Eyal LLC 2

Based on record review and interview, the manager failed to ensure a caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services, for two of four caregivers sampled. The deficient practice posed a risk if the caregivers were unable to meet a resident's needs. Findings include: 1. Review of E1's and E2's personnel records revealed both were hired as caregivers. 2. Review of E1's personnel record revealed no documentation that E1's skills and knowledge were verified. 3. Review of E2's personnel record revealed a document titled "Caregiver/Assistant Caregiver Skills and Knowledge Checklist" which documented E2's skills and knowledge, however, this document was dated two months after E2 began providing physical health services. 4. In an interview, E1 acknowledged E1's and E2's skills and knowledge were not verified and documented before the caregiver provided physical health services.

Based on record review and interview, the manager failed to ensure an employee provided documentation of freedom from infectious tuberculosis (TB) on or before the date the individual began providing services at or on behalf of the assisted living facility, as specified in R9-10-113, for two of four employees reviewed. 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, however, it was dated nine months after E3's documented date of hire. No additional documentation of freedom from infectious TB was available for review. 4. Review of E4's personnel record revealed two negative TB skin tests, however, the tests were dated two months after E4's documented date of hire. No additional documentation of freedom from infectious TB was available for review. 5. In an interview, E1 acknowledged E3 and E4 did not provide documentation of freedom from infectious TB as specified in R9-10-113 on or before the date the individual began providing services at or on behalf of the assisted living facility. Technical assistance was provided on this Rule during the compliance inspection conducted June 29, 2023.

Based on documentation review, 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), for one of four personnel records sampled. The deficient practice posed a risk if E3 was a danger to a vulnerable population. Findings include: A.R.S. \'a7 36-411(C)(1) Owners shall make documented, good faith efforts to: 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. 1. A review of E3's personnel record revealed a document titled "Employment History" which listed three previous jobs. 2. A review of E3's personnel record revealed a document titled "Verbal Reference Check Verification" which listed the contact information for four references for E3, however, all four references stated that the "relationship to applicant" was "friend". No documentation showing that owners had attempted to contact previous employers was available. 3. In an interview, E1 acknowledged documentation of compliance with the requirements in A.R.S. \'a7 36-411(C)(1) for E3 was not available for review.

Based on observation and interview, the manager failed to ensure a calendar of planned activities was prepared at least one week in advance of the date the activity was provided. Findings include: 1. During an environmental inspection of the facility, the Compliance Officer observed the posted activity calendar. The activity calendar was dated August 1, 2023 - August 25, 2024. 2. In an interview, E1 acknowledged a calendar of planned activities was not prepared at least one week in advance.

Based on observation and interview, the manager failed to ensure a resident was treated with dignity, respect, and consideration. The deficient practice posed a risk as a resident's rights were violated. Findings include: 1. During the environmental tour of the facility, the Compliance Officer observed a sign on the outside of R4's bedroom door which stated "DO NOT PEE OR POOP ON YOUR BED OR FLOOR. YOUR ROOM SMELLS URINE AND POOP". 2. In an interview, R4 reported that the sign was a message posted by facility staff to the former resident that R4 shared the room with after facility staff had gotten frustrated with the former resident's incontinence. 3. In an interview, E1 reported that the sign was directed at a previous resident, and did not think it was disrespectful.

Based on documentation review, record review, and interview, the manager failed to ensure a medical record was maintained for each resident according to A.R.S. Title 12, Chapter 13, Article 7.1, for two of four residents reviewed. The deficient practice posed a risk as required information could not be verified and the Department was unable to determine substantial compliance during the inspection. Findings include: A.R.S. \'a7 12-2297(A)(1) Unless otherwise required by statute or by federal law, a health care provider shall retain the original or copies of a patient's medical records as follows: If the patient is an adult, for at least six years after the last date the adult patient received medical or health care services from that provider. 1. Review of Department documentation revealed a report dated September 9, 2024, which alleged that R2 was not provided with care that followed medical orders. 2. Review of Department documentation revealed a report dated October 6, 2023, which alleged that R3's personal items had been stolen and that services had not been provided per R3's service plan. 3. The Compliance Officer requested to review R2's and R3's medical records; however, no medical records were provided for review. 4. In an interview, E1 reported that R2 had been a resident at the facility, but that E1 had given R2's medical record to R2's hospice agency. E1 reported that R3 had been a resident at the facility, but that E1 did not know where R3's record was. 5. In an interview, E1 acknowledged that a medical record for R2 and R3 were not maintained for at least six years after the last date R2 and R3 received services from the facility.

