantial compliance as documentation designating E2 was not available during the inspection, and the documentation was not provided within two hours after a Department request. Findings include: 1. The Compliance Officer observed E2 working alone when the Compliance Office arrived on the premises. 2. A review of E2's (hired in 2021) personnel record revealed documentation designating E2 to be present on the premises and accountable for the assisted living facility when the manager was not present on the premises was not available for review. 3. In an interview, E1 acknowledged a designated individual was not present on the premises when the manager was not present on the premises.

Based on record review, documentation review, and interview, the administrator failed to ensure documentation required by Article 8 was provided to the Department within two hours after a Department request. The deficient practice posed a risk as the Department was unable to determine substantial compliance. Findings include: 1. A review of E2's personnel record revealed documentation designating E2 to be present on the premises and accountable for the assisted living facility when the manager was not present on the premises was not available for review. 2. A review of E1's personnel record revealed documentation of E1's skills and knowledge applicable to the individual's job duties was not available for review. 3. A review of E2's personnel record revealed documentation of E2's skills and knowledge applicable to the individual's job duties was not available for review. 4. A review of E2's personnel record revealed documentation to indicate compliance with A.R.S. \'a7 36-411(C)(2) was not available for review. 5. A review of R1's medical record revealed a current service plan (dated in April 2023). However, the service plan was not signed and dated by the resident's representative. 6. A review of R2's medical record revealed a current service plan (dated in February 2023). However, the service plan was not signed and dated by the resident's representative. 7. A review of R3's medical record revealed a current service plan (dated in May 2023) for directed care services. However, the service plan was not signed and dated by the resident's representative. 8. A review of R3's medical record revealed a document titled "CONSENT FOR RESIDENT'S STAY IN FACILITY" (dated in September 2022). The document stated "...The above mentioned Resident is bed-ridden/wheelchair bound..." The document was signed by a medical practioner. However, documentation to demonstrate the requirements in R9-10-814(B)(2)(b) were met every six months was not available for review. 9. In an interview, E1 acknowledged documentation required by Article 8 was not provided to the Department within two hours after a Department request.

Based on record review and interview, the manager failed to ensure a personnel record for each employee included documentation of the individual's skills and knowledge applicable to the individual's job duties, for two of two personnel records sampled. The deficient practice posed a risk if E1 and E2 were unable to meet a resident's needs, the Department was unable to determine substantial compliance during the inspection, and the documentation was not provided within two hours after a Department request. Findings include: 1. A review of E1's (hired as a manager) personnel record revealed documentation of E1's skills and knowledge applicable to the individual's job duties was not available for review. 2. A review of E2's (hired as a caregiver) personnel record revealed documentation of E2's skills and knowledge applicable to the individual's job duties was not available for review. 3. In an interview, E1 acknowledged E1's and E2's personnel record did not include documentation of E1's and E2's skills and knowledge applicable to their job duties.

Based on record review and interview, the manager failed to ensure a personnel record for each employee included documentation of compliance with the requirements in A.R.S. \'a7 36-411(C)(1)(2), for one of two personnel records sampled. The deficient practice posed a risk as the Department was unable to determine substantial compliance during the inspection, and the documentation was not provided within two hours after a Department request. Findings include: A.R.S. \'a7 36-411(C) Owners shall make documented, good faith efforts to: 1. Contact previous employers to obtain information or recommendations that may be relevant to a person's fitness to work in a residential care institution, nursing care institution or home health agency. 2. Verify the current status of a person's fingerprint clearance card. 1. A review of E2's (hired in 2021) personnel record revealed a valid fingerprint clearance card. However, documentation to indicate compliance with A.R.S. \'a7 36-411(C)(2) was not available for review. 2. In an interview, E1 acknowledged E2's compliance with A.R.S. \'a7 36-411(C)(2) was not available for review.

Based on record review and interview, the manager failed to ensure a written service plan was signed and dated by the resident or resident's representative, for three of three residents sampled. The deficient practice posed a risk as the Department was unable to determine substantial compliance during the inspection, and the documentation was not provided within two hours after a Department request. Findings include: 1. A review of R1's medical record revealed a current service plan (dated in April 2023) for personal care services. However, the service plan was not signed and dated by the resident. 2. A review of R2's medical record revealed a current service plan (dated in February 2023) for personal care services. However, the service plan was not signed and dated by the resident. 3. A review of R3's medical record revealed a current service plan (dated in May 2023) for directed care services. However, the service plan was not signed and dated by the resident's representative. 4. In an interview, E1 acknowledged R1's, R2's, and R3's written service plans did not include a signature and date from the resident or resident's representatives.

Based on record review and interview, the manager retained a resident who was confined to a bed or chair because of an inability to ambulate even with assistance, without meeting the requirements in R9-10-814(B)(2), for one of one resident sampled who was confined to a bed or chair because of an inability to ambulate even with assistance. The deficient practice posed a risk if the facility was unable to meet R1's needs, the Department was unable to determine substantial compliance during the inspection, and the documentation was not provided within two hours after a Department request. Findings include: 1. A review of R3's medical record revealed a document titled "CONSENT FOR RESIDENT'S STAY IN FACILITY" (dated in September 2022). The document stated "...The above mentioned Resident is bed-ridden/wheelchair bound..." The document was signed by a medical practioner. However, documentation to demonstrate the requirements in R9-10-814(B)(2)(b) were met every six months was not available for review. 3. In an interview, E1 reported R3 was bed bound. E1 acknowledged documentation to demonstrate the requirements in R9-10-814(B)(2)(b) were met every six months for R3 was not available for review.