Guardian Care Assisted Living

Based on documentation review, record review, and interview, the chief administrative officer failed to implement tuberculosis (TB) infection control activities including annually providing training and education related to recognizing the signs and symptoms of TB, for one of two sampled employees. The deficient practice posed a potential TB exposure risk to residents. Findings include: 1. A review of the Centers for Disease Control and Prevention (CDC) website revealed a web page titled, "Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Settings, 2005." The web page stated, "All health-care workers (HCWs) should receive training on the prevention, transmission, and symptoms of TB disease that is appropriate to their work responsibilities and setting. Initial training should be provided to all new employees, with annual refresher training thereafter." 2. A review of E2’s personnel record revealed E2 did not receive initial training in identifying the signs and symptoms of tuberculosis. Based on E2’s hire date this was required. 3. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on documentation review, observation, and interview, the governing authority failed to designate, in writing, a manager who had a certificate as an assisted living facility manager, for one of one total manager. The deficient practice posed a risk as the assisted living facility did not have a certified manager. Findings include: 1. A review of Department documentation revealed E1 was the manager. 2. The Compliance Officers observed E1’s license posted on the wall of the assisted living facility. The Compliance Officers observed E1 in the facility at the time of the inspection. 3. A review of the Board of Examiners for Nursing Care Institution Administrators and Assisted Living Facility Managers (NCIA Board) website revealed E1’s manager certificate expired in October 2025. 4. In an interview, E1 was under the impression that E1’s renewal date was in February. 5. In an interview, E1 called the NCIA board to confirm E1’s renewal date. However no one answered and E1 and the Compliance Officers left a voicemail. 6. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on documentation review, observation, record review, and interview, the manager failed to ensure employees provided documentation of freedom from infectious tuberculosis (TB) as specified in R9-10-113 for one of two employees sampled. 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. A 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) or Interferon Gamma Release Assay (IGRA) test is used to test health care personnel upon hire (preplacement), two-step testing should be used." 3. The Compliance Officers observed E2 working at the time of the inspection. 4. A review of E2’s personnel record revealed E2’s first TB skin test was administered October 2025. There was not another TB skin test to be viewed at the time of the inspection. A further review of E2's personnel record revealed there was no documented signs and symptoms risk assessment. Based on E2’s hire date this second TB skin test and a signs and symptoms risk assessment was supposed to be done prior to providing services. 5. In an exit interview, the findings were reviewed with E1, and no additional information was provided.

Based on observation, record review, documentation review, and interview, the manager failed to ensure that a caregiver provided current documentation of first aid training and cardiopulmonary resuscitation (CPR) training for one of two employees sampled. The deficient practice posed a risk if an employee was unable to meet the needs of residents. Findings include: 1. The Compliance Officers observed E2 working at the time of the inspection. 2. A review of E2’s personnel record revealed E2 was hired as a caregiver. A further review of E2’s personnel record revealed E2’s CPR and first aid card was from NationalCPRFoundtation (NCPRF). 3. A review of the NCPRF’s website, https://nationalcprfoundation.com/courses/ revealed the following statement, “Online training is a legal and acceptable form of training, however, NCPRF(™) does not offer in-person training.” 4. 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 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 sampled. Findings include: 1. A review of R2’s medical record revealed a residency agreement that did not have the manager’s signature and date. 2. 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, for two of two sampled residents, a resident had a service plan which accurately included the amount, type, and frequency of assisted living services and ancillary services being provided to the resident. The deficient practice posed a risk if a resident's service plan did not include the services to be provided. Findings include: 1. A review of R1’s current service plan dated, October 2025 revealed the following services that did not include the frequency of the service provided: - Room maintenance was marked, "Dependent" - Laundry was marked, “Dependent” 2. A review of R2’s current service plan dated, November 2025 revealed the following services that did not include the frequency of the service provided: - Room maintenance was marked, "Dependent" - Laundry was marked, “Dependent” 3. In an exit interview, the findings were reviewed with E1 and no additional information was provided.

Based on observation and interview, the manager failed to ensure that poisonous or toxic material stored by the assisted living facility were maintained in a locked area inaccessible to residents. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. During an environmental tour, the Compliance Officer observed an unlocked cabinet that contained Glass Cleaner. 2. In an interview, E1 acknowledged the cabinet that contained Glass Cleaner was unlocked. 3. In an exit interview, the findings were discussed with E1 and no additional information was provided.

