Gentle Care Assisted Living

Based on observation, interview, and documentation review, the administrator failed to ensure a resident bedroom was not used as a passageway to a common area or another sleeping area. The deficient practice posed a potential privacy rights violation to the resident. Findings include: 1. During the facility tour with E1, the Compliance Officer observed R2's bedroom and closet. The Compliance Officer observed E3's personal belongings in the closet. 2. During an interview, E1 reported E1 slept in the bed next to R2 and E3 slept in R2's closet. 3. Review of Department records revealed the facility was originally licensed April 12, 2018, therefore an exception from the Department before October 1, 2013 would not apply.

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 two 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. 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. 3. During an interview, E1 acknowledged documentation was not available showing R1 and R2 provided 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 record review, documentation review, and interview, the manager failed to ensure a residency agreement included the policy and procedure for a resident to terminate residency, including terminating residency because services were not provided to the resident according to the resident's service plan, for two of two residents reviewed accepted by the assisted living home on or after October 1, 2013. The deficient practice posed a health and safety risk to the residents. Findings include: 1. Review of R1's medical record revealed a residency agreement. However, this residency agreement did not include the policy and procedure for a resident to terminate residency, including terminating residency because services were not provided to the resident according to the resident's service plan. Based on R1's acceptance date, this documentation was required. 2. Review of R2's medical record revealed a residency agreement. However, this residency agreement did not include the policy and procedure for a resident to terminate residency, including terminating residency because services were not provided to the resident according to the resident's service plan. Based on R2's acceptance date, this documentation was required. 3. Review of the facility's policies and procedures revealed a policy titled "Termination of Residency (By Resident)" reviewed and signed by E2 January 1, 2023. This policy stated "...The resident may terminate the agreement due to health reasons, such as admission to a hospital or the requirement for extended skilled nursing care. The resident may terminate the residency agreement because he or she needs services that the facility is either not licensed to provide or is licensed to provide but not able to provide. The residency agreement may be terminated with a 30 days notice if the resident is not provided with the services as stated in the service plan." 4. During an interview, E1 acknowledged R1's and R2's residency agreements did not include the policy and procedure for a resident to terminate residency including terminating residency because services were not provided to the resident according to the resident's service plan.

Based on record review and interview, the manager failed to ensure before or at the time of an individual's acceptance by the assisted living facility, there was a documented residency agreement with the assisted living facility which included the manager's signature and date signed, for one of two residents reviewed. Findings include: 1. Review of R1's medical record revealed a residency agreement. However, this residency agreement did not include the signature of the manager and date signed. Based on R1's acceptance date, this documentation was required. 2. During an interview, E1 acknowledged R1's residency agreement did not include the signature of the manager and date signed.

Based on record review, observation, and interview, the manager failed to ensure a resident medical record contained a medication order from a medical practitioner for each medication that was administered, for one of two residents reviewed. The deficient practice posed a health and safety risk. Findings include: 1. Review of R1's medical record revealed no documentation of a signed medication order or a verbal medication order for Calmoseptine. 2. Review of R1's medical record revealed an April 2023 medication administration record (MAR). This MAR did not include documentation Calmoseptine was administered. 3. During an observation of R1's medications, Calmoseptine was available. 4. During an interview, E1 reported R1 received medication administration. E1 reported Calmoseptine was administered two times a day to R1's buttocks and groin. E1 acknowledged R1's medical record did not contain a medication order from a medical practitioner for each medication that was administered.

Based on documentation review, record review, and interview, the manager failed to ensure a resident medical record contained documentation of notification of the resident of the availability of vaccination for influenza (flu) and pneumonia, according to A.R.S. \'a7 36-406(1)(d), to one of one resident reviewed. The deficient practice posed a potential illness risk to residents. Findings include: 1. A.R.S. \'a7 36-406(1)(d) states "The department shall: 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. Review of R2's medical record revealed R2 requested to receive the flu and pneumonia vaccinations January 20, 2023. However, current documentation was not available showing the flu and pneumonia vaccinations were received or refused. Based on R2's acceptance date, this documentation was required. 3. During an interview, E1 acknowledged R2's medical record did not include current documentation showing the flu and pneumonia vaccinations were received or refused.

Based on observation and interview, the manager failed to ensure toxic materials stored by the facility were stored in a locked area and inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During the facility tour with E1, the Compliance Officer observed Member's Mark fabric softener, Windex, Ortho Home Defense, Prestone brake fluid, and PineSol unlocked in the garage. This garage door had a locking device, however was not locked. 2. During an observation, E1 and E3 were the only employees at the facility when the Compliance Officer arrived and were not accessing the toxic materials at the time of arrival. 3. During an interview, E1 acknowledged toxic materials were stored unlocked.

