Fletcher Farms Assisted Living, LLC

Based on documentation review and interview, after the manager had a reasonable basis, according to Arizona Revised Statutes (A.R.S.) § 46-454, to believe abuse, neglect, or exploitation had occurred on the premises, the manager failed to initiate an investigation and document the information required in Arizona Administrative Code (A.A.C.) R9-10-803(J)(5)(a-d), within five working days. The deficient practice posed a risk to the physical health and safety of residents. Findings include: 1. A review of facility documentation revealed there was no documentation to reflect that an investigation was initiated by the facility regarding R2's allegations. 2. In an interview, E1 reported that Adult Protective Services (APS) conducted an on-site visit on September 9, 2025, regarding allegations of abuse of R2; however, E1 reported that there was no investigation initiated and documented by the facility regarding the allegations.

Based on observation, record review, and interview, the manager failed to ensure at least the manager or a caregiver was present at an assisted living home when a resident was present in the assisted living home. The deficient practice posed a risk as no qualified employee was present to meet a resident's needs. Findings include: 1. The facility had a census of nine residents. 2. During the inspection, the Compliance Officer observed E1, E2, and E3 in the facility. However, E1 was observed not to be present in the facility from at least 1:36 pm to 1:57 pm. E2 and E3 were the only employees working in the facility. 3. Review of E1's personnel record revealed E1 was hired as the manager. 4. Review of E2’s personnel record revealed E2 was hired as an assistant caregiver and did not have documentation of completing a caregiver training program approved by the Department or the NCIA Board. Therefore, E2 was not qualified to be left alone with the residents based on the lack of caregiver training. 5. Review of E3’s personnel record revealed E3 was hired as a “Helper/Homecare” and did not have documentation of completing a caregiver training program approved by the Department or the NCIA Board. Therefore, E3 was not qualified to be left alone with the residents based on the lack of caregiver training. 6. In an interview, E1 reported E1 left to go pick up a resident and acknowledged E1 left the facility with no manager or caregiver present in the assisted living home. 7. 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 accepted by the assisted living facility submitted documentation signed by a medical practitioner or a registered nurse that stated whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints, for two of two residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. Review of R1's medical record revealed no documentation that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints. Based on R1’s acceptance date, this documentation was required. 2. Review of R2's medical record revealed documentation that stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints. However, this document was signed after R2's acceptance date. 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 September 19, 2023.

Based on documentation review, record review, and interview, the manager failed to ensure the health care institution developed and administered a training program for all staff regarding fall prevention and fall recovery that included initial training and 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 no documentation of a training program for all staff regarding fall prevention and fall recovery. 2. Review of E1's personnel record revealed E1 worked as the manager and had a hire date of May 1, 2021. The personnel record revealed documentation of fall prevention training dated July 22, 2022. However, current documentation was not available indicating E1 completed fall prevention and fall recovery training. 3. Review of E3's personnel record revealed E3 worked as a caregiver and had a hire date of September 13, 2023. The personnel record did not include documentation showing E3 completed fall prevention and fall recovery training. 4. In an interview, E1 acknowledged documentation was not available showing E1 and E3 had completed initial training and continued competency training for fall prevention and fall recovery. 5. This is a repeat deficiency from the compliance inspection conducted October 27, 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 reviewed. 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 employment in a residential care institution...employees and owners of residential care institutions...shall have valid fingerprint clearance cards... 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..." 2. Review of E3's personnel record revealed E3 worked as a caregiver and had a hire date of September 13, 2023. The personnel record revealed a fingerprint clearance card issued on September 7, 2023. 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 E3's fitness to work in a residential care institution. 4. Review of the Department of Public Safety (DPS) fingerprint clearance card database on September 19, 2023, revealed E3's fingerprint clearance card was valid. 4. In an interview, E1 acknowledged documentation was not available showing E3's work references were obtained 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 one 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 E3's personnel record revealed no documentation of a risk assessment of prior exposure to infectious TB or a determination if E3 had signs or symptoms of TB. Based on E3's hire date, this documentation was required. 3. In an interview, E1 acknowledged E3 did not provide documentation of a risk assessment of prior exposure to infectious TB or a determination if E3 had signs or symptoms of TB. 4. Technical assistance was provided on this Rule during the compliance inspection conducted October 27, 2022.

Based on record review and interview, the manager failed to ensure a resident provided documentation of freedom from infectious tuberculosis (TB) as specified in R9-10-113, for two of two residents reviewed. 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. Review of R1's medical record revealed no documentation of a risk assessment of prior exposure to infectious TB or a determination if R1 had signs or symptoms of TB. Based on R1's acceptance date, this documentation was required. 3. Review of R2's medical record revealed no documentation of a risk assessment of prior exposure to infectious TB or a determination if R2 had signs or symptoms of TB. Based on R2's acceptance date, this documentation was required. 4. In an interview, E1 acknowledged R1 and R2 did not provide documentation of a risk assessment of prior exposure to infectious TB or a determination if R1 and R2 had signs or symptoms of TB. 5. Technical assistance was provided on this Rule during the compliance inspection conducted October 27, 2022.

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 R1's medical record revealed no documentation stating whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints. Based on R1's acceptance date, this documentation was required. 2. In an interview, E1 acknowledged R1 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, record review, and interview, the manager failed to ensure the facility did not retain a resident who was confined to a bed or chair because of an inability to ambulate even with assistance, unless the facility obtained a written determination from a medical practitioner, upon the onset of the condition and every six months thereafter, stating the resident's needs could be met by the facility and the resident's needs were within the facility's scope of services, for one of one resident reviewed who was confined to a bed or chair. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. During an observation, the Compliance Officer observed E1, E2, and E3 transferring R2 with the use of a Hoyer lift. 2. Review of R2's medical record revealed no documentation indicating R2's medical practitioner examined R2 upon the onset of the condition and every six months thereafter, signed and dated a determination stating R2's needs could be met by the facility, and reviewed the facility's scope of services. 3. In an interview, E1 reported R2 was unable to ambulate even with assistance for approximately two months and acknowledged R2's medical practitioner did not provide a written determination upon the onset of the condition and every six months thereafter.

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's documentation revealed no policy and procedure that covered TB infection control activities. 2. Review of E3's personnel record revealed E3 worked as a caregiver and had a hire date of September 13, 2023. The personnel record did not include documentation of training and education related to recognizing the signs and symptoms of TB. 3. Review of facility documentation revealed no documentation of an annual assessment of the health care institution's risk of exposure to infectious TB. 4. In an interview, E1 acknowledged E3 had not completed training and education related to recognizing the signs and symptoms of TB and an assessment of the health care institution's risk of exposure to infectious TB was not conducted. 5. Technical assistance was provided on this Rule during the compliance inspection conducted October 27, 2022.

Based on record review and interview, the manager failed to ensure a written service plan was updated at least once every six months, for two of two residents reviewed receiving personal care services. The deficient practice posed a health and safety risk to the resident if the employees did not know what services the resident needed. Findings include: 1. Review of R1's medical record revealed a current written service plan for personal care services dated May 2, 2022. However, a service plan after May 2, 2022 was not available for review. 2. Review of R2's medical record revealed a current written service plan for personal care services dated June 20, 2022. However, a service plan after June 20, 2022 was not available for review. 3. During an interview, E1 acknowledged R1 and R2 received personal care services and the service plans were not updated at least once every six months.