Desert Ranch Assisted Living Home, LLC

Based on record review and interview, for one of three residents reviewed, the manager failed to ensure the service plan, for a resident receiving directed care services, included skin maintenance to prevent and treat bruises, injuries, pressure sores, and infections. The deficient practice posed a risk if an individual was unable to meet a resident's needs. Findings include: 1. A review of R3's medical record revealed a service plan dated May 21, 2025. However, the service plan did not include skin maintenance to prevent and treat bruises, injuries, pressure sores, and infections. 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 the service plan for a resident receiving directed care services includes cognitive stimulation and activities to maximize functioning for one of three residents reviewed. 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 record revealed a service plan dated May 21, 2025. However, the service plan did not include documentation of cognitive stimulation and activities to maximize functioning. 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 a resident's written service plan included strategies to ensure the resident's personal safety for one of three records reviewed. The deficient practice posed a risk if employees were unable to ensure the health and safety of a resident with a history of multiple falls. Findings include: 1. A review of R3's medical record revealed a service plan dated May 21, 2025. However, the service plan did not include strategies to ensure the resident's personal safety. 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 the service plan for a resident receiving directed care services includes encouragement to eat meals and snacks for one of three records reviewed. 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 record revealed a service plan dated May 21, 2025. However, the service plan did not include documentation of encouragement to eat meals and snacks. 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 a service plan for a resident receiving directed care services included coordination of communications with the resident's representative and other individuals identified in the resident's service plan, for one of three residents reviewed who received directed care services. 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 R3's medical record revealed a service plan dated May 21, 2025. However, the service plan did not include documentation of coordination of communication with the R3's representative. 2. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on observation, documentation review, and interview, the manager failed to establish, document, and implement a policy and procedure to protect the health and safety of a resident that cover methods by which an assisted living facility was aware of the general or specific whereabouts of a resident, based on the level of assisted living services provided to the resident and the assisted living services the assisted living facility was authorized to provide which is a health and safety risk. Findings include: 1. The compliance officer observed residents residing at the facility. 2. The compliance officer requested and was not provided with the facility's policy and procedure that cover the methods by which the facility was aware of the general whereabouts of a resident. 3. In an interview, E4 acknowledged there was no policy and procedure that covered the whereabouts of all the assisted living residents at the facility.

Based on documentation review and interview, the manager failed to ensure the health care institution administered a training program for all staff regarding fall prevention and fall recovery which posed a health and safety risk to residents, for one of five sampled personnel records reviewed. Findings include: 1. Review of the facility's documents revealed no documented evidence the fall prevention and fall recovery training program had been implemented for all staff. 2. Review of five sampled personnel records revealed there was no documentation that E5 had completed the required training. 3. In an interview, E4 acknowledged the facility did not have documentation that E5 had completed fall prevention and fall recovery training as required. This is a repeat deficiency from the compliance inspection conducted on June 15, 2022.

Based on record review and interview, the manager failed to ensure that 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 which posed a health and safety risk for one of five personnel records reviewed who were required to complete first aid and CPR training. Findings include: 1. Review of E2's personnel record revealed that the employee was hired on October 1, 2017 to work as a caregiver, however, there was documented evidence that E2's first aid and CPR training had expired on May 31, 2023. 2. In an interview, E2 and E4 acknowledged E2's first aid and CPR had expired and E2 continued to work as a caregiver.

Based on observation, record review, documentation review, and interview, the manager failed to establish and document a policy and procedure as part of the required policies and procedure required in R9-10-803(C)(1)(h) to ensure the manager or a caregiver was available as a back-up to provide assisted living services to a resident if the manager or a caregiver assigned to work was not available or not able to provide the required assisted living services which posed a health and safety risk. Findings include: 1. Review of the facility's documentation revealed the facility had not established, documented, and implemented a policy and procedure to ensure the manager or caregiver was available as back-up to provide assisted living services to a resident if the manager or a caregiver assigned to work became unavailable to work. The facility had eight residents residing at the facility. 2. In an interview, E4 acknowledged there was no policy and procedure that covered back-up staffing.

Based on record review and interview, the manager failed to ensure a resident had a written service plan when initially developed and when updated, that was signed and dated by the manager, for three of eight residents' records reviewed. The deficient practice posed a risk if the service plan was not developed and updated to articulate decisions and agreements. Findings include: 1. Review of R1's medical record revealed service plan dated March 28, 2023 did not include the manager's dated signature. 2. Review of R6's medical record revealed service plan dated January 16, 2023 did not include the manager's dated signature. 3. Review of R8's medical record revealed service plan dated January 15, 2023 did not include the manager's dated signature. 4. In an interview, E4 acknowledged the sampled residents' service plans did not include the manager's dated signature. .

Based on record review and interview, the manager failed to ensure a service plan included skin maintenance to prevent and treat bruises, injuries, pressure sores, and infections; offering sufficient fluids to maintain hydration; cognitive stimulation and activities to maximize functioning; strategies to ensure a resident's personal safety; and documentation of the resident's weight, or documentation from a medical practitioner stating that weighing the resident was contraindicated, for one of three sampled residents receiving directed care services, which posed a health risk to the resident. Findings include: 1. Review of R1's medical record revealed a current written service plan dated March 28, 2023 that stated R1 required directed care services. This service plan revealed no documentation that included skin maintenance to prevent and treat bruises, injuries, pressure sores, and infections; offering sufficient fluids to maintain hydration; cognitive stimulation and activities to maximize functioning; strategies to ensure personal safety; and documentation of the resident's weight. R1's medical record contained no documentation from a medical practitioner stating that weighing the resident was contraindicated. 2. During an interview, E2 and E4 acknowledged this sampled resident's service plan did not include documentation of all the requirements for a resident receiving directed care services. E4 reported the facility forgot to complete the entire updated service plan in March for R1.

Based on observation and interview, the manager failed to ensure medications stored by the facility were stored in a locked room, closet, cabinet, or self-contained unit; which posed a health and safety risk. Findings include: 1. During a facility tour, E2, E4, and the compliance officer observed the unlocked cabinet adjacent to the facility's kitchen and residents' common area where there was stored eight facility pre-filled medication organizers containing medications scheduled to be given to the eight residents residing at the facility along with bottles of Osmotic Laxative, Polyethylene Glycol, and Milk of Magnesia. The lock appeared to be broken. The compliance officer observed E4 trying to fix the lock to this medication cabinet with no success. 2. In an interview, E4 acknowledged the unlocked medications and the broken lock to the cabinet.

Based on observation, documentation review, and interview, the manager failed to ensure a fire alarm system was installed and in working order. The deficient practice posed a risk if safety measures were not in place to protect residents in a fire. Findings include: 1. During a facility tour of the facility, E2 and the compliance officer observed the facility's class A fire panel located in the facility's laundry working indicated on the screen that the fire system was malfunctioning. The screen read in amber color, "Trouble". 2. In an interview, E2 and E4 acknowledged the fire system for the facility was not kept in working order.

Based on observation and interview, the manager failed to ensure oxygen containers were secured. Findings include: 1. During a tour of the facility, E2 and the compliance officer observed in R2's bedroom closet there were three unsecured oxygen containers. 2. In an interview, E2 and E4 acknowledged the unsecured oxygen containers in R2's bedroom closet.