Elmer Place for Parents

Based on observation and interview, the manager failed to ensure a food menu was conspicuously posted at least one calendar day before the first meal on the food menu was served. Findings include: 1 . During an environmental inspection of the facility, the Compliance Officer observed a "Week Three Menu September, 2025" posted. 2 . In an exit interview, the findings were discussed with E1 and no additional information was presented.

Based on observation and interview, the manager failed to ensure a means of exiting the facility for a resident who does not have a key, special knowledge for egress, or the ability to expend increased physical effort controlled 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. During an environmental inspection of the facility, the compliance officers observed a sliding door leading out to the backyard patio. The door was equipped with an alarm at the top of the door frame. However, the alarm was turned off. 2. In an interview, E1 acknowledged the door leading to the backyard patio did not control or alert employees of the egress of a resident from the facility.

Based on observation and interview, the manager failed to ensure that medications stored by the facility were stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. Findings include: 1. During an environmental inspection of the facility, the compliance officers observed a box of prefilled syringes containing Lorazepam 2 milligram/milliliter in an unlocked drawer in the kitchen refrigerator. The box was equipped with a lock, however, it was not locked. 2. During an interview, E2 acknowledged that medication was not stored in a seperate locked room, closet, cabinet, or self-contained unit used only for medication storage.

Based on documentation review, record review, and interview, the manager failed to ensure a caregiver provided current documentation of first aid and cardiopulmonary resuscitation (CPR) training that included a demonstration of the individual's ability to perform CPR, before providing assisted living services, for two of four caregivers. The deficient practice posed a risk if an employee was unable to meet a resident's needs during an emergency. Findings include: 1. Review of the facility's policy and procedure revealed a policy titled "First Aid/CPR Training Requirements" that stated "Assisted living facilities are required that facility staff members who provide care for residents, should have completed courses in First Aid and CPR and hold a currently valid care documenting completion of such courses in the facility at all times...1. The manager requires that a caregiver obtains and provides documentation of cardiopulmonary resuscitation training specific to adults, which includes a demonstration of the caregiver's ability to perform cardiopulmonary resuscitation..." 2. Review of E2's personnel record revealed E2 worked as a caregiver and had a hire date of April 3, 2023. The personnel record revealed no documentation of first aid training. 3. Review of E3's personnel record revealed E3 worked as an assistant caregiver and had a hire date of April 1, 2023. The personnel record revealed a CPR card that was obtained from "NationalCPRFoundation" issued on March 2, 2022, and valid for two years. There was no other current documentation of CPR training available for review that documented E3 had attended an approved CPR training course that included a demonstration of the individual's ability to perform CPR. 4. In an email exchange, a representative from NationalCPRFoundation, stated "Our courses are online only." 5. Review of the October 2023 personnel schedule revealed E2 and E3 worked every day. 6. In an interview, E1 acknowledged E2 did not have current documentation of first aid training and E3 did not have current documentation of CPR training, that included a demonstration of the individual's ability to perform CPR.

Based on documentation review, record 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 that included continued competency training. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. Review of facility documentation revealed a document titled "ARS 36-40.01: Health care Institutions; Fall Prevention and Fall recovery; Training Programs (ref: SB1373)" that stated "In compliance to ARS 36-420.01 We have included fall prevention and fall recovery training for all staff prior to providing services to our residents. This will be included in their orientation training. Fall prevention and fall recovery training will be part of the personnel requirement to complete at least once every 12 months." 2. Review of E1's personnel record revealed E1 worked as a caregiver and had a hire date of April 15, 2022. The personnel record revealed documentation of fall prevention and fall recovery training dated June 8, 2022. However, current documentation was not available indicating E1 completed fall prevention and fall recovery training. 3. In an interview, E1 acknowledged documentation was not available that showed E1 completed current training for fall prevention and fall recovery. 4. This is a repeat deficiency from the compliance inspection conducted January 9, 2023.

Based on documentation review, record review, and interview, the governing authority failed to ensure compliance with A.R.S. \'a7 36-411, for one of four employees. The deficient practice posed a risk if the employee was a danger to a vulnerable population. Findings include: 1. A.R.S. \'a7 36-411 states, "A... as a condition of licensure or continued licensure of a residential care institution, a nursing care institution or a home health agency and as a condition of employment in a residential care institution, a nursing care institution or a home health agency, employees and owners of residential care institutions, nursing care institutions or home health agencies or contracted persons or volunteers who provide medical services, nursing services, behavioral health services, health-related services, home health services or supportive services and who have not been subject to the fingerprinting requirements of a health professional's regulatory board pursuant to title 32 shall have valid fingerprint clearance cards that are issued pursuant to title 41, chapter 12, article 3.1 or shall apply for a fingerprint clearance card within twenty working days of employment or beginning volunteer work... 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..." 2. Review of E4's personnel record revealed E4 worked as the manager and had a hire date of July 1, 2023. The personnel record revealed a fingerprint clearance card issued on September 20, 2021. However, the personnel record did not contain documentation of good faith efforts to contact previous employers to obtain information or recommendations that may be relevant to E4's fitness to work in a residential care institution. In addition, E4's record did not contain documentation of good faith efforts to verify the current status of a E4's fingerprint clearance card. 3. Review of the Department of Public Safety (DPS) fingerprint clearance card database on October 23, 2023, revealed E4's fingerprint clearance card was valid. 4. In an interview, E1 acknowledged documentation was not available that showed E4's work references were obtained and the fingerprint clearance card was verified with DPS upon hire at the facility.