Based on observation and interview, the manager failed to ensure a current drug reference guide was available for use by personnel members. Findings include: 1. The Compliance Officer observed the facility's drug reference guide was the "Mosby's 2022 Nursing Drug Reference 35th edition". 2. Review of the publisher's website revealed the "Mosby's 2025 Nursing Drug Reference 38th edition" was the most recent edition. 3. In an interview, E1 acknowledged that a current drug reference guide was not available for use by personnel members.

Based on observation and interview, the manager failed to ensure that a current toxicology reference guide was available for use by personnel members. Findings include: 1. The toxicology guide available for use by personnel members was the "Poisoning & Drug Overdose" Seventh edition, published by McGraw Hill Lange. 2. Review of the publishers website revealed that "Poisoning & Drug Overdose" Eighth edition was the current version. 3. In an interview, E1 acknowledged that a current toxicology reference guide was not available for use by personnel members.

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 a tour of the facility, the Compliance Officers observed a food menu dated August 1 - August 3, 2024. 2. In an interview, E1 reported E1 had forgotten to post an updated menu. E1 acknowledged the food menu was not conspicuously posted at least one calendar day before the first meal on the food menu was served.

Based on interview, documentation review, and interview, the manager failed to ensure a current therapeutic diet manual was available for use by employees. The deficient practiced posed a risk if the employees did not have access to dietary information required to meet a resident's need. Findings include: 1. In an interview, E1 reported the facility provided therapeutic diets for residents when required by the resident's service plan. E1 reported that R2 received a diabetic diet. 2. Review of the facility's policies and procedures revealed a policy titled "Food Services" which stated "Eyal LLC 2 offers therapeutic diets, a manager shall ensure that: a. A current therapeutic diet manual is available for use by employees." 3. In an interview, E1 reported having no therapeutic diet manual available on site, for use by employees.

Based on interview and record review, the manager failed to ensure a therapeutic diet was provided to a resident according to a written order from the resident's primary care provider or a medical practitioner. Findings include: 1. In an interview, E1 reported that R2 received a therapeutic diabetic diet. 2. Review of R2's medical record revealed no written orders for a diabetic diet. 3. In an interview, E1 acknowledged R2 received a diabetic diet and a therapeutic diet order was not available.

Based on document review and interview, the manager failed to ensure that smoke detectors were tested at least once a month. The deficient practice posed a health and safety risk if the smoke detectors did not work properly during an emergency. Findings include: 1. A review of facility documentation revealed documentation that the smoke detectors were last tested in July 2024. No documentation was available showing that smoke detectors had been tested in August 2024. 2. In an interview, E1 acknowledged that no documentation was available showing that smoke detectors had been tested at least once a month.

Based on documentation review and interview, the manager failed to ensure the disaster plan required in subsection (A)(1) 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. A review of facility documentation revealed a disaster plan dated April 1, 2022. However, documentation to indicate the disaster plan had been reviewed at least once every 12 months was not available for review. 2. In an interview, O1 acknowledged the disaster plan had not been reviewed at least once every 12 months.

Based on observation and interview, the manager failed to ensure poisonous or toxic materials were maintained in a locked area and were inaccessible to residents. The deficient practice posed a physical health and safety risk to residents. Findings include: 1. The Compliance Officer observed six ambulatory residents on the premises. 2. The Compliance Officer observed a cabinet underneath a common bathroom sink. The cabinet contained a latch and the following poisonous or toxic materials: -Windex; and -Lysol toilet cleaner. The bottles contained warning labels. 3. The Compliance Officer observed an unlocked cabinet in the master bathroom of R4's and R8's shared bedroom. The cabinet contained the following poisonous or toxic materials: -Clorox Bleach; and -WD-40. The bottles contained warning labels. 4. In an interview, O1 acknowledged the poisonous or toxic materials were not secured with a lock and were accessible to residents.

