Doctor's Choice Assisted Living

Based on record review and interview, the manager failed to ensure that the caregiver documented the services provided in a resident’s medical record, for two out of two 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 for October 2, 2025, which included the following: Day and night checks every 1-2 hours, daily; Incontinence care (no frequency); Requires showers 1-3 times per week; Skin care checks every shower with incontinence care, and; Required a communication device. 2. A review of R1’s December 2025 activities of daily living sheet revealed the following missing documentation in accordance with the services listed in R1's service plan: Day and night checks occurred every 4 hours instead of every 2 hours on December 1-31, 2025 No documentation of incontinence care on December 1-31, 2025; No documentation of skin care checks every shower on December 1-31, 2025; and No documentation of usage, nor the presence of a communication device. E3 stated, "They never had a device." 3. A review of R2’s medical record revealed a service plan dated for July 17, 2025, which included the following: shower 1-3 times a week on Tuesdays and Thursdays. 4. A review of R2’s December 2025 activities of daily living sheet revealed the following missing documentation in accordance with the services listed in R2's service plan: No documentation of showers on December 1-31, 2025. 5. In an exit interview, the findings were reviewed with E3 and no additional information was provided. 6. This is a repeat deficiency from the inspection conducted on July 11, 2023.

Based on record review and interview, the manager failed to ensure that a medical record was established and maintained for each resident according to A.R.S. Title 12, Chapter 13, Article 7.1, for two of four residents sampled. Findings include: 1. A medical record was not available for R3 and R4. 2. In an exit interview, the findings were reviewed with E3 and no additional information was provided.

Based on observation and interview, the manager failed to ensure that a bell, intercom, or other mechanical means to alert employees to a resident’s needs or emergencies was available and accessible in a bedroom. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed there was no bell, intercom, or other mechanical means to alert employees to a resident’s needs or emergencies for several residents. 2. In an interview, E3 acknowledged that there was no bell, intercom, or other mechanical means to alert employees to a resident’s needs or emergencies besides verbally shouting for assistance for several residents and that E3 was currently awaiting the arrival of the bells in the mail. 3. In an exit interview, the findings were reviewed with E3 and no additional information was provided. 4. This is an uncorrected deficiency from the inspection conducted on December 3, 2025.

Based on record review, observation, and interview, the manager failed to ensure medication administered to a resident was administered in compliance with a medication order and documented in the resident’s medical record. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication or the medication could not be verified as administered against a medication order. Findings include: 1. A review of R2’s medical record revealed R2 received medication administration services. 2. A review of R2’s medical record revealed a signed medication order dated September 15, 2025 that stated "Lorazepam 2 mg po 1 tab every night" and "Clopidogrel/Plavix 75 mg 1 tab po every day". 3. A review of R2’s December 2025 Medication Administration Record revealed no documentation of administration of Lorazepam and Clopidogrel/Plavix to R2 on December 1-31, 2025. 4. In an interview, E3 reported R2 had not been receiving Lorazepam due to lack of insurance coverage. E3 also stated R2 had been receiving Clopidogrel/Plavix, however, the facility staff failed to document the administration of the medication. 5. In an exit interview, the findings were reviewed with E3, and no additional information was provided.

Based on observation and interview, the manager failed to ensure that the premises and the equipment used at the facility were free from a condition or situation that may cause a resident or other individual to suffer physical injury. The deficient practice posed potential dangers to residents. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed a door leading to a patio in the back of the facility that locked from the inside. The door was being held open by a small rock, which, if moved, would cause the door to close and lock a person outside on the patio. There was no other accessible exit in the backyard and no means to alert staff or individuals inside the facility if someone were locked out on the patio. 2. In an exit interview, the findings were reviewed with E3 and no additional information was provided. 3. This is an uncorrected deficiency from the inspection conducted on December 3, 2025.

Based on observation and interview, the manager failed to ensure a bathroom accessible from a common area contained soap in a dispenser. The deficient practice posed an infection control risk. Findings include: 1. During an environmental inspection of the facility with E3, the Compliance Officer observed that the bathrooms in the facility were missing soap. 2. In an exit interview, the findings were reviewed with E3 and no additional information was provided.