Based on observation, documentation review, and interview, the manager failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage. The deficient practice posed a risk to residents who were not prescribed the accessible medication. Findings include: 1. The Compliance Officer observed ambulatory residents within the facility. 2. The Compliance Officer observed a plastic bag of Lidocaine patches 4% in an unlocked pull out drawer near the kitchen. On the kitchen counter the Compliance Officer observed a blister pack of Extra strength Gas-X 125 mg. 3. The Compliance Officer observed an unlocked staff room. Inside of the room was a bottle of Cyclobenzaprine 5 MG and a bottle of Advil Liqui-Gels 200 MG. 4. The Compliance Officer observed a tube of Chamosyn with Manuka Honey in a bathroom medicine cabinet that was locked with a child proof latch. The Chamosyn with Manuka Honey had a drug fact label that listed the following: - Menthol .45% and - Zinc oxide 20% 5. A review of facility policy and procedures revealed a policy titled, "Medications" which stated, "5. All resident medications must be secured in a locked storage area. Only the manager and trained caregivers shall be in possession of the keys to the facility's medication storage area." 6. In an interview, E1 acknowledged medication was not stored in a separate locked room, closet, cabinet, or self-contained unit used only for medication storage

Based on documentation review, record review, and interview, the health care institution failed to administer a training program for all staff regarding fall prevention and fall recovery to include initial training and continued competency training in fall prevention and fall recovery. The deficient practice posed a risk as a training program clarifies the standards expected of all staff, and the Department was unable to determine substantial compliance. Findings include: 1. A review of the facility's policies and procedures revealed a policy titled "Fall Prevention and Recovery" dated May 12, 2022. The policy stated "During training and annually, with guidance from the Arizona Fall Prevention Coalition, each employee will develop the knowledge, skills, and abilities necessary to recognize the risk of falls, implement fall prevention techniques, and manage injuries that occur as a result of a fall." 2. A review of E1's personnel record revealed an initial training related to fall prevention and fall recovery dated May 24, 2022. However, documentation of continued competency was not available. 3. A review of E2's personnel record revealed documentation of initial training or continued competency training in fall prevention and fall recovery was not available for review. 4. In an interview, E1 and E2 acknowledged documentation of a training program for all staff regarding fall prevention and fall recovery initially and continued competency was not available for review.

Based on record review and interview, the manager failed to ensure a resident provided evidence of freedom from infectious tuberculosis (TB), before the resident's date of occupancy, for one resident sampled who was admitted in 2023. The deficient practice posed a TB exposure risk to residents, and the Department was unable to determine substantial compliance. Findings include: 1. A review of R1's medical record revealed documentation of evidence of freedom from infectious TB was not available for review. 2. In an interview, E1 and E2 acknowledged R1's freedom from evidence from infectious TB was not able to be provided for review.

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. The deficient practice posed a risk as the services provided were unable to be verified against a service plan, and the Department was unable to determine substantial compliance. Findings include: 1. A review of R3's medical record revealed a service plan for directed care services. The service plan stated "Complete bath...shower... weekly on wednesdays... shampoo... every shower... oral care... daily...nail care... check fingernails & trim/file as needed... check toenails & trim/file as needed... skin care... daily... hair care... blow dry after each shampoo... toileting... assistance of 1 caregiver..." 2. A review of R3's medical record revealed an activities of daily living (ADL) document for June 2023. However, the document revealed showering and snacks had not been documented as provided for June 1, 2023 through June 6, 2023. 3. In an interview, E1 and E2 reported R3 was provided the services in the service plan, but E1 had forgotten to document it. E1 and E2 acknowledged the services provided to R3 had not been documented in R3's medical record.

Based on record review and interview, the manager failed to ensure a service plan included skin maintenance to prevent and treat bruises, injuries, pressure sores, and infections, for two of two directed care residents sampled. The deficient practice posed a risk as the service plan did not reinforce and clarify services to be provided to a resident, and the Department was unable to determine substantial compliance. Findings include: 1. A review of R2's medical record revealed a service plan for directed care services dated in March 2023. However, the service plan did not include skin maintenance to prevent and treat bruises, injuries, pressure sores, and infections. 2. A review of R3's medical record revealed a service plan for directed care services dated in May 2023. However, the service plan did not include skin maintenance to prevent and treat bruises, injuries, pressure sores, and infections. 3. In an interview, E1 and E2 acknowledged R2's and R3's service plans did not include documentation of skin maintenance to prevent and treat bruises, injuries, pressure sores, and infections.

Based on record review and interview, the manager failed to ensure a service plan included cognitive stimulation and activities to maximize functioning, for two of two directed care residents sampled. The deficient practice posed a risk as the service plan did not reinforce and clarify services to be provided to a resident, and the Department was unable to determine substantial compliance. Findings include: 1. A review of R2's medical record revealed a service plan for directed care services dated in March 2023. However, the service plan did not include cognitive stimulation and activities to maximize functioning. 2. A review of R3's medical record revealed a service plan for directed care services dated in May 2023. However, the service plan did not include cognitive stimulation and activities to maximize functioning. 3. In an interview, E1 and E2 acknowledged R2's and R3's service plans did not include cognitive stimulation and activities to maximize functioning.

Based on record review and interview, the manager failed to ensure the service plan for a resident included encouragement to eat meals and snacks, for two of two directed care residents sampled. The deficient practice posed a risk as the service plan did not reinforce and clarify services to be provided to a resident, and the Department was unable to determine substantial compliance. Findings include: 1. A review of R2's medical record revealed a service plan for directed care services dated in March 2023. However, the service plan did not include encouragement to eat meals and snacks. 2. A review of R3's medical record revealed a service plan for directed care services dated in May 2023. However, the service plan did not include encouragement to eat meals and snacks. 3. In an interview, E1 and E2 acknowledged R2's and R3's service plans did not include encouragement to eat meals and snacks.