Golden Age Assisted Living LLC

Based on record review, observation, and interview, the manager failed to ensure that medication administered to a resident was administered in compliance with a medication order, for one of three 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 signed document titled "Agave Hospice Physician Order" dated January 30, 2025 for the following medication: HOLD Senna every Sunday and Wednesday. 2. A review of R1's medical record revealed a Medication Administration Record (MAR) for April 2025 documenting R1 was administered the following: Senna-S 8.6-50 milligram(MG) Tablet - Give one tab by mouth twice a day for constipation hold for diarrhea. 3 . A review of R1's MAR revealed Senna-S 8.6-50 milligram(MG) Table was administered at the following dates and times: April 1, 2025 to April 11, 2025 at 8:00AM; and April 1, 2025 to April 10, 2025 at 8:00PM. However, no documentation that the medication was held on Sunday and Wednesday per order was available for review. 4 . In an interview, E1 acknowledged medication administered to R1 was not administered in compliance with a medication order.

Based on record review and interview, the manager did not ensure a standardized emergency responder patient information form as described in subsection A of this section, was completed and maintained for two of two residents sampled. The deficient practiced posed a risk as required patient information was not prepared in case of an emergency. Findings include: 1. A review of R1's and R2's medical records revealed documentation of a standardized emergency responder patient information form completed as required by Arizona Revised Statute (A.R.S.) § 36-420.04(A)(1) through (9). However, the following were not included in the documentation: - A standardized space to be filled in with the reason or reasons the emergency responder was requested on behalf of the resident. 2. In an interview, E1 acknowledged the information required in A.R.S. § 36-420.04 was not prepared in a standardized emergency responder patient information form as required.

Based on record review and interview, the manager failed to ensure that a resident had a written service plan that included the amount, type, and frequency of assisted living services being provided to the resident, for one of two residents sampled. Findings include: 1. Review of R2's medical record revealed a personal care service plan. The service plan stated "Bathing, twice weekly and as needed Caregivers to help with showers and bed baths." However, the resident was bed bound and can only receive bed baths. 2. In an interview, E1 reported R2 only received bed baths and could not receive a shower as indicated in R2's service plan. E1 acknowledged R2's service plan did not include the correct type of bathing service to meet R2's needs.

Based on observation and interview, the manager failed to ensure an assistant caregiver interacted with residents under the supervision of a manager or caregiver. The deficient practice posed a risk as E3 and E4 were not qualified to provide the required services. Findings include: A.R.S. \'a7 36-401.A.42. "Supervision" means direct overseeing and inspection of the act of accomplishing a function or activity. 1. Review of E2's and E3's personnel records revealed E2 and E3 were hired as assistant caregivers in January 2024. 2. The Compliance Officers observed E2 at the time of the inspection providing direct services to residents. The direct services witnessed included assisting a resident walking to the bathroom using a walker and spoon feeding a resident lunch without the direct supervision of a manager or caregiver. 3. In an interview, R2 reported E3 provided R2 bed baths alone with no caregiver or manager present. 4. In an interview, E2 acknowledged E2 assisted a resident from their bed to the bathroom using their walker and fed a resident lunch without being under the direct supervision of a manger or caregiver. 5. In an interview, E1 acknowledged E2 and E3 were assistant caregivers. E1 acknowledged E2 and E3 provided services to residents without being under the direct supervision of a caregiver or manager.

Based on documentation review, record review, and interview, the manager failed to ensure an assistant caregivers' skills and knowledge were verified and documented before providing physical health services and according to policies and procedures, for two of two assistant caregivers reviewed. The deficient practice posed a health and safety risk. Findings include: 1. Review of the facility's policy and procedure revealed a policy titled "Assistant Caregivers". The policy stated "Assistant Caregivers Services will be provided to the resident only after receiving specific training, documentation and under the supervision and direction of another caregiver or manager." 2. Review of E2's and E3's personnel records revealed E2 and E3 were hired as assistant caregivers in January 2024. The personnel records revealed no documentation of E2's and E3's skills and knowledge verified as assistant caregivers. 3. In an interview, E1 reported E2 and E3 were working at the facility prior to E1 working at the facility and were hired by the previous manager. E1 acknowledged E2's and E3's personnel records did not include documentation of skills and knowledge verified.

Based on observation, documentation review, and interview, the manager failed to ensure documentation was maintained of the caregivers and assistant caregivers working each day, including the hours worked. The deficient practice posed a risk as there was no documentation to identify the staff that was present each day to ensure the health and safety of residents. Findings include: 1. The Compliance Officers observed E1 and E2 working at the facility at the time of the inspection. 2. A request for the March 2024 personnel schedule revealed no schedule was available for review. 3. In an interview, E1 reported E1 needed to create the March 2024 schedule. E1 reported E1 was unaware assistant caregivers were to be documented on the schedule. E1 acknowledged documentation was not maintained of the assistant caregiver working each day, including the hours worked for the month of March 2024.

Based on record review and interview, the manager failed to ensure a residency agreement included whether the manager or a caregiver was awake during nighttime hours, for one of two residents reviewed accepted by the assisted living home on or after July 1, 2014. The deficient practice posed a health and safety risk if a resident was unable to awaken the caregivers during nighttime hours. Findings include: 1. Review of R1's medical record revealed a residency agreement. However, this residency agreement did not include documentation of whether the manager or a caregiver was awake during nighttime hours. Based on R1's acceptance date, this documentation was required. 2. In an interview, E1 reported caregivers sleep at night and wake up if the residents need assistance. E1 acknowledged R1's residency agreement did not include that information.