Based on record review, documentation review, and interview, the manager failed to ensure an individual authorized to administer opioids documented in the resident's medical record the identification of the need for the opioid and the effect of the opioid administered, for one of two residents sampled. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. A review of R2's medical record revealed a service plan dated on November 7, 2025, for personal care services that stated R2 required medication administration. 2. A review of R2’s medical record revealed a document titled "Controlled Medication (Opioid) Administration/Inventory Record" for the month of November 2025. The administration record stated "oxycodone 5mg, take 1 tab po q6hr prn pain 4-40/10" and included documentation showing Oxycodone was administered on November 4, 6, 8, 9, 11, 13, 16, 17, 23, 26, and 29, in 2025. The administration record did not include documentation of R2's need for the opioid or the effect of the opioid administered. 3. A review of facility documentation revealed a policy titled "Administering Opioid Medication." The policy stated the following: "Only a Manager or Caregiver who had training on what opioids are and its effects can administer opioids. Document in the OPIOID MEDICATION LOG SHEET before administration the identification of the resident's pain (through verbal assessment or pain chart), date and time of administration, medication inventory and Trained Caregiver's initials showing adherence to opioid Policies and Procedures. Manager or Caregiver will document the effect of the opioid after 30 mins of administration." 4. In an exit interview, the findings were reviewed with E1 and no additional information was provided. 5. This is a repeat deficiency from the inspection conducted on December 28, 2022.

Based on observation and interview, the manager failed to ensure that residents' medical records were 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 inspection of the facility, the Compliance Officer observed medical records displayed on the walls of the facility and in binders sitting out on tables with residents' names and private health information inside. 2. 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 bell, intercom, or other mechanical means to alert employees to a resident’s needs or emergencies was available and accessible in a bedroom being used by a resident receiving personal care services. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. During an environmental inspection of the facility with E1, the Compliance Officer observed there was no bell, intercom, or other mechanical means to alert employees to a resident’s needs or emergencies besides verbally shouting for assistance for R3 and R4. 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 medication was administered to a resident 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 R1’s service plan dated November 20, 2025, revealed R2 received medication administration. 2. A review of R1's medical record revealed a documented medication order from a doctor dated November 24, 2025. The order stated "start lisinopril 10 mg daily, 1 tablet by mouth for hypertension." The order said to increase the previous 5 mg tablets to 10 mg starting November 24, 2025. 3. A review of R1’s November 2025 medication administration record (MAR) revealed R1 received Lisinopril 5 mg once a day at 8 am from November 16, 2025 - to December 2, 2025. The pill bottle read "Lisinopril 10 mg, 1 tab by mouth every day..." However, the pills inside were a mixture of 5mg tablets of Lisinopril and 10 mg tablets of Lisinopril. 4. In an interview, the Compliance Officer asked if R1 received 5mg or 10 mg of Lisinopril and E1 stated they did not know and was unsure which dosage was correct. 5. 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 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. During an environmental inspection of the facility, the Compliance Officer (CO) observed a bottle of "guaifenesin, Codeine, take 10 mL by mouth every 4 hours as needed for cough" sitting in the bedroom of R5. The medication was prescribed to and belonged to R5. 2. A review of R5's medical record revealed R5 received medication administration and R5 did not have authorization by a doctor to store medication in R5's bedroom. 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided. 4. This is a repeat deficiency from the inspection conducted on December 28, 2022.

Based on observation and interview, the manager failed to ensure that foods requiring refrigeration were maintained at 41° F or below. The deficient practice posed a risk for potential food borne illnesses. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed a half empty bottle of salsa stored in the pantry of the facility. The bottle still had product inside and was warm to the touch. R6's name was written on the bottle. The words, "Promptly refrigerate after opening" were listed on the back of the bottle's product information. 2. 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 the premises and the equipment used at the facility were free from a condition or situation that may cause a resident or other individual to suffer physical injury. Findings include: 1. During an environmental tour of the facility, the Compliance Officer observed a door leading to a patio in the back of the facility that locked from the inside. During the tour, the door, which was being held open by a small rock, accidentally closed, and the Compliance Officer and staff were locked outside on the patio. There was no other accessible exit in the backyard and no means to alert staff or individuals inside the facility that someone was locked out on the patio. 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 medical record is maintained for each resident according to A.R.S. Title 12, Chapter 13, Article 7.1. The deficient practice posed a risk as required information could not be verified for one resident. Findings include: 1. A review of medical records revealed a medical record for R1 was not available for review. 2. The Compliance Officer requested to review R1's medical record. However, R1's medical record was not provided for review. 3. In an interview, E1 reported E1 did not maintain a medical record for R1. E1 reported R1 had been at the facility for about 3 weeks and was unaware of R1's level of care. E1 acknowledged R1's medical record was not maintained.

Based on observation and interview, the manager failed to ensure the premises and equipment used at the assisted living facility were clean. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed a strong odor of urine permeated the entire facility, and was particularly strong on the north side of building and in multiple resident rooms. 2. In an interview, E1 acknowledged the observed strong odor of urine throughout the facility. E1 acknowledged the manager failed to ensure the premises and equipment used at the assisted living facility were clean.