Based on record review and interview, the manager failed to ensure an employee provided documentation of freedom from infectious tuberculosis (TB) as specified in R9-10-113, for two of four caregivers. The deficient practice posed a potential 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. Review of the Centers for Disease Control and Prevention website revealed a web page titled "TB Screening and Testing of Health Care Personnel." The web page stated, "If the Mantoux tuberculin skin test (TST) is used to test health care personnel upon hire (preplacement), two-step testing should be used." 3. Review of E3's personnel record revealed a negative TB skin test that was less than 12 months old, however no additional documentation of freedom from infectious TB was available for review. Based on E3's hire date, this documentation was required. 4. Review of E4's personnel record revealed a negative TB skin test that was more than 13 months old and no additional documentation of freedom from infectious TB was available for review. Based on E4's hire date, this documentation was required. 5. In an interview, E1 acknowledged E3 and E4 did not provide documentation of freedom from infectious TB as specified in R9-10-113. 6. Technical assistance was provided on this Rule during the compliance inspection conducted January 9, 2023.

Based on documentation review, record review, and interview, the manager failed to ensure a caregiver received orientation that was specific to the duties to be performed before providing assisted living services to a resident, for one of four caregivers. The deficient practice posed a risk if the employee was unable to meet the needs of a resident. Findings include: 1. Review of the facility's policy and procedure revealed a policy titled "Orientation, In-Service Trainings for Employees" that stated "The Manager (or designee) is responsible for the training and orientation of all employees to enable them to perform the responsibilities of their jobs in an effective and efficient manner before providing services." 2. Review of E4's personnel record revealed E4 worked as the manager and had a hire date of July 1, 2023. The personnel record revealed no documentation that showed E4 received orientation specific to the duties to be performed. 3. In an interview, E1 acknowledged documentation was not available that showed E4 received orientation specific to the duties to be performed.

Based on record review and interview, the manager failed to ensure a resident accepted by the assisted living facility submitted documentation signed by a medical practitioner or a registered nurse stating whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, for one of two residents reviewed accepted by the assisted living facility on or after October 1, 2013. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. Review of R2's medical record revealed no documentation stating whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints. Based on R2's acceptance date, this documentation was required. 2. In an interview, E1 acknowledged R2 did not provide documentation signed by a medical practitioner or a registered nurse stating whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints.

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. During an environmental inspection of the facility with E1 and E2, the Compliance Officer observed the facility's thermometer in the kitchen refrigerator. This thermometer read 62\'b0 F. The Compliance Officer placed a Department issued thermometer in the refrigerator for 10 minutes. The refrigerator was not accessed during this time and the thermometer read 66.8\'b0 F. This refrigerator contained perishable foods such as eggs. 2. In an interview, E1 reported the refrigerator was in the process of being repaired. E1 and E2 acknowledged the refrigerator was used to store food for the residents and was not maintained at 41\'b0 F or below.

Based on documentation review and interview, the manager failed to ensure the facility's disaster plan was reviewed at least once every 12 months. The deficient practice posed a risk as a disaster plan reinforces and clarifies standards expected of employees. Findings include: 1. Review of the facility's policy and procedure revealed a policy titled "Disaster Plan." A document titled "Disaster Plan Review" revealed the disaster plan was last reviewed January 1, 2022. 2. In an interview, E1 acknowledged the facility's disaster plan was not reviewed within the last 12 months.

Based on documentation review and interview, the manager failed to ensure an employee disaster drill was conducted on each shift at least once every three months and documented. The deficient practice posed a risk if employees were unable to implement the disaster plan. Findings include: 1. Review of the October 2023 personnel schedule revealed two shifts; 7am -7pm (day shift) and 7pm - 7am (night shift). 2. Review of the facility's employee disaster drills revealed the most current disaster drill conducted May 9, 2023 on the day and night shift. No other employee disaster drills were available after May 9, 2023. 3. In an interview, E1 acknowledged the employee disaster drills were not conducted on each shift at least once every three months.

Based on observation, interview, and record review, the manager failed to ensure the premises 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 the resident. Findings include: 1. During an environmental inspection of the facility with E2, the Compliance Officer observed R1 lying in bed. R1's bed had a full bedrail in the upright position. 2. In an interview, E2 reported the bedrail was used to prevent R1 from failing out of the bed. 3. Review of R1's medical record revealed a current written service plan for directed care services dated October 1, 2023. This service plan stated R1 was "unable to recognize consequences of actions, unable to make needs known, cannot call for help, cannot make safe judgement, and unable to recognize danger". In addition, the service plan stated R1 had a diagnosis of " dementia" was "total assist of 1 caregiver" and was "bed bound". 4. In an interview, E1 reported R1 could not move the rail up or down. E1 acknowledged the situation may cause the resident to suffer physical injury.

Based on documentation review, record review, and interview, the health care institution failed to establish, document, and implement tuberculosis (TB) infection control activities as specified in R9-10-113. The deficient practice posed a risk as the caregiver received no organized instruction or information related to TB surveillance and posed a TB exposure risk to residents and staff. Findings include: 1. Review of facility documentation revealed no policy and procedure that covered TB infection control activities. 2. Review of E1's personnel record revealed E1 worked as a caregiver and had a hire date of April 15, 2022. The personnel record did not include documentation of training and education related to recognizing the signs and symptoms of TB. 3. Review of E2's personnel record revealed E2 worked as a caregiver and had a hire date of April 3, 2023. The personnel record did not include documentation of training and education related to recognizing the signs and symptoms of TB. 4. Review of E3's personnel record revealed E3 worked as an assistant caregiver and had a hire date of April 1, 2023. The personnel record did not include documentation of training and education related to recognizing the signs and symptoms of TB. 5. Review of facility documentation revealed no documentation of an annual assessment of the health care institution's risk of exposure to infectious TB. 6. In an interview, E1 acknowledged the facility had not established, documented, and implemented a TB infection control program as specified in R9-10-113. 7. Technical assistance was provided on this Rule during the compliance inspection conducted January 9, 2023.