Granite Gate Senior Living

Based on record review and interview, the manager failed to ensure a caregiver or an assistant caregiver provided a resident with the assisted living services in the resident's service plan, for one of three sampled residents. The deficient practice posed a risk as services were not provided per a resident's service plan. Findings include: 1. A review of R1’s current service plan dated January 29, 2026. This service plan revealed R1 received full assist bathing services Monday, Wednesday, and Saturday at 12:00 pm. 2. A review of R1’s “Care History” for February 2026 revealed on February 14, 2026 the following note, “we don’t have the staff for this showers and several attempts were tried to shower and they-” 3. In an interview, E1 acknowledged R1 did not receive a shower on February 14, 2026. 4. In an exit interview, the findings were reviewed with E1 and E3, and no additional information was provided.

Based on record review and interview, the manager failed to ensure a caregiver or assistant caregiver documented the services provided in the resident's medical record, for one of three residents sampled. Findings include: 1. A review of R2’s current service plan dated January 30, 2026 revealed R2 received AM/PM dressing assistance twice daily. 2. A review of R2’s “Care History” for the months of March 2026 and February 2026 revealed dressing assistance was not documented on the following days: March 8, 2026; March 7, 2026; March 5, 2026; March 4, 2026; March 2, 2026; March 1, 2026; February 28, 2026; February 26, 2026; February 25, 2026; February 23, 2026; February 22, 2026; February 21, 2026; February 19, 2026; February 18, 2026; February 16, 2026; February 15, 2026; February 14, 2026; February 12, 2026; February 11, 2026; February 9, 2026; February 8, 2026; February 7, 2026; February 5, 2026; February 4, 2026; February 2, 2026; and February 1, 2026. 3. In an interview, E1 acknowledged R2’s dressing assistance was not documented on R2’s “Care History”. 4. In an exit interview, the findings were reviewed with E1 and E3, and no additional information was provided. 5. This was a repeat citation from the complaint inspection conducted on April 14, 2023, and the complaint and compliance inspection conducted on September 19, 2023.

Based on record review 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 R3’s medical record revealed R3’s current service plan dated December 2025, which revealed R3 received medication administration. 2. A review of R3’s medical record revealed a medication order signed in November 2025 for Keflex 250 mg one tablet, one time a day. However, the medication order did not indicate a stop date. 3. A review of R3’s medical record revealed a medication administration record (MAR) for March 2026. On March 1, 2025, it was stated in the MAR notifications, “Finished”. On March 2, 2026, it was stated in the MAR notifications, “infection tablets are done”. 4. In an interview, E3 reported that R3 did not receive Keflex 250 mg from March 1, 2026, to March 2, 2026. 5. In an exit interview, the findings were reviewed with E1 and E3, and no additional information was provided. 6. This was a repeat citation from the complaint and compliance inspection conducted on September 19, 2023.

Based on documentation review and interview, the manager failed to ensure that a disaster drill for employees 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 a disaster plan. Findings include: 1. A review of facility documentation disaster drills revealed documentation for one disaster drill being conducted on October 31, 2025. No other documentation was available for review of the disaster drill being done at least once every three months and documented within the last 12 months. 2. In an exit interview, the findings were reviewed with E1 and E10, and no additional information was provided.

Based on record review and interview, the manager failed to ensure that 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 one of eight residents sampled. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R5’s medical record revealed documentation stated whether the resident required continuous medical services, continuous or intermittent nursing services, or restraints; however, this documentation was not completed within 90 calendar days before the individual was accepted by the assisted living facility. 2. In an exit interview, the findings were reviewed with E1 and E10, and no additional information was provided. This is a repeat deficiency from the inspection conducted on October 23, 2024.