Based on observation and interview, the manager failed to ensure a resident bathroom contained paper towels in a dispenser or a mechanical air hand dryer. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed no paper towels or mechanical air hand dryer in the middle hallway bathroom, and the bathroom located on the northwest side of the facility. 2. In an interview, E1 acknowledged the manager failed to ensure a resident bathroom contained paper towels in a dispenser or a mechanical air hand dryer. This is a repeat citation from the complaint inspection conducted on December 28, 2022 and the two previous compliance inspections completed on June 27, 2022 and September 8, 2021.

Based on record 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, to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse or physician assistant, for one of four residents sampled. Findings include: 1. A review of R1's medical record revealed no documentation dated within 90 calendar days before R1 was accepted by the assisted living facility to include whether R1 required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse or physician assistant. 2. In an interview, E1 acknowledged 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, to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse or physician assistant.

Based on record review and interview, the manager failed to ensure a caregiver or assistant 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 two of four sampled residents. Findings include: 1. A review of R1's medical record revealed a service plan dated April 18, 2023. The service plan documented R1 would receive the following service: "Catheter Care for foley, wash skin around catheter with soap and water daily and after each bowel movement, and empty drainage bag every 4-8 hours or more frequently if it becomes filled before then." 2. Further review of R1's medical record revealed a document titled "ADL log". The ADL log contained no documentation to indicate R1 received catheter care as required in R1's service plan from July 1, 2023 through July 11, 2023. 3. A review of R2's medical record revealed a service plan dated June 23, 2023. The service plan documented R2 would receive assistance with dressing daily. The service plan also indicate R2 would receive the following service: "resident receives a full bath from hospice services two days a week to complete full bath. Caregivers will provide partial bath on days when complete bath is not given." 4. Further review of R2's medical record revealed a document titled "ADL log". The ADL log contained no documentation to indicate R2 received any bath or assistance with dressing as required in R2's service plan from July 1, 2023 through July 11, 2023. 5. In an interview, E1 acknowledged the manager failed to ensure a caregiver or assistant 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.

Based on observation and interview, the manager failed to ensure a calendar of planned activities was prepared at least one week in advance, posted in a location easily seen by the residents, updated as necessary to reflect substitutions, and maintained for at least 12 months. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer did not observe any evidence of a calendar of planned activities. 2. In an interview, E1 reported there was no calendar of planned activities. E1 acknowledged the manager failed to ensure a calendar of planned activities was prepared at least one week in advance, posted in a location easily seen by the residents, updated as necessary to reflect substitutions, and maintained for at least 12 months.

Based on documentation review, record review, and interview, the manager failed to ensure a resident's medical record contained documentation of notification of the resident of the availability of vaccination for influenza and pneumonia, according to Arizona Revised Statutes (A.R.S.) \'a7 36-406(1)(d), for two of four residents sampled. The deficient practice posed a potential illness risk to residents. Findings include: 1. A.R.S. \'a7 36-406(1)(d) states: "1. The department shall: (d) 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 licensee 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 R2's medical record revealed no documentation of the notification of R2 of the availability of vaccination for influenza and pneumonia. Based on R2's acceptance date, this documentation was required. 3. A review of R3's medical record revealed no documentation of the notification of R3 of the availability of vaccination for influenza and pneumonia. Based on R3's acceptance date, this documentation was required. 4. In an interview, E1 acknowledged R2's and R3's medical records did not include current documentation showing the influenza and pneumonia vaccination was offered or received.

Based on documentation review and interview, the manager failed to ensure policies and procedures for medication administration were reviewed and approved by a medical practitioner, registered nurse, or pharmacist. Findings include: 1. A review of facility documentation revealed a policy and procedure manual, dated August 13, 2022. The manual included several policies and procedures for medication administration, including "Medication Administration Authorization," and "Medication Statement." However, there was no documentation to indicate the policies and procedures were reviewed and approved by a medical practitioner, registered nurse, or pharmacist. 2. In an interview, E1 acknowledged the policies and procedures for medication administration were not reviewed and approved by a medical practitioner, registered nurse, or pharmacist.

Based on observation and interview, the manager failed to ensure a resident's sleeping area had a window or door that could be used for direct egress to outside the building. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed R2's bedroom contained a glass door leading outside the building. However, the door could not be used for direct egress due to R2's bed being in front of the door. 2. During the environmental inspection of the facility, the Compliance Officer observed R5's bedroom contained a glass door leading outside the building. However, the door could not be used for direct egress due to a bed, nightstand, and trash can being in front of the door. 3. In an interview, E1 acknowledged the manager failed to ensure two resident's sleeping areas had a window or door that could be used for direct egress to outside the building. This is a repeat citation from the the complaint inspection conducted on December 28, 2022.