Based on 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, every six months, 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 two residents reviewed who were 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. Review of R2's medical record revealed a current written service plan for directed care services dated April 7, 2023. This service plan stated "Confined to bed". 2. Review of R2's medical record revealed a written determination from R2's medical practitioner signed and dated July 30, 2022. However, documentation was not available stating R2's needs were met by the facility and R2's needs were within the facility's scope of services, at least once every six months. 3. During an interview, E1 reported R2 was unable to ambulate even with assistance since acceptance and acknowledged R2's medical practitioner did not provide a written determination at least once every six months.

Based on documentation review, observation, and interview, the manager failed to ensure there was a means of exiting the facility for a resident who did not have a key, special knowledge for egress, or the ability to expend increased physical effort, that provided access to an outside area that 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. Review of the license issued by the Department revealed the facility was authorized to provide directed care services. 2. During the facility tour with E1, the surveyor observed the outside area, in the backyard, allowed residents to be a least 30 feet away from the facility. The door leading out to the backyard had a device that was intended to alert employees to the egress of a resident to the outside area. However, the device did not work. 3. During an interview, E1 acknowledged there was not a means of exiting the facility that controlled or alerted employees of the egress of the resident.

Based on record review, observation, and interview, the manager failed to ensure a medication was administered in compliance with a medication order, for one of two residents reviewed. The deficient practice posed a risk if the resident experienced a change in condition due to improper administration of medication. Findings include: 1. Review of R1's medical record revealed signed medication orders. These orders were not dated, however the document signed was dated March 21, 2023 - April 20, 2023. These medication orders stated the following: "Docusate Sodium (Colace) 100mg, Give 100mg (1 capsule(s)) by mouth Twice a day" "Polyethylene Glycol 3350 (Miralax) 17G, Give 17 gram (1 packet(s)) by mouth Daily" "Guaifenesin (Mucinex) 600mg, Give 600mg/1 tablet(s)) by mouth Every 12 hours" "Sennosides (Senna Lax) 8.6mg, Give 8.6mg (1 tablet(s)) by mouth Daily" 2. Review of R1's medical record revealed no documentation of a signed medication order or a verbal medication order for Calmoseptine. 3. Review of R1's medical record revealed an April 2023 medication administration record (MAR). This MAR did not include documentation Docusate Sodium, Polyethylene Glycol, Guaifenesin, Sennosides, or Calmoseptine were administered. 4. During an observation of R1's medications, the following was observed: Docusate Sodium was not available. Polyethylene Glycol was available. Guaifenesin was not available. Sennosides was not available. Calmoseptine was available. 5. During an interview, E1 reported R1 received medication administration. E1 reported Docusate Sodium, Polyethylene Glycol, Guaifenesin, and Sennosides were not administered. E1 additionally reported, Calmoseptine was administered two times a day to R1's buttocks and groin. E1 acknowledged R1's medications were not administered in compliance with an available medication order.

Based on record review, observation, and interview, the manager failed to ensure a medication administered to a resident was documented in the resident's medical record, for one of two residents reviewed. The deficient practice posed a health and safety risk. Findings include: 1. Review of R1's medical record revealed no documentation of a signed medication order or a verbal medication order for Calmoseptine. 2. Review of R1's medical record revealed an April 2023 medication administration record (MAR). This MAR did not include documentation Calmoseptine was administered. 3. During an observation of R1's medications, Calmoseptine was available. 4. During an interview, E1 reported R1 received medication administration. E1 reported Calmoseptine was administered two times a day to R1's buttocks and groin. E1 acknowledged documentation was not available showing the medication was administered.

Based on observation and interview, the manager failed to ensure medications stored by the facility were stored in a separate locked room, closet, cabinet, or self-contained unit. The deficient practice posed a risk to residents who could access the medication. Findings include: 1. During the facility tour with E1, the Compliance Officer observed Morphine, Lorazepam, and Atropine unlocked in a box in the kitchen refrigerator. This box had a locking device, however was not locked. In addition, the medication cabinet in the kitchen that held seven residents' medications was observed unlocked. The cabinet had a locking device, however was not locked. 2. During an observation, E1 and E3 were the only employees at the facility when the Compliance Officer arrived and were not accessing the medications at the time of arrival. 3. During an interview, E1 acknowledged medications were stored unlocked.

Based on observation and interview, the manager failed to ensure an evacuation path was conspicuously posted on each hallway of each floor of the assisted living facility. The deficient practice posed a risk as a way to exit the facility in the event of an emergency was not posted. Findings include: 1. During the facility tour with E1, the Compliance Officer observed that the hallway on the west and north side of the facility did not have a posted evacuation path. 2. During an interview, E1 acknowledged the evacuation path was not posted on each hallway of the assisted living facility.

Based on observation and interview, the manager failed to ensure hot water temperatures were maintained between 95\'b0 F and 120\'b0 F in the areas of a facility used by residents. The deficient practice posed a health and safety risk to the residents. Findings include: 1. During the facility tour with E1, the Compliance Officer observed the hot water temperature at 125.2\'b0 F in the hall bathroom. 2. During an interview, E1 acknowledged the hot water temperature was not maintained between 95\'b0 F and 120\'b0 F in the areas of a facility used by residents.