Based on observation, record review, documentation review and interview, for two of two residents sampled, who received opioid medication, without an active malignancy or an end of life condition, the manager failed to ensure an individual authorized to administer opioids documented in the resident's medical record; an identification of the resident's need for the opioid before the opioid was administered, and the monitoring of the effect of the opioid administered. The deficient practice posed a risk to a resident's health and safety if the facility did not appropriately assess and monitor opioid administration for a resident. Findings include: 1. During the environmental inspection, R1's medications were observed at the facility, and included "TRAMADOL HCL 50MG TABLET, 1 TAB BY MOUTH THREE TIMES DAILY for pain.” 2. A record review of R1's medical record revealed a service plan for directed care services and medication administration services. A review of R1's medication order revealed "TRAMADOL HCL 50MG TABLET, 1 TAB BY MOUTH THREE TIMES DAILY for pain.” A review of R1's electronic medication administration record (eMAR) included documentation that R1 received the TRAMADOL HCL 50MG medication daily from October 2025 to present. The medical record did not include documentation of monitoring of the effect of the opioid administered. R1's medical record did not include documentation of an active malignancy or an end-of-life condition. 3. During the environmental inspection, R8's medications were observed at the facility, and included "TRAMADOL HCL 50MG TABLET, 1 TAB BY MOUTH TWICE A DAY for pain.” 4. A record review of R8's medical record revealed a service plan for directed care services and medication administration services. A review of R8's medication order revealed "TRAMADOL HCL 50MG TABLET, 1 TAB BY MOUTH TWICE A DAY for pain.” A review of R8's eMAR included documentation that R8 received the TRAMADOL HCL 50MG TABLET medication daily from November 2025 to present. The medical record did not include documentation of an identification of the need for the opioid before the opioid was administered, nor did it include monitoring of the effect of the opioid administered. R8's medical record did not include documentation of an active malignancy or an end-of-life condition. 5. A review of facility policies revealed a policy titled "Arizona Opioid Policy | HW 120." The policy stated, "4. Ensure that an Individual authorized by the HCIs policies and procedures to administer an opioid in treating a resident or to provide assistance in the self-administration medication for a prescribed opioid: a. Identifies the resident’s need for the opioid before administering or providing assistance with the self-administration of an opioid; i. Pain Scale will be used and noted in ECP. b. Monitors the residents response to the opioid; and i. RAs, HWD or HWC to revisit resident and check effectiveness one hour after administration. c. Documents in the resident medica

Based on the record review, and interview, the manager failed to ensure that a caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services for three of nine caregivers sampled. The deficient practice posed a risk if the employees did not have the skills and knowledge required to ensure the health and safety of residents. Findings include: 1. A review of E4’s personnel record revealed E4 was hired as a caregiver in October 2025. 2. A review of E5’s personnel record revealed E5 was hired as an assistant caregiver in October 2025. 3. A review of E6’s personnel record revealed E6 was hired as an assistant caregiver in November 2025. 4. A review of E4's, E5’s and E6’s personnel records revealed no documented verification of E4's, E5’s and E6’s skills and knowledge. 5. In an exit interview, the findings were reviewed with E1 and E10, and no additional information was provided. This is a repeat deficiency from an inspection conducted on September 20, 2023, and this is an uncorrected deficiency from the inspection conducted on November 6, 2025.

Based on observation, 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 three of nine caregivers. The deficient practice posed a risk if the employees were unable to meet residents' needs. Findings include: 1. A review of E4’s personnel record revealed E4 was hired as a caregiver in October 2025. 2. A review of E4’s personnel record revealed E5 was hired as an assistant caregiver in October 2025. 3. A review of E4’s personnel record revealed E6 was hired as an assistant caregiver in November 2025. 4. A review of E4’s, E5’s, and E6’s personnel records revealed that E4, E5, and E6 did not receive orientation. 5. In an exit interview, the findings were reviewed with E1 and E10, and no additional information was provided. This is a repeat citation from an inspection conducted on September 20, 2023.

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 eight residents sampled. Findings include: 1. A review of R3’s medical record revealed a residency agreement that included the manager’s signature and date; however, the manager’s signature was dated ten days after the date of occupancy. 2. In an exit interview, the findings were reviewed with E1, E10, and no additional information was provided.

Based on documentation review, record review, and interview, the manager failed to ensure a resident's written service plan included the amount, type, and frequency of assisted living services being provided to the resident, for one of eight residents sampled. The deficient practice posed a risk as the service plans did not reinforce and clarify services to be provided to a resident. Findings include: 1. In an interview, E11 reported that R4 was non-ambulatory and was repositioned every two hours. 2. A review of R4's medical record revealed a current service plan. The service plan reported transfer assistance: one-person transfer, help the resident to a stable position, and put on the gait belt around their waist. However, there was no documentation of the need for repositioning the resident. 3. In an interview, E1 acknowledged R4's service plans did not include the frequency of the repositioning provided to the residents. 4. In an exit interview, the findings were reviewed with E1 and E10, and no additional information was provided.