Based on observation, interview, and documentation review, the manager failed to ensure a personnel record for an employee or volunteer was maintained throughout the individual's period of providing services in or for the assisted living facility. The deficient practice posed a risk as required information could not be verified for E2, E3, and E4. Findings include: 1. The Compliance Officer observed E2, E3, and E4 on the premises working and interaction with residents upon arrival at 8:30 AM. 2. In an interview, E2 reported E2 started working at the facility approximately one month ago. E2 reported E3 and E4 started working at the facility approximately three weeks ago. 3. In an interview, E3 stated E3 was "helping out" at the facility. 4. A review of facility documentation revealed a document titled "SCHEDULE FROM; JUNE 26-JULY 10/23 DAY NIGHT." The document revealed E2, E3, and E4 were scheduled to work the following days and shifts: -E2: June 26-27, 2023 (day and night shifts), June 29, 2023 (night shift), July 2, 2023 (night shift), July 3-4, 2023 (day and night shift), and July 6, 2023 (day shift); -E3: June 28-29, 2023 (day and night shift), June 30-July 2, 2023 (day shift), July 5-6, 2023 (day and night shift), and July 7, 2023 (day shift); and -E4: June 26-July 7, 2023 (day and night shift). 4. A review of facility documentation revealed E4 had a current cardiopulmonary resuscitation (CPR) and first aid training card. 5. The Compliance Officer requested to review E2's, E3's, and E4's personnel record. However, personnel records were not provided for review. 6. In an interview, E3 showed the Compliance Officer the following displayed on E3's mobile phone: -A valid caregiver training certificate; -A valid fingerprint clearance card; -Documentation of current CPR and first aid training; and -Documentation 12 hours of continuing education units to include "Fall Prevention and Fall Recovery." 7. In an interview, O1 reported E2 was an assistant caregiver, E3 was a volunteer, and E4 was an assistant caregiver. O1 reported E1 had not maintained a personnel record throughout E2's, E3's, and E4's period of providing services in or for the assisted living facility.

Based on record review and interview, the manager failed to ensure a resident provided evidence of freedom from infectious tuberculosis (TB) before or within seven calendar days after the resident's date of occupancy. The deficient practice posed a TB exposure risk to residents. Findings include: 1. A review of R1's (admitted in 2022) medical record revealed a chest x-ray document dated January 19, 2022. The document stated, "Reason For Exam (Chest Single View Adult Portable) placement ...Report: CLINICAL HISTORY: placement ...2/11/22 Free From TB." However, the medical record revealed no evidence R1 had a history of a positive skin test or other TB screening test recommended by the Centers for Disease Control and Prevention (CDC); and the chest x-ray was not an infectious TB screening test. 2. In an interview, O1 acknowledged R1 did not provide current documentation of freedom from infectious TB.

Based on record review and interview, the manager failed to ensure a resident had a written service plan, when initially completed and updated, signed and dated by the resident or resident's representative and the manager, for nine of nine residents sampled. Findings include: 1. A review of R1's (admitted in 2022) medical record revealed a service plan dated in April 2023 for directed care services. However, the service plan was not signed and dated by the resident's representative or the manager. 2. A review of R2's (admitted in 2023) medical record revealed a service plan dated in March 2023 for personal care services. However, the service plan was not signed and dated by the resident or the manager. 3. A review of R3's (admitted in 2022) medical record revealed a service plan dated in March 2023 for personal care services. However, the service plan was not signed and dated by the resident or the manager. 4. A review of R4's (admitted in 2023) medical record revealed a service plan dated in April 2023 for personal care services. However, the service plan was not signed and dated by the manager. 5. A review of R5's (admitted in 2023) medical record revealed a service plan dated in May 2023 for personal care services. However, the service plan was not signed and dated by the resident or the manager. 6. A review of R6's (admitted in 2023) medical record revealed a service plan dated in May 2023 for personal care services. However, the service plan was not signed and dated by the manager. 7. A review of R7's (admitted in 2022) medical record revealed a service plan dated in January 2023 for personal care services. However, the service plan was not signed and dated by the resident or the manager. 8. A review of R8's (admitted in 2022) medical record revealed a service plan dated in April 2023 for directed care services. However, the service plan was not signed and dated by the resident's representative or the manager. 9. A review of R9's (admitted in 2022) medical record revealed a service plan dated in April 2023 for directed care services. However, the service plan was not signed and dated by the resident's representative or the manager. 10. In an interview, O1 acknowledged the service plans provided for R1, R8, and R9 had not been signed and dated by the resident's representatives or the manager. 11. In an interview, O1 acknowledged the service plans provided for R2, R3, R5, and R7 had not been signed and dated by the resident or the manager. 12. In an interview, O1 acknowledged the service plans provided for R4 and R6 had not been signed and dated by the manager.

Based on record review and interview, the manager failed to ensure the service plan for a resident receiving directed care services included documentation of the resident's weight or from a medical practitioner stating weighing the resident was contraindicated, for one of three residents sampled who received directed care services. Findings include: 1. A review of R1's medical record revealed a current service plan dated in April 2023 for directed care services. However, the service plan did not include documentation of R1's weight or documentation from a medical practitioner stating weighing R1 was contraindicated. 2. In an interview, O1 acknowledged R1's service plan did not include the resident's weight or documentation from a medical practitioner stating weighing the resident was contraindicated.