Based on observation, documentation, and interview, the manager failed to ensure that a resident was treated with dignity, respect, and consideration. The deficient practice violated a resident's rights. Findings include: 1. During the environmental inspection of the facility, the Compliance Officers entered R6's and R9's rooms. The Compliance Officers pulled the pull cord in the bathroom to alert staff and check wait time; however, the pull cord did not work, and the staff member never came to check on the residents. 2. During the environmental inspection of the facility, the Compliance Officers entered R2's, R7's and R8's rooms in the memory care unit. The residents in the memory care units were supposed to have a pendant. The Compliance Officers pushed the pendant to check wait time; however, no staff member came to the room. Upon further investigation, the staff member in the memory care unit did not have the walkie-talkie or beeper that alerts them. 3. The Compliance Officers requested to see the pendant/bath call alert system. Upon reviewing the pendant/bath call alert system, it revealed that several residents had pushed their pendants, and the wait time was up to 50 minutes. 4. A review of R2’s, R7’s, and R8's medical records revealed service plans for directed care. The service plans stated “safety and evacuation: emergency call pendant; check that resident has pendant in arm's reach. Resident has been provided with and has demonstrated ability to use an emergency call pendant and pull cord in the bathroom for emergent and urgent needs.” 5. In an interview, E12 reported that they did not have the walkie-talkie or beeper that alerts them to the needs of a resident in the memory care unit. 6. In separate interviews, R6 and R9 reported that the facility staff member takes a while to come check on them when they push the pendants or bathroom cords. 7. In an exit interview, the findings were reviewed with E1 and E10, and no additional information was provided.

Based on interview and record review, the manager failed to ensure the facility did not accept or 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, that stated 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 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. In an interview, E11 reported that R4 was non-ambulatory and was repositioned every two hours. 2. A review of R4's medical record revealed no documentation of a written determination from a medical practitioner, every six months, that stated the resident's needs could be met by the facility and the resident's needs were within the facility's scope of services, for R4, who was confined to a bed or chair. 3. In an exit interview, the findings were reviewed with E1, E10, and no additional information was provided.

Based on observation, documentation review, record and interview, the manager failed to ensure a bell, intercom, or other mechanical means to alert employees to a resident's needs or emergencies was available in a bedroom being used by a resident receiving directed care services, or had implemented another means to alert a caregiver or assistant caregiver to a resident's needs or emergencies. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During the environmental inspection of the facility, the Compliance Officers entered R2's, R7's and R8's rooms in the memory care unit. The residents in the memory care units were supposed to have a pendant. The Compliance Officers pushed the pendant check wait time; however, no staff member came to the room. Upon further investigation, the staff member in the memory care unit did not have the walkie-talkie or beeper that alerts them. 2. A review of R2’s, R7’s, and R8's medical records revealed service plans for directed care. The service plans stated “safety and evacuation: emergency call pendant; check that resident has pendant in arm’s reach. Resident has been provided with and has demonstrated ability to use an emergency call pendant and pull cord in the bathroom for emergent and urgent needs.” 3. In an interview, E12 reported that they did not have the walkie-talkie or beeper that alerts them to the needs of a resident in the memory care unit. 4. In an exit interview, the findings were reviewed with E1 and E10, and no additional information was provided.

Based on documentation review, observation, and interview, the manager failed to ensure 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 monitored 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 egress of a resident from the facility. Findings include: 1. A review of Department documentation revealed the facility is licensed for direct care. 2. During the environmental inspection of the facility, the Compliance Officers observed ambulatory residents on all three levels of the facility. 3. During the environmental inspection, the Compliance Officers observed that the facility’s fire exit doors on all three levels were not monitored, did not alert staff when a resident exited the facility, and did not have a mechanism that met the requirements for special egress-control devices. 4. In an exit interview, the findings were reviewed with E1 and E10, and no additional information was provided.

Based on documentation review and interview, the manager failed to ensure that an evacuation drill for employees and residents was conducted once every six months and documented. The deficient practice posed a risk if employees were unable to evacuate the residents in an emergency. Findings include: 1. A review of facility documentation evacuation drill revealed documentation for two evacuation drills being conducted on August 22, 2024, and November 31, 2025. No other documentation was available for review of the evacuation drill being conducted once every six months and documented within the last 12 months. 2. In an exit interview, the findings were reviewed with E1 and E10, and no additional information was provided.

Based on the observation, record review, and interview, the manager failed to ensure that a caregiver's skills and knowledge were verified and documented before the caregiver provided physical health services for two of two caregivers sampled. The deficient practice posed a risk if the employees did not have the skills and knowledge required to ensure the health and safety of residents. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed E2 at the facility. The Compliance Officer observed E2 providing health care services to residents at the time of inspection 2. During the environmental inspection of the facility, the Compliance Officer observed E3 at the facility. The Compliance Officer observed E3 providing health care services to residents at the time of inspection 3. A review of E2's and E3’s personnel records revealed no documented verification of E2's and E3's skills and knowledge. 4. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on documentation, record review, and interview, the manager failed to ensure a medical record was maintained at the facility for three of four sampled residents, which posed a health and safety risk for lack of information provided to caregivers. Findings include: 1. E1 reported that R1, R3, and R4, had been residents, but were no longer at the facility. 2. A request for R1, R3, and R4 medical records revealed no medical records available for review at the time of inspection. 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.